An incentive for quality

7CPA should fund pharmacists for counselling, not just for dispensing, researchers say

Rather than fee-for-service funding that encourages pharmacies to maximise their revenue by dispensing many prescriptions quickly, pharmacists should be paid to improve quality use of medicines, says former Pharmacist of the Year, John Jackson.

Writing in The Conversation, Mr Jackson, a researcher at the Monash University Faculty of Pharmacy and Pharmaceutical Sciences, says “rather than fast dispensing, it would be better for patients and the health-care system if the funding model paid pharmacists for improving the use of medicines, not just for supplying them”.

And moving to this model of pay should be an objective of the Seventh Community Pharmacy Agreement, he says.

“At present, the dispensing fee to the pharmacy does not change depending on the level of counselling you need,” wrote Mr Jackson, a former hospital pharmacy-based practice owner.

“Indeed, the current funding model is a disincentive for the pharmacist to spend time with you explaining your medicine. That’s because the longer they spend counselling, the fewer prescriptions they can dispense, and the fewer dispensing fees they receive”.

He advocates performance-based funding, in which payment is adjusted in recognition of the efforts of the service provider or the outcomes of the service delivered, as an alternative. This could be linked to the actual time it takes to dispense the prescription, Mr Jackson said.

“We propose dispensing fees should be linked to the effort pharmacists make to promote improved use of medicines. This is based on the principle that counselling means people are more likely to take their medications as prescribed, which improves their health.

In other words, pharmacists would receive higher dispensing fees when more counselling is required or if counselling leads to patients taking their medications as prescribed,” he said in the article, co-written with US researcher, Ben Urick, who has researched performance-based pharmacy payment models.

“The longer the time [for dispensing], the higher the fee. The time taken would depend on the nature of the drug; the complexity of the patient’s treatment; recent changes in the patient’s health status or other medicines that need to be taken into account; consultation with the prescribing doctor; and the level of advice and education provided.

A blended payment model could include a fee-for-service payment for commercial processes and a performance-linked payment for professional functions”.

At present, there is no incentive, other than professionalism, for pharmacists to value to an interaction, he says.

“The proposed changes would require a major restructure to the funding of dispensing to provide incentives that are equitable and transparent and that did not adversely affect disadvantaged, rural and Indigenous people”.

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