Clinical interventions: a ‘lost opportunity’?

Most pharmacists in this survey disagreed with the withdrawal of funding for clinical interventions

Nearly 70% of pharmacists surveyed in the UTS Pharmacy Barometer 2020 said payment for the clinical interventions program should have been retained in the 7CPA.

A quarter of the 360 respondents agreed with its withdrawal, with the remainder unsure.

Among the sample, half worked as owners/owner managers while 31% were pharmacist-in-charge/pharmacy managers, and 19% were employee pharmacists.

Clinical interventions were omitted in funding allocations for continuing community pharmacy programs as part of the 7CPA, which began from 1 July 2020. By comparison, the program was allocated nearly $20 million in the first year of the 6CPA alone.

Clinical intervention payments have been absorbed into other expenditure on professional programs, such as additional funding for Dose Administration Aids (DAAs), Aboriginal and Torres Strait Islander programs and rural pharmacy support, a Guild spokesperson confirmed to AJP in June last year.

“The CI payment was introduced in the 5CPA as an ‘incentive’ payment to record the routine clinical interventions undertaken by pharmacists as part of the dispensing process, in order to provide an extensive database for a previously unrecognised service,” the spokesperson said.

“Pharmacists will continue to exercise their professional and clinical judgement in managing the medication and related health needs of their patients – just as they did before the advent of the clinical intervention incentive payments.”

In their report published this month, the UTS Pharmacy team has queried why the funding was dropped.

For example, they ask, was there a lack of robust clinical evidence supporting the clinical and economic benefits, its cost effectiveness or lack of clarity on the definition of a clinical intervention?

Based on the results from surveyed pharmacists, “[there is] clearly a marked disagreement with the discontinuation of payment for clinical interventions,” commented UTS Adjunct Professor John Montgomery.

“Is this a lost opportunity or a reflection on expected versus actual outcomes?” Professor Montgomery asked.

When the 7CPA was signed, PSA national president Chris Freeman told AJP it was “unfortunate” to see clinical interventions no longer funded in the 7CPA.

“In the original research funded through the PROMISe research trials that led to funding commencing in the 5CPA, clinical interventions were show to save in the order of $280 in health care costs [per intervention],” he said.

“Unfortunately, the implementation of the clinical interventions program did not match the recommendations from the trials, there was a lack of data collected about the types of interventions, and there was not sufficient support in place to assist the delivery of clinical interventions.

“This has meant that clinical interventions have ended up being collateral damage when it comes to ongoing funding.”

However with such strong support for a program from the pharmacy community, the UTS team notes it is “surprising that greater efforts were not made to keep the funding available, or considerations made to restructure the program so that the required evidence could be obtained”.

“Why are we not listening to the overwhelming viewpoint from pharmacists?” said Dr Victoria Garcia Cardenas, Senior Lecturer in Pharmacy Practice, UTS Graduate School of Health.

“Let’s take the time to ensure these programs are viable.”

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