Embedded pharmacists: a way forward?


Doctor on the phone

Australia’s Chief Medical Officer has cited the benefits of embedding pharmacists in aged care facilities before the Royal Commission into Aged Care

Trials embedding pharmacists in residential aged care facilities have shown “very good benefit” for the reduction of antipsychotics and should be prioritised, Australia’s Chief Medical Officer Professor Brendan Murphy has told the Royal Commission into Aged Care Quality and Safety on Tuesday.

Professor Murphy was answering a question about the use of multidisciplinary teams to combat overprescribing of psychotropic medications.

He described the pilot program to embed pharmacists in aged care facilities across the ACT, into which the Federal government had promised to invest $3.7 million.

“The Department funded trials previously in Tasmania and the RedUSe trial and they’ve funded trials in New South Wales. The RedUSe trial particularly in Tasmania showed pretty good benefit from that model and the whole of ACT trial is the one that’s currently proposed, if that goes ahead, and then that will be with a view to looking at, is it something that we should roll out nation-wide,” said Professor Murphy.

“Was it evaluated in Tasmania?” asked counsel assisting Peter Gray.

“It was evaluated very well in Tasmania in the RedUSe trial with very good benefit,” responded Professor Murphy.

“Did they include reduction of prescription of antipsychotics?” asked Mr Gray.

“Absolutely. Yes. Yes,” said Professor Murphy.

Dr Juanita Westbury, who led the RedUSe trial, told the Commission on Wednesday that the large study of 12,153 residents across 150 residential aged care facilities saw a 13% reduction in overall antipsychotic use.

This was from from baseline to the six-month (from 22% to 19% of residents).

In this project, 76 pharmacists were trained to deliver RedUSe educational content to over 2500 residential aged care facility nursing staff and carers.

Dr Westbury told the Commission that while she has applied for further funding of the RedUSe project, she has not received any.

“The project was spruiked by Aged Care Minister Ken Wyatt … but no, it has not been implemented and no funding has been received to continue to project.”

Dr Westbury explained to AJP that they had applied to expand the program through pharmacy trials in 2017 but were told they were unsuccessful because they had already received $146,000 funding for the pilot study in 2008 and, secondly, according to an expert employed by the Department of Health there was not a problem with psychotropic use in aged care homes any longer.

“A lot of pharmacy researchers were quite upset how the final decision was made,” she said.

With the Royal Commission underway, times look to be changing—when asked about which training initiatives which should be funded by the government to curb psychotropic use in aged care homes, the Chief Medical Officer pointed to the embedding of pharmacists as a priority.

“At the moment the [Aged Care Clinical Advisory Committee’s] view was that the highest priority was probably the embedded pharmacist because there is available pharmacy workforce now, and the trial results showed the benefit, and there’s a benefit well beyond psychotropic medication,” said Professor Murphy.

“There’s a whole range of medication issues in aged care. So that was the option that was put to the previous government before the election, now in caretaker, agreed to do – expand that Canberra trial.”

However he highlighted that a decision to fund any such program would be in the hands of the future government.

One of the key tenets in the PSA’s Pharmacists in 2023 report calls for pharmacists to be embedded within healthcare teams.

The highest priority is embedded pharmacists because there is available pharmacy workforce now, the trial results show the benefit, and there’s a benefit well beyond psychotropic medication. — Professor Brendan Murphy

PSA national president Dr Chris Freeman says Professor Murphy’s comments highlight more recognition for pharmacists’ clinical role.

“It’s a reflection on what the current evidence shows – that when a pharmacist is embedded into environments like an aged care facility, that you have improved medication use, you have improved medication safety, and at the end of the day patients have access to greater access to medicine expertise in the form of a pharmacist,” Dr Freeman told AJP.

“In the past pharmacists have been seen as a luxury item or something that’s nice to have, I think Professor Murphy’s comments really highlight that there’s been a shift in that paradigm and that’s something governments and other stakeholders are starting to see—pharmacists as an absolute necessity in a multidisciplinary team.”

Dr Freeman said Professor Murphy had supported budget allocation for the ACT trial for pharmacists to be embedded into aged care facilities.

“It’s been with Professor Murphy’s support that that Budget measure was put forward. It’s pleasing to see that he has again reiterated that support,” said Dr Freeman.

“We will be strongly working with whoever is in government to see that patients in aged care facilities across the country should have access to pharmacists in aged care facilities.

“I think the other reflection in this is that PSA strongly believes that wherever a medicine is, that a pharmacist should be an integral element of that healthcare team.

“We’ve been advocating for pharmacists to work in general practice and Aboriginal Community Controlled Health Organisations, pharmacists in aged care is a natural extension of that role.

“Really, the environment is one thing but what we’re broadly advocating for is pharmacists to be embedded across the healthcare system so that their skills can be better utilised wherever medicines are used or discussed.”

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