Focus on non-dispensing roles, not fragmentation: GP


Non-dispensing pharmacists can strongly benefit patients and doctors, a leading GP has written – but the dispensing pharmacist model fragments care, she says

Dr Ines Rio, Chair, AMAV Section of GP and North Western Melbourne PHN, writes in Vicdoc that particularly for patients with complex and/or chronic health needs, other health professionals are “frequently valuable” working alongside GPs.

This collaborative approach, part of the Patient Centred Medical Home model, has recently been demonstrated to her via a non-dispensing pharmacist at her practice, she writes.

The project, managed by PSA, had attracted funding directed through the North Western Melbourne Primary Health Network.

“Non-dispensing practice pharmacists provide a wealth of potential benefits to both patient and doctor,” Dr Rio writes.

“Their deep expertise in pharmacotherapy positions them to help drive reductions in polypharmacy and drug-related problems (a cause of a significant number of hospital admissions), improve patient compliance through simpler dosing, enhance patient understanding of self-medication techniques, and save time for the GP.

“This is a totally different concept and practice to dispensing pharmacists and those who provide independent services, with this model increasing fragmentation and working at odds with the PCMH.”

Dr Rio writes that a central role for non-dispensing pharmacists is active medication reconciliation.

“The value of this becomes apparent when you consider that up to two-thirds of medication histories contain at least one error and a third of those are potentially harmful. The majority of these errors occur during transition to and from hospital.

“Additionally, patients who are missing medications on discharge are more than twice as likely to be readmitted.

“It’s a problem likely to get worse without conscious planning.”

The pharmacist who worked at Dr Rio’s clinic was able to isolate a number of cases where prescribers and patients “weren’t on the same page”, she said.

“They also found patients taking old medications alongside the new and cases where opiate analgesic patches were being confused with hormone replacement patches.”

The pharmacist noted that different doctors at the practice were providing different dosing instructions on the same medicines, and the process was then streamlined; the pharmacist advised on falls, vaccine eligibility and changes to medication regimes.

“In short, non-dispensing pharmacists in general practice is an evidence-based model with significant potential benefits for individual patients, GPs, pharmacists and the healthcare system as a whole,” writes Dr Rio.

“It is supported by the AMA and the PSA and underpins truly coordinated and comprehensive multi-disciplinary care.

“It would be much better value for our patients if pharmacy stops developing other models that fragment and compromise care and instead focus on a sustainable funding mechanism to make non-dispensing pharmacists available for every general practice.”

Read the full Vicdoc piece here.

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  1. Apotheke

    The sooner Pharmacists scope of practice was expanded to work collaboratively within large multi-GP practices the better for patients, GPs and the health budget. The cost to the government of their wages $$80,000+ p.a would be recouped many times over in reduced patient morbidity and hospitalizations due to medication errors.

    • The likely way for the model to work is for the salary is to be paid by the GP practice to the Pharmacist. They then receive incentive payments to employ Pharmacists just as they do now for Nurses through the PNIP. There will possibly also be new MBS item numbers for Pharmacists use within the practice as part of a collaborative team care arrangement. Both the Pharmacist and the referring GP will receive payments from Medicare. In the case of the Pharmacist that fee will be to the practice and even perhaps split with the Pharmacist by percentage as is currently done for GPs. This model will be restricted to GP practices only and freelance Pharmacists working outside of a dedicated practice would not be part of the picture, I imagine. This is primarily an enhancement of the GP and their primary health role not the Pharmacist. But, it is a great start for many further developments. Those Pharmacists involved at the early stages need very much to show their value and then this can be enhanced in due course. The PSA would be all for this as they are a professional body. The Guild doesn’t like it because it takes the available employable Pharmacist workforce away from them and in a different direction to the joys (?) and rewards (?) of Community Pharmacy.

  2. Tim Hewitt

    HMR provides (arguably) a better service and outcome (If Dr reads report), solves all these issues, and also addresses problems WITHIN the patients home setting, AND is necessarily conducted by trained and accredited consultant pharmacists (who undergo annual re-accreditation).. the system is already set up, working and funded (sort of).. do we need service duplication, or will HMR ‘die on the vine’?

    • Julie Grint

      HMRs would be enhanced as Pharmacists working from within GP practices would have access to the patient’s full medical and prescription drug history not the summary provided in a referral. The only problem I see is the objections of the Pharmacy Guild who do not want to lose control of an income stream. After all the Guild exists wholly and solely to promote and protect the interests of Pharmacy owners not the interests of the profession as a whole and definitely not the interests of public health.

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