GP outcry over Chronic Pain MedsCheck trial


pharmacies better value: $20 note, pills, stethoscope

Doctors have responded with outrage as the Guild confirms that the trial will forge ahead, publishing a schedule of trial payment fees

The Pharmacy Guild of Australia has released details of its Chronic Pain MedsCheck Trial, along with a schedule of trial payments.

In January this year, Health Minister Greg Hunt announced the trial as part of the Sixth Community Pharmacy Agreement Pharmacy Trial Program.

“All community pharmacies will be able to participate in this service,” Mr Hunt said in announcing the trial.

“Community pharmacies participating in the trial will build relationships with GPs and other health professionals who support patients with chronic pain.”

It was put on hold in March due to the need to meet Commonwealth Grants Rules and Guidelines.

However a recent release from the Guild inviting pharmacies to register their interest in participating by 17 September confirms that the trial will be forging ahead as planned.

The Guild’s detailed pharmacy information statement states the primary objective of the trial is “to evaluate the efficacy of the Chronic Pain MedsCheck in preventing incorrect use and/or overuse of pain medication, increasing patients’ pain medication health literacy, improving their ability to self-manage their chronic pain and improve their overall quality of life”.

It will involve two randomly selected intervention groups including the list of community pharmacies that express interest to participate in the trial.

In addition, 50 pharmacies from each group will be randomly selected to be “evaluation trial” sites.

The Guild anticipates that patient recruitment to the trial will commence by October 2018, with each pharmacy asked to recruit around 40 patients until 1 June 2019.

Its statement also includes a schedule of trial payments that will be made for each trial service.

Under the scheme, a pharmacy will receive $98.41 for an initial in-pharmacy 45-minute face-to-face consultation with a patient.

Completion of a 15-minute in-pharmacy review three months later for Group A participants, with an additional 15-minute telephone consultation at six weeks for Group B participants, will both attract a payment of $32.81.

Evaluation sites who will be required to submit additional data will receive an initial consultation payment of $162.21, a follow-up face-to-face consultation payment of $96.61, as well as a telephone consultation payment of $64.71.

The AMA slammed the initial announcement of the Pain Meds Check trial, with then AMA President Dr Michael Gannon, calling it a “slap in the face for GPs”.

Readers of the Australian Doctor website have now expressed outrage at the Chronic Pain MedsCheck proposal, as well as the payments involved, comparing the trial payments to what they receive for an equivalent consultation.

Under the MBS, GPs receive about $107.15 for a new visit of at least 40 minutes, while a review of less than 20 minutes attracts a payment of $37.60.

Meanwhile a pain specialist may receive $130.20 for a new visit, and $65.20 or $37.15 for a review.

Here are some comments from doctors online:

“This is another conspiracy between the Pharmacy Guild and the current government to waste tax payer money in order to line up the deep pockets of the pharmacy owners. What do the pharmacists know about pain management apart from pushing low dose codeine over the counter.”

“Oh dear, another nail in the coffin of continuity of care.”

“Personally, I would really love to move all my pain patients across to a pharmacist, but what are they going to achieve?”

“This is amongst the top 5 most challenging areas of practice. I think pharmacists will get a shock. It is not just about the drugs or a plan. Will they take over the challenge of accessing services such as neurosurgery specialist clinics and psychologists.”

“The whole system has descended into madness, and things which really matter to patients are poorly remunerated by Medicare.”

“Wow. Not sure why I bothered with decades of training to become a pain specialist.”

“I really don’t understand this truly ridiculous proposal. It flies in the face of the current biopsychosocial model of caring for pain and the importance of exercise physiotherapy and multidisciplinary care.”

“GPs are already seeing these patients, most if not many would have care plans or action plans in place already. Pretty sure, medications are being reviewed with signs of dependency monitored by their doctors. So what’s the point? I just don’t get it.”

“That’s it !! Even if a GP does it on a Sunday afternoon or Saturday night,he rebate is only $89 and the GP covers all other options AS WELL as medications.”

However the Pharmacy Guild points out that the fees are sourced from within the 6CPA and make no impact on those available to doctors through the MBS.

“We warmly welcome the start of the Chronic Pain MedsCheck trial as a further service to patients to help them manage and understand chronic pain,” said a spokesperson for the Guild.

“As health professionals, pharmacists work collaboratively with others including doctors in the interests of patients.

“The Chronic Pain MedsCheck trial is funded entirely from within the Community Pharmacy Agreement existing funding, and has no impact whatsoever on the funds available to the MBS,” they told the AJP.

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