GPs outline non-dispensing pharmacists recommendations


Pharmacists in general practice are one of several changes the Australian Medical Association wants to encourage, outlined in its submission to the Primary Health Care Review.

The AMA Submission to the Government’s Primary Health Care Review highlights the robustness of the Australian health system, says the AMA, particularly the role of general practice, and stresses the need to build on the proven track record of general practice with significant new investment.

AMA President, Professor Brian Owler, says that the Review must focus on strengthening the parts of the system that deliver quality, accessible, and affordable care to the community, most notably general practice.

“This is not the time to throw the baby out with the bathwater,” Prof Owler says.

“In terms of both cost and health outcomes, the Australian health system is performing very well by world standards, and general practice delivers outstanding public health outcomes from modest Government investment.

“We must avoid radical change for change’s sake.”

The Submission says about 700,000 patients with co-morbidities would benefit from a review of their medications, but funding under the 5CPA only provides for about 52,000 HMRs in each year of the Agreement.

“This is a significant gap,” it says. “In addition, there are more than 7 million patients with chronic diseases (based on Australian Institute of Health and Welfare estimates) in Australia who could potentially benefit from having their medications reviewed.

“Evidence suggests that where pharmacists are integrated within general practices there is greater capacity for interdisciplinary teamwork and the improvement of patient care. Working in collaboration with GPs in a general practice provides the ideal setting for pharmacists to utilise their complementary skills to ensure the quality use of medicines and the reduction of ADEs in patients.

“It has also been shown that where there is an integrated pharmacist conducting HMRs the timeliness, uptake and completion of HMRs is increased.

“Further, the PINCER trial, conducted in England in 2010, found that pharmacists play a critical role in reducing medication errors in general practice. Study findings demonstrated that pharmacist input and collaboration with GPs reduced the frequency of prescription errors and medicine monitoring errors.”

The proposed role for pharmacists would not include dispensing, prescribing or issuing repeat scripts. It would instead focus on medication management, in particular:

  • medication management reviews conducted in the practice, an Aboriginal Health Service, the home or a Residential Aged Care Facility;
  • patient medication advice to facilitate increased medication compliance and medication optimisation;
  • supporting GP prescribing;
  • liaising with outreach services and hospitals when patients with complex medication regimes are discharged from hospital;
  • updating GPs on new drugs;
  • quality or medication safety audits; and
  • developing and managing drug safety monitoring systems.

 

“Supplementary activities, depending on the needs of individual practices, could include activities such as patient education sessions, mentoring new prescribers and teaching GP registrars on pharmacy issues,” the submission says.

It proposes funding the model in the same way as the existing incentive payments provided for nurses working in general practice.

The submission cites the Deloitte Access Economics analysis of the AMA’s proposed initiative which demonstrates that the initiative and funding model would result in significant savings to the Australian health system: $544.87 million over four years.

The submission also recommends:

  • provided there is no overall reduction in funding, reform of existing Medicare chronic disease items to strengthen the role of the patients usual GP, cut red tape, streamline access to GP referred allied health care services and reward longitudinal health care;
  • the adoption of pro-active models of care-coordination for patients with higher levels of chronic disease and who are at risk of unplanned hospitalisation – similar to the Coordinated Veterans’ Care program that has been established by the Department of Veterans’ Affairs;
  • the introduction of an incentive payment through the Practice Incentives Program to support quality improvement, informed by better data collection;
  • an enhanced role for private health insurers to fund targeted programs that support general practice in caring for patients with chronic disease;
  • the utilisation of Primary Health Networks to support GPs in providing care for patients, particularly in improving the connection between primary and hospital care; and
  • better use of technology, including the use of point of care testing.

 

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