Pharmacists are concerned about the findings of a new report which shows low rates of prescribing and dispensing of key medicines after cardiovascular events
The report, Delivering better cardiac outcomes in Victoria, is an initiative of the National Data Linkage Demonstration Project and was developed by the Victorian Agency for Health Information.
It includes the results for 33,806 patients hospitalised for atrial fibrillation, and 10,639 patients hospitalised for acute myocardial infarction over a five-year period.
“Use of both oral anticoagulants (OACs) in AF patients and adenosine diphosphate (ADP) receptor antagonists in AMI patients in the month after discharge is low (30.4% and 53.9%, respectively), despite being considered best-practice,” the report found.
“Furthermore, there is significant variation in dispensing rates between Victorian hospitals for both conditions, ranging from 22% to 40% for OACs in AF patients and 22% to 74% for ADP receptor antagonists in AMI patients, at 30 days post-discharge.
“Improving post-discharge dispensing rates of these medicines could reduce rates of stroke, myocardial infarction, and death in high-risk cardiac patients.
“Focusing on variation in care, and strategies to reduce it, can help ensure everyone is receiving high quality care.”
Kristin Michaels, chief executive of the Society of Hospital Pharmacists of Australia, said this evidence is “alarming”.
“Despite the Federal Government’s commitment to and investment in PBS medicines, two-thirds of patients are still not being provided with the best preventative medicines despite their risk of readmission after heart attacks and strokes,” she said.
“Strokes and heart attacks account for a significant proportion of hospital admissions, and given medication treatment guidelines for strokes and acute myocardial infarctions are very well established, it is alarming this data shows many patients are not being supplied the appropriate PBS medicines after treatment for a stroke or heart attack.
“Rather than dispensing themselves, many Victorian hospitals will provide a prescription for patients to collect their medicines at their local community pharmacy.
“This report indicates patients are often not getting those medicines dispensed, which increases their risk of another heart attack or stroke resulting in hospital readmission.”
Ms Michaels said that “Hospital pharmacists routinely calculate patient risk levels of cardiac and stroke events and, based on these assessments, provide advice to doctors on prescribing the most appropriate PBS medicines regimen upon discharge against evidence-based guidelines, to prevent patients from having another heart attack or another stroke”.
“However, they can only do this with clinical pharmacy capacity, traditionally supported by the Federal Government, to ensure PBS medicines are used effectively.”
She noted that the 2019 Federal Budget saw public and private hospital pharmacies have their funding through the PBS cut by $44 million annually, from 1 July.
This puts 500 clinical pharmacist jobs at risk, she warned.
“Clearly, there is more work to be done and more investment in hospital pharmacy services to support effective and evidence-based prescribing of PBS medicines to reduce incidence of stroke and heart attacks is required,” said Ms Michaels.
“These preventative costs are comparatively insignificant compared to the excessive costs to the healthcare system incurred by treating preventable strokes and heart attacks in people who are, unfortunately, going without key PBS medicines.
“These results demonstrate not just to the Victorian Government, but all governments, that now is the time to increase investments into the hospital pharmacy workforce.
“PBS medicines cannot be separated from the clinical pharmacy services needed to ensure their appropriate use.”