King Review leaves hospital pharmacists out in the cold

Pharmacist choosing stock from shelves

The King Review has failed to acknowledge the role of hospital pharmacists, says the SHPA

The interim report of the Review of Pharmacy Remuneration and Regulation’s failure to acknowledge or leverage the “pivotal” role of hospital pharmacists in ensuring Australians have appropriate and convenient access to medicines, the Society of Hospital Pharmacists of Australia says.

In its formal response to the interim report, SHPA highlighted managing transitions of care between hospitals and the community and prioritising the development of HMRs as key aspects of the King Review.

It also reaffirmed what it sees as the “crucial” value of including SHPA in Agreement negotiations and decisions.

SHPA Chief Executive Kristin Michaels says SHPA’s response to the King Review was driven by the position of hospital pharmacists as progressive advocates for clinical excellence and committed to evidence-based practice.

“As a vital stakeholder group, managing significant PBS resources and trained to most appropriately initiate and manage the transition of care to the community setting, it is crucial the role of hospital pharmacists in ensuring Quality Use of Medicines is recognised through the involvement of SHPA in CPA negotiations,” she says.

Ms Michaels says hospital pharmacists are equipped to influence a reduction in the 230,000 medicine-related hospital admissions per year in Australia, which cost the health budget $1.2bn annually.

“Hospital pharmacists are an untapped resource in efforts to deliver truly patient-centred care, a goal which recognises people need considered guidance and support upon hospital discharge to ensure they can access and use the medicines they need.

“SHPA represents a workforce that is armed with the expertise and operating within the infrastructure needed to immediately tackle this critical problem, in close partnership with community pharmacy, if liberated to do so through policy change.”

Ms Michaels says SHPA will continue to welcome support of hospital-initiated HMR referral pathways, as expressed by the King Review panel.

“It is important the proven value of medication review is fully realised by increasing access for high-risk patients through funding hospital initiated HMRs.

“This is SHPA’s long-held position and, in numerous international examples, has led to improved transitional care, demonstrating the importance of addressing this complex area with hospital and community pharmacy workforces.”

In it submission SHPA says that it agrees with the Panel’s statement that in the future “there will be a need for a greater focus on integrated, rather than episodic, care [and that] the pharmacy sector must take a shared responsibility for its own future if the system is to remain sustainable”.

But it expresses dismay that the Panel’s own recommendations do the opposite and ignore the non-community pharmacy setting.

“As hospital pharmacists, the role of our members has the potential to successfully straddle primary healthcare and acute settings.

“This is already happening in many locations where pharmacy services have ‘branched out’ from both hospital and primary health services, meeting in the middle.”

SHPA proposes 12 key changes should be made which it says would significantly improve consumer access and patient care:

  • Conduct greater consultation with SHPA regarding the CPA and examination of potential implications which affect the 17 per cent of PBS expenditure, as required in Federal Government principles regarding stakeholder negotiation.
  • Clarify the management of funding outside the CPA; future pharmacy innovation should be encouraged in all pharmacy settings through a process independent of signatories of the CPA.
  • Build PBS reform – including reforms of the PBS medicines in hospitals program – on the Key Performance Indicators listed in the Australian Pharmacy Advisory Council’s Guiding Principles for Achieving Continuity in Medication Management as mandated in the Pharmaceutical Reforms Agreement.
  • Align funding for community pharmacy services with the delivery of other allied health services and focus on patient outcomes.
  • Ensure policy and remuneration planning for community pharmacies supports greater liaison with hospital pharmacies for the benefit of patients, rather than being limited to non-collaborative dispensing or patient counselling.
  • Prioritising the development of hospital initiated referral pathways for Home Medicine Reviews to enable independent accredited pharmacists to support patients who have recently attended the acute care setting.
  • Support the development of electronic prescribing and electronic prescription records, interoperable with hospital-wide electronic medical records, in a hospital setting to ensure current and accurate records can be provided to and accessed in primary care settings and community pharmacies.
  • Build on the quality of care mandated in the Public Hospital Pharmaceutical Reform Agreements and the Australian Pharmacy Advisory Council’s Guiding Principles for Achieving Continuity in Medication Management to support care for patients transitioning from hospital into community.
  • Introduce an MBS item number for clinical review and advanced pharmacist consultation to support greater utilisation of clinical pharmacy skills.
  • Remove the cap for high-risk patients to avoid inequitable access to Home Medicine Reviews.
  • Enable hospital pharmacies to supply Dose Administration Aids with the same funding conditions as community pharmacies to prevent high-risk patients having delayed or disrupted access to medicines when discharged from hospital.
  • Provide support for consumer access to pharmacy services that recognises, in some circumstances, access to a hospital pharmacy, rather than a community pharmacy, is preferable.

“Looking forward twenty years, SHPA envisions a pharmacy profession recognised as an essential element of both primary and acute healthcare, with a strong evidence-base for patient-focused clinical pharmacy services, contributing to better health outcomes for Australians and the Australian healthcare system,” the submission states.

“We believe our members will be working collaboratively with community pharmacy colleagues, in a consistent remunerated framework for the benefit of patients.”

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