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Pharmacy organisations have responded to a Productivity Commission report that reveals there were nearly 3 million avoidable emergency presentations in 2017-18

Nationally there were around 2.9 million “avoidable” presentations to public hospital emergency departments in 2017-18, where people who should have seen a GP went to the emergency department instead, according to a new report by the Productivity Commission on government services.

“Potentially avoidable presentations to emergency departments are presentations for conditions that could be appropriately managed in the primary and community health sector,” said the commission in its report.

“Factors contributing to GP-type presentations at emergency departments include perceived or actual lack of access to GP services, the proximity of emergency departments and trust in emergency department staff.”

The report also revealed that in 2017-18, 4% of the Australian population reported that they delayed or did not visit a GP in the previous 12 months due to cost, and nearly 20% of people who saw a GP said they waited longer than they felt was acceptable to be seen.

Community pharmacies an asset

The Pharmacy Guild of Australia and the Pharmaceutical Society of Australia (PSA) say community pharmacies stand ready to ease the burden on hospital emergency departments.

“Community pharmacies are an under-utilised and highly accessible asset in our health system, and we can do more to ease the strain both on hospital emergency departments and on hardpressed doctors’ surgeries,” said George Tambassis, National President of the Pharmacy Guild.

“We agree with those doctor groups who are saying that avoidable hospital presentations are an inefficient use of the health system, putting pressure on hospitals and increasing waiting times,” said Mr Tambassis.

“There is no single solution to this problem, but among the solutions is the better use of the full scope of pharmacist practice being facilitated across the 5,700 community pharmacies across Australia.

“Within our existing scope of practice and acting collaboratively with local doctors, community pharmacies can ease the burden on hospitals and doctors, giving them more time to give patients appropriate care,” he said.

Mr Tambassis pointed out that community pharmacists “represent a highly skilled network of primary health care professionals providing quality medicine dispensing, advice and services, including advice on common ailments, vaccinations, medication management, chronic disease support, continued and emergency dispensing, and triage and risk assessment.”

Community pharmacies are equitably distributed and highly accessible, and often operate over extended hours in urban, rural and remote areas, he adds.

PSA National Vice President Dr Shane Jackson agreed that community pharmacists could help to address the access issues.

“What the Productivity Commission report shows us is that we continue to have some challenges with access to healthcare in this country. Nearly 20% of consumers waited longer than they thought was acceptable to be seen by their GP,” he told AJP.

“This is another reason why we need to utilise pharmacists to address access issues in Australia. We believe a nationally coordinated triage and referral program would assist in GP access, as well the 2.9 million non-urgent type presentations to the emergency department across the country,” said Dr Jackson.

“Community pharmacists are well placed to assist in improving access to healthcare by dealing with non-urgent type emergency department presentations and linking more urgent presentations into the patients GP or emergency department through robust referral pathways.”

Research on the topic

Recent research from Canada has shown that more than a third of unnecessary (“GP-type”) emergency department visits for non-urgent health conditions could be managed by pharmacists.

In a seven-year study covering 34,550,020 unscheduled emergency department visits that occurred in Ontario, Canada, 6,668,215 (19.3%) were “less urgent” or “non-urgent” visits related to a condition that could be managed by a general practitioner.

More than one third of these visits for GP-type conditions were deemed visits that could potentially be managed by pharmacists.

The top 10 diagnoses represented 70% of all cases of avoidable and potentially pharmacist-manageable visits, and included acute pharyngitis, conjunctivitis, rash and other non-specific skin eruption, otitis externa, cough, acute sinusitis, other dermatitis, urticaria, and unspecific contact dermatitis.

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