Looking at the numbers

What has been the uptake of the 6CPA new and expanded pharmacy programs following the Pharmacy Compact in 2017?

This September the third meeting of the Community Pharmacy Stakeholder Forum was held in Sydney, which included progress updates on new and expanded pharmacy programs.

Pharmacy programs received funding from the $600 million held in the Contingency Reserve for new and expanded community pharmacy programs as part of the Pharmacy Compact 2017, signed by Health Minister Greg Hunt and the Pharmacy Guild of Australia in May last year.

Now the Department of Health and the Pharmacy Guild of Australia have released figures on patient uptake within these programs.

Data collection commenced on 1 July 2017 for the Staged Supply program, and 1 February 2018 for the DAA and MedsCheck programs.

Evaluation of the data is being undertaken by HealthConsult. The organisation also provided a ‘Progress Update’ on the evaluation of the New/Expanded 6CPA Pharmacy Programs to the forum held in September, however the documents have been made unavailable on the PBS website.

Here we take a glance at the allocated funding and patient uptake within each program.

$340 million allocated for enhanced Dose Administration Aids (DAA) program

  • Based on figures for February-June 2018, DAA services have so far been provided to 301,311 unique patients, by 4,774 community pharmacies.
  • Funding went towards a contribution of $6 per DAA for eligible patients.

$80 million allocated for new Staged Supply program

  • From July 2017-June 18, Staged Supply services were provided to 13,483 unique patients, by 3,204 community pharmacies.
  • This is a fee-for-service model allowing payment of up to $31.90 per eligible patient per week, capped at four patients per pharmacy.

$90 million allocated for expansion of MedsCheck and Diabetes MedsCheck

  • From July 2017-June 18, MedsCheck services were provided to 299,530 unique patients across 3,887 community pharmacies.
  • Diabetes MedsCheck services were provided to 75,087 unique patients by 2,945 community pharmacies.
  • The number of patient services doubled from 1 July 2017.
  • Data released by the Department of Health shows that payments for claims under the two programs jumped from $9.13 million in 2015/16 to $12.3 million in 2016/17 and then to $17.7 million for 2017/18 – up to the 30 April.
  • The latest jump coincides with the increase in the amount of MedsCheck and Diabetes MedsCheck services pharmacists are able to undertake and claim for – from 10 to 20 per calendar month – from 1 July 2017.

$60 million allocated for expansion of Home Medicines Reviews (HMRs)

  • The Pharmacy Guild did not provide uptake data on HMRs.
  • The enhanced program will reportedly include a service to enable pharmacies to implement the patient’s Medication management Plan and provide a follow-up service.

$30 million allocated for new Health Care Homes program

  • Last month the Health Minister and Pharmacy Guild took the next step towards the delivery of the trial program for community pharmacy involvement in Health Care Homes. A series of interprofessional support workshops centred in the Primary Health Networks (PHNs) currently participating in the Health Care Homes Trial are currently being held.
  • A series of online training modules to support community pharmacies and their staff are being developed by Guild Learning and Development and the PSA, with the PSA also developing official guidelines for pharmacists participating in the trial program.

A November 2017 update from HealthConsult on the outcomes of its cost effectiveness review of pharmacy programs found the following:

DAAs: Available information is inconclusive as to whether DAAs are effective in improving medication adherence, clinical outcomes, patient satisfaction or are cost effective. Further research is required to make a more robust assessment of the clinical and cost effectiveness of DAAs.

Staged supply: No studies were identified that assessed the impact of Staged Supply improving medication adherence or any other health related outcomes. No conclusion could be made regarding Staged Supply services effectiveness or cost-effectiveness. Further research is required.

MedsCheck: Available studies suggest the effect of MedsCheck on patients outcomes was mixed – some studies showing benefit in certain populations whilst others showing no positive effect. Further research is required.

Clinical Interventions: Other than work funded under CPAs, no studies were identified that assessed the clinical and cost effectiveness of providing incentives to community pharmacists to deliver Clinical Interventions.

HMRs: The available systematic reviews and lower level evidence did not allow a determination to be made on the clinical and cost-effectiveness of HMRs performed by pharmacists. There is a larger body of evidence for more comprehensive and multidisciplinary medication reviews interventions focused on improving clinical outcomes – but findings cannot be extrapolated to HMRs conducted by pharmacist in a patient’s home. Further research is required.

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  1. Debbie Rigby

    How will these findings influence the continuance and sustainability of these professional programs?

    Whilst I agree that Government funding for programs should be supported by quality evidence of satisfaction impact and outcomes, there is a case for face validity. Absence of evidence is not evidence of absence. Meaning just because no-one has done a study of adequate size and duration, it doesn’t mean the program is not worth funding.

    It is also challenging using overseas studies which use different models and have different healthcare systems and funding. Lots of caveats needs to be considered before drawing any conclusions.

    Regarding HMRs, the conclusion was “There is a larger body of evidence for more comprehensive and multidisciplinary medication reviews interventions focused on improving clinical outcomes – but
    findings cannot be extrapolated to the HMR program”

    I find this a somewhat disturbing conclusion as HMRs are comprehensive and multidisciplinary. And by their conclusion, have a larger body of evidence. Surely this provides evidence of benefit for HMRs.

    As has been proposed by previous evaluations and expert commentary, the HealthConsult report recommends:
    – Identify characteristics of patients that experience adverse medication events and target research towards determining whether HMRs by a pharmacist can prevent those problems occurring
    – Direct research towards developing a multidisciplinary (at the point of care) HMR delivery model.

    The 2nd recommendation could mean HMRs conducted by practice pharmacists. Results of the REMAIN HOME study may provide some insight into the benefits of this model. In my experience, doing HMRs from or in a GP practice is a good model, largely because of access to the patient’s clinical record and the relationship between the accredited pharmacists and GPs. GPs are more likely to be specific about the reason for referral and it’s much easier to have a chat with the GP after the home visit to discuss the implementation of your recommendations. It’s also more feasible to follow-up on the impact of changes, and make further changes if necessary. And much easier to liaise with the community pharmacy – again based on relationships, trust and respect.

    • Apotheke

      Looks like there is plenty of scope for Pharmacist and Medical academics to evaluate the short, medium and long term health impacts if any of Clinical interventions, Medscheks, Diabetes Medscheks, HMRs, RMMRs, GP collaborative HMRs on patient health (morbidity & mortality data), medications management, rates of hospitalization etc. Right now we do not seem to have any good local evidence to justify the funding of any of these programs.Playing devils advocate here Debbie. Show me the evidence!!!

      • Debbie Rigby

        I agree there is a need for more research to support the value of professional services. Prospective collection of data and outcomes is needed. As the report suggested there is moderate level evidence for HMRs and RMMRs – have a look at the report. Measuring reduction in hospitalisations is challenging, lots of studies are not conducted with sufficient duration to detect changes. A frequent error is comparing results from overseas (especially UK models) to our HMRs, which are collaborative and comprehensive and conducted in the patient’s home.

      • Debbie Rigby

        The AACP website has a comprehensive list of publications on HMRs and RMMRs. 29 pages!

  2. Debbie Rigby

    RMMRs are not included in this summary but the HealthConsult report concluded:

    – RMMRs have an impact in terms of pharmacists identifying medication-related problems and making recommendations that GPs are likely to implement.
    – RMMRs have an impact in improving the appropriateness of prescribing and reducing the drug burden on residents of aged care facilities.

    Hopefully this supports changes to the program rules to allow greater access to RMMRs, especially in light of the Royal commission into aged care, which includes inappropriate and overuse of certain medications.

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