‘Natural allies’ for QUM in remote Australia

Pharmacists are crucial to safe medication use for Aboriginal and Torres Strait Islander people in residential aged care, the Royal Commission has heard

The Royal Commission into Aged Care Quality and Safety heard from Professor Leon Flicker AO in Broome, WA, on Monday.

The professor of geriatric medicine at the University of Western Australia gave evidence about his perspective on delivering aged care in remote Australia.

He referred to the importance of allied health staff – including pharmacists – and the multidisciplinary team in delivering quality care to Aboriginal and Torres Strait Islander patients.

“One of the things that I notice in my own practice is that I’m not very helpful by myself,” said Professor Flicker.

“I spend most of my time when I’m seeing patients by myself is I’m just crossing off medications, just stopping medications, and diagnosis and maybe looking at other issues.

“I’m involved in a couple of projects trying to look at decreasing medication use in residential care. The natural allies for us there are the pharmacists because they’re looking at the quality of medication use within residential care.”

The PSA has been advocating for pharmacists to be embedded in teams wherever medicines are used, including within residential care facilities and Aboriginal Community Controlled Health Organisations.

In its Pharmacists in 2023 report, the organisation said: “The full integration of pharmacists into collaborative, patient-centred models of care, is a long-term objective, and important for supporting at-risk groups within our community such as Aboriginal and Torres Strait Islander people, rural and remote communities and disability services.”

Professor Flicker continued that a multidisciplinary approach is required to manage people onto more appropriate therapies.

“We need a team approach because one of the issues that we have with over-medication use or too much psychotropic medication use in particular is that you can’t just withdraw the medications and say that that’s it.

“Part of the problem that we have in residential care is that people’s behaviour is complex. It’s because not only of their cognitive impairment, but their nature and their history; there are triggers that are involved in challenging behaviours.

“We have to work through what they are. We need trained nurses who can understand this and can initiate non-pharmacological strategies to help.

“So we don’t just want to take medications – though that would be a good thing, taking medications off people which is causing them harm, but we also want to put something in its place that would be better for people.”

Professor Flicker spoke about the challenges for Aboriginal and Torres Strait Islander people in accessing culturally appropriate residential aged care in rural and remote Australia.

“People who live in rural and remote conditions may not have a nearby service. So if somebody doesn’t have a nearby service it means that they’re going to move from their family and friends, which happens for non-Aboriginal people as well,” he said.

“But the other thing that complicates the matter for Aboriginal and Torres Strait Islander people is that they are moving from country. A lot of Aboriginal and Torres Strait Islander people have an innate attachment to the land that they’re living in.”

He adds that “the care [also] has to be culturally safe and this means that the staff have to be trained in how to manage and how to assess and treat older Aboriginal people and this is something that does not necessarily come intuitively.”

Greater flexibility in funding and care delivery could increase access to Aboriginal and Torres Strait Islander health workers in pharmacies “to support provision of more culturally safe pharmacist care”, the PSA has said.

“There is an urgent need to address the considerable health disparities for Aboriginal and Torres Strait Islander peoples,” says the organisation.

“Specific culturally appropriate programs for pharmacists within Aboriginal Health Services as well as within community pharmacies must be developed to support healthcare delivery for Indigenous Australians.”

Counsel assisting Paul Bolster noted that while over 60% of Aboriginal and Torres Strait Islander people live in major cities or inner regional areas, it was important that the Royal Commission when inquiring into aged care in remote areas, consider aged care services for people who identify as Aboriginal and Torres Strait Islander.

He said the particular needs of Aboriginal and Torres Strait Islander people living in urban areas will be explored further in later hearings, including the Perth hearing next week.

The Commission continues.

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