Pharmacy key in ‘third wave’ health reforms

The Pharmacy Guild has begun talks with Health Minister Greg Hunt to discuss how pharmacy can help avoid hospital admissions

In this week’s edition of Guild newsletter Forefront, national executive director David Quilty has examined how community pharmacy can expand its role in managing chronic conditions and deliver on the Minister’s “third wave” of health reforms.

Mr Hunt has foreshadowed this third wave “with the objective of avoiding hospital admissions as chronic disease and an ageing population put unsustainable pressure on health budgets,” Mr Quilty writes.

“It is clear that Minister Hunt believes that the focus needs to move from reducing avoidable hospital admissions to rewarding the States, private health providers and health professionals for actually avoiding admissions and readmissions in the first place.”

Avoiding hospital admissions is set to become the single most important health policy imperative for governments, he says, in Australia and around the world.

“Minister Hunt is sending signals that he is willing to enter into a long-term health funding agreement that will have at its epicentre substantial financial rewards for States and Territories that manage down their hospital admission levels.

“The Minister sees primary care as playing a major role in avoiding hospital admissions, with community pharmacies a key participant given that medicine-related issues are the cause of an estimated 230,000 hospital admissions costing over $1.2 billion annually.”

There is a “crying need” for community pharmacies to be able to deliver more personalised medicines support, Mr Quilty writes, citing the medicines compliance figure of roughly 50 to 60%.

Moves are underway to highlight and expand upon the work that community pharmacies can do, however.

“The Guild has commenced conversations with Minister Hunt about how community pharmacies can make a real difference in helping deliver on his third wave of health reforms and our willingness to consider funding models that reward community pharmacies for delivering health outcomes that keep patients out of hospital,” Mr Quilty writes.

“The Minister is genuinely interested in the role that pharmacies can play.”

Already the Government has included community pharmacy in the Health Care Homes trial, which Mr Quilty says will help address the compliance issue “by ensuring that the highest risk patients have their own medicine plans with support services delivered by community pharmacies working in close collaboration with general practice”.

Community pharmacy’s role in helping manage the transition from the hospital setting to the community can also be of great value, he writes.

“There is ample evidence to demonstrate that patients are most at risk from medicine misadventure when they first leave hospital and that patients who leave hospital after suffering, for example, a cardiac-related event are most prone to early and often preventable hospital readmission.

“Community pharmacies already do and can play an increased role in the transitioning of patients between care settings.

“The use of a shared electronic discharge medicines list which can be reconciled by the patient’s community pharmacy in collaboration with their GP is key and is the subject of a Pharmacy Trial Program trial that will commence shortly.

“Around the world, there is growing evidence that allowing pharmacists to practise at the top of their professional skills can take pressure off the wider health system and reduce unnecessary hospital admissions.  

“Pharmacists can help manage the causes of hospitalisation and provide overworked GPs with increased time to focus on diagnosing and treating complex and higher risk patients.”

Allowing continuing or emergency dispensing for a variety of conditions is an “obvious first step,” he says, by expanding the limited number of medicines where continued dispensing is already permitted; prescription renewal would also be useful.

Mr Quilty cites the example of Canada, where appropriately trained community pharmacists can adapt prescriptions and deprescribe, as well as ordering and sometimes undertaking point of care tests.

Minor ailments schemes also help take pressure off GPs and emergencies, he says, as do lifestyle-related assessments and support.

“In the meantime, there is one very achievable example where community pharmacies can take pressure off GPs and hospital emergency departments.  

“Community pharmacists all around Australia are now able to vaccinate adults for influenza and the current flu epidemic demonstrates the urgent need to build herd immunity by lifting flu vaccination rates.  

“The convenience of community pharmacy and the fact that 94% of Australian adults visit a pharmacy annually make it an ideal setting to vaccinate people who don’t otherwise visit a doctor.  

“A more level playing field whereby community pharmacists have access to free vaccines under the National Immunisation Program (NIP) for at-risk patients and over time, potentially access to the MBS as well, would go a long way in helping ameliorate the impact of future flu epidemics.”

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