‘Service roles should not be duplicated.’


Guild rejects proposal to embed pharmacists independent of community pharmacy, saying this would lead to duplication and fragmentation of care

Pharmacists would be best integrated into aged care facilities through an outreach program using local community pharmacists, rather than by being embedded into facilities, argues the Pharmacy Guild.

“This would ensure better care and flexibility, and see patients have potential access to the full range of a pharmacy’s expertise and infrastructure,” says the organisation in its recent submission to the Royal Commission into Aged Care Quality and Safety.

These should be funded by facility-based pharmacy aged care packages, it says, adding that government-funded trials of embedding pharmacists in facilities should be assessed for cost-effectiveness, economic benefit and patient outcomes.

Meanwhile, “proposals to embed pharmacists within residential aged care facilities, independent of the medicine dispensing service, would simply lead to duplication of services and fragmentation of care,” argues the Guild.

“Service roles should not be duplicated, and patient care must not be fragmented by employment of embedded pharmacists.”

Community pharmacies are already contracted to dispense medicines and associated medicines management services to approximately 3,000 residential aged care facilities around Australia, it points out.

“The local community pharmacy should be used as a first preference to support efficiencies with timely access and continuity of care given that 99% of residential aged care facilities have access to at least one community pharmacy within 2.5km radius in metropolitan areas and 93% in regional areas.”

Not a zero-sum game?

PSA maintains that embedding pharmacists is an answer to addressing medicine-related harm in aged care, but highlights that this does not exclude community pharmacists from the equation.

“Pharmacists embedded in facilities can contribute to improving quality use of medicines facility-wide and reducing harm caused by overuse of medicines,” said PSA national president, Associate Professor Chris Freeman on the organisation’s release of its submission.

“It has been clear through evidence provided to the Royal Commission that we need to have pharmacists protecting patients from the inappropriate prescribing and use of medicines.”

However A/Prof Freeman emphasises that both community and non-community pharmacists could be embedded in residential aged care facilities.

“It’s actually about those vulnerable patients in aged care facilities getting the right services from people with the right skillset – that might be the pharmacy with the contract to provide services, another pharmacy or an independent provider,” he tells AJP.

“Our view is broad in that there is an obvious need here, and that we need pharmacists to have more time with patients and in aged care facilities. Whether that comes from the community pharmacy or outside should be dependent on the person having the right skillset to deliver those services.”

What you said

In July pharmacist researcher Dr Janet Sluggett, an NHMRC early career fellow at Monash University’s Centre for Medicine Use and Safety, told the Royal Commission that embedded non-dispensing pharmacists could undertake a range of activities to create safer medicines use in aged care facilities.

She said: “There is an urgent need for a subsidised model of practice which enables pharmacists to be integrated within residential aged care facilities, to provide clinical pharmacy services and support quality use of medicines in residential aged care.

“Integrating pharmacists within residential aged care facility will improve provision of medicines information at the point of care,” said Dr Sluggett.

Following this, over 300 AJP readers voted in a poll asking: ‘Do you think there should be specific roles for non-dispensing pharmacists embedded in aged care facilities?’

Forty-one percent (137 voters) said ‘Yes, I think it’s a good idea and should be implemented immediately’.

A further 36% (120 voters) said ‘Yes, I think it’s a good idea but only if there is appropriate funding for it’.

Eighteen percent (59 voters) said ‘No, I think local community pharmacists should be playing a bigger role in this space instead’.

And four percent (15 voters) said ‘No, I think off-site accredited consultant pharmacists should be providing more RMMRs and QUM services instead’.

A small 1% voted ‘other’ or ‘none of the above’.

 

Comments from people who voted ‘other’ included:

“I think embedded pharmacists should also dispense (as per hospital pharmacists), but of course funding is required for embedded pharmacist wages, whether dispensing or not.”

“A non-dispensing pharmacist should be present on site, the pharmacist should obviously understand all of the patients’ medicine use history. This pharmacist should also be available for the few incidences when aged care staff require drug information and at whose cost?”

“Local community pharmacists should play a bigger role in conjunction with accredited pharmacists – there must be a link between the medication supply and medication management – funding should also be given for this service.”

Comments from readers included:

“I have been in both situations. I was not directly employed by an RACF but have been the QUM and RMMR and dispensing pharmacist for 5 facilities since the beginning of these programs. I then became the independent contractor for RMMR and QUM services and I liaise with the dispensing pharmacies – we have an excellent relationship. Being an embedded pharmacist would give me a greater flexibility and respect within the facility. The pilot in Canberra is a good start BUT those facilities are within 30 minutes of home of that pharmacist. Mine are five to six hours drive away. To provide my services I need accommodation, travel expenses, ability to digitally download charts, access to recent blood tests and discharge summaries. Embedding a pharmacist will be a significant step forward as at least you will have more autonomy as to how you practice in the team environment.” Karalyn Huxhagen

“I have been working in this area for many years and find that on the list we are doing all the activities listed except ‘ward rounds, prescribing, and immunisation. We work very closely with the ACF staff, allied health people, geriatricians, GPs and community pharmacy. It can be done. I welcome some additional funding and time to complete the collaborative approach. Our current QUM funding does not provide the time to perform our full role.” Jenny Gowan

“I don’t want to be involved in supply, as an accredited pharmacist I am not competing for your supply income. What I DO want is best practice care for ACF residents and being employed on site is a means to deliver this, in collaboration with the supply pharmacy.” mary b

“Of course the Pharmacy Guild pushes back because any change to the role of pharmacists from being pharmacy owners (Guild members) or the employees of the same is a threat. Pharmacists paid by aged care facilities would not be beholden to a Pharmacy proprietor whose income is dependent on the quantum and frequency of drug supply to a facility.” Apotheke

Read the Guild’s full submission to the Royal Commission into Aged Care Quality and Safety here

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3 Comments

  1. Jarrod McMaugh
    16/10/2019

    On this matter the guild is wrong, and fundamentally so.

    Any pharmacist who has had a contract to supply any services of any kind to a RACF knows that contracts are at best run at a loss before PBS script volumes, and at worst run at an outright loss after PBS SCRIPT volumes.

    This has come about through high levels of competition between pharmacies looking to have high volume PBS dispensing through nursing home contracts, and the willingness of these pharmacies to “invest” significant time/staffing/money in serving these contracts… including paying for RACF subscriptions to electronic charting, medicine trolleys, etc.

    In this setting, a pharmacist seconded to an RACF will likely be done at a loss, with subsequent disincentive by the employer for that pharmacist to spend any more than the absolute minimum amount of time at the facility.

    Pharmacist’s employed in an RACF setting are not only disencumbered from such a “loss leading” arrangement, but they will provide significant benefit to contacted pharmacies through on-site expertise, coordination of communication, & collaboration on medicine use improvements…. all without the community pharmacy contributing to that pharmacists wages.

    It makes very little sense to restrict how a pharmacist would be employed in a RACF, and there is zero regulatory or legislative mechanisms to do so (which is why there are already pharmacists employed in RACF now!)

  2. George Papadopoulos
    16/10/2019

    We already have private hospital pharmacies with pharmacists ’embedded’ in a system that doesn’t interact with community pharmacies. Can’t see how an aged care model is going to be a fragmentation of care. It will be a lost business opportunity for community pharmacies…

  3. Manya Angley
    16/10/2019

    I think that the Guild’s proposal is potentially dangerous and self serving. The Royal Commission in aged care has clearly shown the need to ensure medication safety in RACFs is paramount and we need our best and brightest pharmacists with a high level of geriatric expertise serving our most vulnerable Australians. On the other hand, the PSA’s proposal to embed pharmacists (community or non-community) in RACFs has residents’ interests as the primary focus and just makes sense. If translated to an hourly rate, current remuneration for RMMRs is low as is funding for QUM services (especially if appropriate time is allocated and quality services are provided). It’s simply not enough to have pharmacists doing RMMRs intermittently, sometimes not visiting the facility and rarely seeing residents or staff. Moreover, we are at the mercy of GPs making RMMR referrals before getting paid to review a patient and then not considering our reports. Aged care pharmacists need to be ‘on the ground’ at the facilities and a key member of the team around the residents and showing our value, especially to GPs. The PSA’s proposal is flexible and accommodates a community pharmacist outreaching to a RACF, which could certainly result in synergies, as well as non-community pharmacists taking up the role. If aged care pharmacists are embedded, valued and properly remunerated, older Australian will get the ‘top drawer’ pharmacists they deserve.

    And, pharmacists should be embedded throughout all aged care settings not just RACFs, in particular Home Care Services

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