Stacks on pharmacists in doctor comments

doctor makes "stop" gesture with hand - ama

Doctors have slammed the Chronic Pain MedsChecks trial, following a doctors’ magazine report on anaesthetists’ concerns

As reported in AJP last month, Dr Meredith Craigie, Dean of the Faculty of Pain Medicine of the Australian and New Zealand College of Anaesthetists, wrote to the federal Health Minister Greg Hunt expressing concern that the Chronic Pain MedsCheck scheme was introduced without input from specialist pain medicine physicians.

“While we welcome the substantial new investment in chronic pain care the faculty is concerned that the scheme has been developed without appropriate input from medical specialists and does not adequately recognise that the successful treatment of chronic pain requires a complex, co-ordinated approach,” Dr Craigie said at the time.

“Chronic pain treatment includes movement, physiotherapy and psychosocial interventions and needs to be much broader than focusing on medications which in many cases are ineffective.

“Unfortunately there’s a perception that chronic pain can only be treated by drugs such as opioids. This has in part led to the opioid crisis we are seeing today where patients take increasing doses of opioids to relieve pain and end up with serious complications including dependence, addiction or even death, especially when mixed with other sedatives like benzodiazepines.”

Australian Doctor has now reported on developments with Chronic Pain MedsChecks, particularly the ANZCA concerns, prompting a flurry of criticism from doctors.

Prominent GP Dr Evan Ackermann, a long-standing critic of the pharmacy sector who was recently awarded the RACGP’s highest honour, the Rose-Hunt Award, led the pack, saying Dr Craigie’s comments should be “seriously considered” by Government.

“The evidence to support ‘medschecks’ for anything is very poor,” he wrote in response to the AusDoc article.

“The impact of either pharmacist education or Medscheck in chronic pain has not been shown to be clinically beneficial. Patients have a right to know this before they give consent to have their existing care re-analysed by a pharmacist.”

He labelled the pharmacy-based poster promoting the trial as “misleading,” because it suggests the trial is a “service” rather than a “trial for which patients have a choice and need information to make an informed decision”.

“This trial should be actively ignored by patients, and seriously reconsidered by Government,” he said.

Another doctor, Iliya Englin, called Chronic Pain MedsChecks a “stupid idea” and said “it may give someone a warm, inner glow of not being ‘just a pharmacist’, but $100 for 45 minutes is hardly worth getting out of bed for”.

“Chronic pain is complex medicine, and they are better off giving that money to private pain docs.”

Clinical Pharmacy Lecturer at La Trobe University and Quality Use of Medicine Lead at the Western Victoria PHN Pene Wood was among pharmacists who stepped in to clarify the situation.

In response to Dr Ackermann’s claims that there was no evidence to support pharmacist involvement, she pointed out that Chronic Pain MedsChecks were a trial, and trials were conducted to examine whether there was benefit in particular activities.

She said that the training consistently emphasises collaboration with the whole healthcare team, especially the GP.

“There is a whole section on the appropriate use of opioids and how to identify issues and work with GPs and others on reducing their use and the harms from them!” she writes.

“And there is a massive emphasis on non-drug management of pain.

“Why does it have to be a turf war on doctors vs pharmacists? Why can’t it be a collaborative effort everyone working together to focus on the most important factor—getting the best outcome for the PATIENT!!!”

Another pharmacist stepped in to point out that for country patients, private pain doctors are unavailable or at least not available without long waiting lists.

Commenting doctors did not seem convinced.

One said that “we won’t know we’re in collaboration with anybody, because the patient will almost certainly not tell us they have gone to the chemist for advice on pain management, because they know, quite rightly, that we will probably not be all that keen (modest understatement) on the idea”.

Another attacked the retail aspect of community pharmacy, saying “fancy being allowed to sell aftershave, toiletries, supplements etc as a registrant”.

“Must have training in cosmetics at uni as well. I am concerned at the erosion of the doctor-patient relationship, deaths and side-effects stewardship.”

Ms Wood told the AJP that she was disappointed in the comments from doctors.

“Pharmacists don’t want to take over from GPs, we want to work with them collaboratively!” she said.

In response to the original communication from ANZCA to the Health Minister, the national president of the Pharmacy Guild, George Tambassis, also emphasised the importance of collaboration.

“Unfortunately the Faculty has misrepresented or misunderstood the collaborative nature of this important trial,” he said at the time.

An invitation was extended by the Trial Expert Panel to the Faculty of Medicine to participate as a member of the panel.

Chronic Pain MedsChecks began this week.

Some comments have been edited for clarity.

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