Tension over pharmacy trial funding

a bunch of 20 dollar notes

Investment in the Pharmacy Trial Program is seen as “highly valued”, but stakeholders have expressed scepticism about what has been described as a “secretive” tender process for trial grants

The Federal Department of Health has released a review of the implementation of the Pharmacy Trial Program (PTP), which received $50 million in funding under the 6CPA to trial new and expanded community pharmacy programs.

This review was conducted by Healthcare Management Advisors (HMA), a management consulting firm that advises the health, human services and medical science sectors, and although it was completed in November 2019 the final report was published by the Department last Friday.

Seven trials had signed funding agreements at the time of the review (Feb-June 2019), including the Pharmacy Diabetes Screening Trial and Indigenous Medication Review Service Feasibility Study as part of Tranche 1.

Tranche 2 included the IPAC Project, Asthma Trial, ReMInDAR Trial and the CVD Trial, while Tranche 3 comprised the Chronic Pain MedsCheck Trial.

A further trial under Tranche 3 was announced in March 2019 – the Bridging the Gap between Physical and Mental Illness in Community Pharmacy Trial (PharMIbridge Trial), set to commence in the 2019–20 financial year.

Based on the evidence collected during the review process, investment in the PTP was “highly valued” by the pharmacy sector, HMA found.

As other research funding sources do not specifically target the objectives of the PTP, the review found that the expected outcomes of the PTP are unlikely to be achieved without specific PTP funding.

“Furthermore, noting the limited capacity of community pharmacy to implement programs without financial incentives for staff time, expanding existing programs would be challenging without funding for trials,” found the review.

It concluded that funding of a program for service delivery trials is an appropriate response for the stated objectives of the PTP, which were to improve the clinical outcomes for consumers, and/or extend the role of pharmacists in the delivery of primary healthcare services.

However the review also noted concerns over lack of transparency and a level of scepticism among stakeholders about how decisions were made about which organisations were approved to receive funds.

Many professional peak bodies—including the PSA, SHPA and RACGP—commented on the levels of transparency regarding Tranches 1 and 3 of the PTP.

“Professional and advocacy peak bodies consulted had concerns about the lack of transparency of the PTP key decision-making processes,” HMA found.

“It was felt that the rationale for selecting priority areas or approved trials was not communicated more broadly to interested stakeholders. This resulted in a level of scepticism among stakeholders about how decisions were made about which organisations were approved to receive funds.”

Stakeholder scepticism of processes for these tranches was increased by the large number of approved trials led by the Guild (four of seven trials), including the Chronic Pain MedsCheck trial, which received notably higher funding (at approximately $21 million) than the other PTP trials (at an average of $3.2 million per trial), found the review.

Funding for the Chronic Pain MedsCheck Trial breaks down to $20.85 million for the Guild and $500,000 for the PSA.

“Communication…on the PTP on the whole has not been great,” read one advocacy peak body comment. And a pharmacist survey respondent was quoted as saying: “The tender process was secretive and opaque.”

In response to this observation by HMA, the Guild commented that, although they were the lead organisation from a contract perspective, the engaged universities and researchers were in charge of the trials and leading the day-to-day implementation.

There was also a perception among many stakeholders that the Guild was the administrator of the PTP as they had been for the R&D program under previous CPAs. While this perception is incorrect, the confusion added to general scepticism in the sector, as reported to the review team.

Most professional peak bodies, advocacy groups, grant applicants and Trials Advisory Group members consulted felt that PTP tranches should not be non-competitive rounds.

Limited communication on the rationale for the non-competitive tranches was also expressed by stakeholders, and professional peak bodies commented that the non-competitive grant round in Tranches 1 and 3 were announced without consultation and associated documentation appeared to some of those interviewed to be “discouraging of applications from others in the profession”.

Stakeholders also told reviewers that, as implementation of the program progressed, there was a growing disparity between the sector’s vision for the PTP and the grant activity that eventuated.

An unnamed peak professional body stated: “The PTP has been a program of lost opportunity; it could’ve been research that could have seriously impacted practice. It could’ve given us evidence around new programs…This was a once-in-a-lifetime investment in community pharmacy that will result in very little.”

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  1. Dr Evan Ackermann

    Final Report Page 11
    MSAC review of existing Continuing Pharmacy Programmes In 2016–2017, evidence reviews on the clinical and cost effectiveness of Continuing Pharmacy Programmes were undertaken. Programs reviewed included:
     Dose Administration Aids;
     Staged Supply support allowances;
     Clinical Interventions;
     Home Medicines Review (HMR);
     Residential Medication Management Review;
     MedsCheck; and
     Diabetes MedsCheck [36].
    MSAC concluded that there was insufficient evidence and a lack of empirical research to determine the clinical and cost effectiveness of the reviewed programs

    Yet funding of $1.2B continued in the 7th CPA. Essentially a backdoor payment to pharmacies. So much more could have been done to improve the pharmacy profession with these funds.

  2. Dr Evan Ackermann

    Page 22
    The following comment from a community pharmacy employee highlights several barriers to the implementation of new pharmacy service delivery programs.
    ‘[There is a] conflict of interest between the retail offering with the owner’s need for profitability and delivering an authentic health service. Pharmacists are positioned more so as shop or business managers. The bread-and-butter task of being a true pharmacist becomes an automated constant background task.
    Current industry structure regarding location rules and traditional pharmacy models [is a barrier]. These stores are overworked and under supported – and the constant blame is either PBS cuts or discount competitors.’

    Community pharmacist – employee

    Says a lot.

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