‘The Queensland UTI trial is just the beginning.’

Lucy Walker explores independent prescribing and professional services in other countries, and says now is the time for Australia to catch up and make great strides in pharmacy practice

Lucy Walker, owner of the Terry White Chemmart Goondiwindi in rural Queensland and 2017 Pharmacy of the Year winner, has presented an APP Online session about her 2018 Churchill Fellowship experience.

In late 2019, Ms Walker conducted an international pharmacy study tour funded by the fellowship, during which she visited several countries and investigated their pharmacy practice.

“I wanted to learn about research from around the globe,” she told APP Online delegates in the session sponsored by PDL.

She started her trip at the International Pharmaceutical Federation (FIP) Congress in Abu Dhabi.

“When I was at FIP, I heard for the first time about the Australian common ailments service. The research showed that it was cost effective and actually led to more appropriate referrals for consumers,” said Ms Walker.

“At the same session I heard about Sweden’s vision for e-health. They’ve had electronic scripts for about 20 years and about 99% of people use e-scripts. That shows how far behind we are in Australia.

“As you can see with coronavirus, one of the responses by the Australian government was to enable prescribing and also delivery. What we really need to do is embrace this change now and be ahead of our competitors.

“The world is changing and so are we.”

Pharmacies around the world are more widely utilised than here in Australia. We are catching up and we will continue to catch up.

Ms Walker visited Scotland, which she said has a “really, really wide scope of pharmacist practice”.

The country has a common ailments service called Pharmacy First, which encourages people to go to the pharmacy first for advice in order to reduce the burden of an ageing population and doctor shortages.

She met independent pharmacist prescribers, who were able to prescribe several medicines including antibiotics, managed a lot of patients and had very collaborative relationships with GPs and specialists.

“I was really impressed by the Scottish independent prescribers that I did meet,” she said.

It was also in Scotland that Ms Walker also encountered 24-hour collection services, where patients would get a text message to their phone telling them their medicine was ready.

Pharmacists in Scotland are also funded to help patients who have just started on a new medication.

“I get calls all the time from patients and I don’t have any funding and I don’t always have the time to go through everything. So just imagine if we had the time to follow up for things like metformin and asthma puffers,” said Ms Walker.

The US landscape – or what she described as “corporate USA” – was very different, and there was much that frustrated Ms Walker.

“I really hated the lack of transparency and the complexity when I was in the States,” she said, describing how medicines are paid for by middle men between insurance companies and the pharmacies, called pharmacy benefit managers, that can also “clawback” funds.

Some pharmacies were also giving 90 days’ supply of new medications.

“They said, it makes it look really good for the insurance companies because when they see during the computer generated KPI that they have been taking 90 days. I asked, are you doing any counselling? They said, no it just looks good for the computer systems. I thought, you know what? That’s just going to lead to a whole lot of wastage.”

This journey has made me realise that we need to do what is necessary for the health of our patients and our communities.

Meanwhile Ms Walker was inspired by what she saw in Alberta, Canada, and in New Zealand.

“All pharmacists in Alberta since 2007 have had the ability to prescribe for the purpose of adapting the prescription. They can also prescribe for the purpose of continuing care,” she said.

“This really helped when they had their forest fires in Canada, the need for medication continuance is going to be an ongoing problem. Last month for us Australians it was bushfires, now it’s COVID… we really need a way for patients to get their medications regularly and I think now is the time to make it happen.”

Pharmacists in Alberta are also funded to provide various common ailments services and are able to provide collaborative chronic care plans.

Meanwhile in New Zealand pharmacists provide UTI testing, gout programs, INR testing and more.

Other countries she visited included Germany, England and Ireland.

“What I got from my pharmacy adventure was a wider perspective at what is coming. The difficulty is how we can bring all these things that we learnt back home and actually implement something useful?” she said.

“Pharmacies around the world are more widely utilised than here in Australia. We are catching up and we will continue to catch up. In Queensland the use of travel meds and different things like the UTI trial, that’s really just the beginning.

“When you think about it, the world’s changing and so can we. With every challenge there are opportunities but we can’t just try to do our best. This journey has made me realise that we need to do what is necessary for the health of our patients and our communities.”

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