‘We have waited far too long for this to occur.’

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New studies reveal the value of pharmacists in general practice, and dispel the “baseless fear mongering” surrounding the model of practice, say researchers

Recent research demonstrates high levels of interaction between pharmacists in the community pharmacy and general practice settings, says Dr Chris Freeman, Clinical Senior Lecturer in QUM at the University of Queensland and National Vice President of the PSA.

However there is room for improvement if pharmacists who are working in general practice are better enabled to easily engage with community pharmacy, says Dr Freeman.

He shared the results of a 2017 survey of 43 Australian pharmacists working within general practice at a panel session held at PSA conference last week.

The survey found 77% of respondents had contact with community pharmacy at least once per week, and 70% believed that community pharmacists were accepting or very accepting of their role.

Sixty-seven percent said they referred patients to their community pharmacy of choice for professional services, while 63% said they were a point of contact for community pharmacy regarding clinical questions about patients.

The high levels of interaction “occurred organically without any framework guiding the pharmacist in general practice collaboration with the community pharmacy, a figure that will increase with a targeted framework being developed by PSA,” explains Dr Freeman, who has previously completed a PhD on pharmacist roles in general practice and other healthcare settings.

Not only were there high levels of contact between the pharmacists on a weekly basis, there were also a significant number of referrals of patients to their community pharmacy for services such as MedsChecks, DAAs and HMRs, he adds.

“It is understandable that at a time of exceptional pressure on the viability of the community pharmacy sector, that the development of roles for pharmacists outside of the community pharmacy setting are perceived as potential threats.

“These results are important as they start to dispel some of the baseless fear-mongering which has surrounded this model of practice and the potential impact on the community pharmacy setting.

“The models of pharmacists working in community pharmacies and general practices are not mutually exclusive, and there would be many occasions were the pharmacist in the community pharmacy would also be integrated into the general practice setting.”

Dr Freeman says that in regional and remote settings, or where the community pharmacist has an existing strongly established relationship with the general practice, it is likely that the pharmacist will be sourced from the community pharmacy.

“As a profession we need to be taking opportunities such as this with both hands and stop continually being paralysed when given the opportunity to work outside our comfort zones.

“The Workforce Incentive Program is a good start to see this model becoming sustainable in the future but is just a beginning.”

The models of pharmacists working in community pharmacies and general practices are not mutually exclusive, says Dr Chris Freeman
The models of pharmacists working in community pharmacies and general practices are not mutually exclusive, says Dr Chris Freeman

What do GP pharmacists actually get up to?

Newly published research describing the activities of general practice pharmacists over six months in a pilot trial has also been published this month in the Australian Journal of General Practice.

The initiative of the Capital Health Network – ACT’s PHN – saw three non-dispensing pharmacists complete 944 hours of work activity over six months.

They spent most of their time undertaking quality of practice duties (37%), the largest proportion of this being devoted to conducting clinical audits (47%).

Examples of clinical audit improvements include pharmacists identifying and addressing:

  • Patients with chronic atrial fibrillation not receiving guideline-recommended anticoagulant therapy and making the recommendation to GPs to initiate it, potentially reducing the risk of ischaemic stroke;
  • Use of dual antiplatelet therapy for longer than indicated following coronary angioplasty;
  • Ongoing oral corticosteroid therapy and risk of osteoporosis;
  • No record of HbA1c results for some patients with type 2 diabetes;
  • Patients with heart failure for whom angiotensin converting enzyme inhibitors or angiotensin receptor blockers had not been prescribed.

Communication with GPs was found to have increased gradually over the trial period.

The pharmacists spent 15% of their time providing medication information to practice staff, while contact with patients comprised medication review (19%) and patient education (11%).

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Dr Mark Naunton sees pharmacists in general practice as a ‘no brainer’.

Asthma, aged care, post-hospital discharge and polypharmacy (with the aim to deprescribe) were the main reasons for medication review referral.

Patient education was 51% medication related and 49% lifestyle related; the latter including smoking cessation when not directly related to medications used in cessation.

Administration duties took up about 34% of the pharmacists’ time – however this number decreased in the final months once they became more established in the practice.

Overall two-thirds of their time was spent in clinically related duties.

“The results from our study are important because they provide some important ‘real world’ data from pharmacists who have previously not worked in general practice,” says study author Dr Mark Naunton, Associate Professor and Head of Discipline, Pharmacy at the University of Canberra.

“We are starting to define what the roles may be for pharmacists working in general practice. It is also important because we have shown that pharmacists’ communication with GPs increases over time,” Dr Naunton tells AJP.

“Hopefully this helps take out some of the heat from different stakeholders who have been concerned about this. Some have questioned why we would need pharmacists in general practice, and our data is telling us that GPs (and others working within the practice as well as patients) really value the input from the pharmacists.”

Based on the results, does Dr Naunton think pharmacists should be included in all general practices across the country?

“Each practice should consider if they can use a pharmacist within their practice,” he says.

“Although we have not presented the data yet, there will be significant cost-savings to society based on some of the activities the pharmacists undertake (e.g. clinical audits).

“As a pharmacist, I see it as a no brainer. I remember when it was a big issue about having nurses in GP and now they are pretty much routinely found in GP. With so many drug-related problems and so many new drugs hitting the market we need professionals with expertise to address and prevent them from occurring. Pharmacists are uniquely trained to do this.

“We have waited far too long for this to occur. Australia is lagging behind the world (for example, parts of Canada, UK) on this issue. The time for change is now. I am very proud to work with a team to deliver these results and we look forward to publishing second year results soon.”

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