We want to be embedded in aged care, say pharmacists


Not a zero-sum game: pharmacists should be able to perform medication management activities – whether they come from community pharmacy or elsewhere, says PSA

This week AJP covered the topic of integrating non-dispensing pharmacists into aged care facilities.

Pharmacist researcher Dr Janet Sluggett told the Royal Commission into Aged Care that non-dispensing pharmacists could undertake a range of activities to create safer medicines use in aged care facilities.

However Pharmacy Guild Acting National President Trent Twomey said embedding non-dispensing pharmacists in aged care facilities would be “the wrong approach”.

“The key is to bolster the connection between local community pharmacies and the aged care facilities, so that the pharmacist dispensing the medication is also the pharmacist overseeing the medication management for the patient,” he told AJP.

“Our view is that wherever possible, the delivery of these services should be directly connected to medicines supply by the local pharmacy.”

Pharmacists whether they come from community pharmacy or elsewhere should be able to perform these activities.—Dr Chris Freeman

PSA released its submission to the Royal Commission on Thursday, making it clear that it believes embedding pharmacists is the answer to addressing medicine-related harm in aged care.

“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 Dr Chris Freeman.

“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.”

PSA told AJP that both community pharmacists and non-community pharmacists should be able to be embedded in residential aged care facilities.

“It’s actually about time on the ground in the facility addressing the multitude of medication management issues,” said Dr Freeman.

“That person should have the right skills to do that. Arguing over where they come from does residents a disservice because it’s actually about devoting the time based in the facility to address these issues and we need the funding to be able to do this,” he told AJP.

“Pharmacists whether they come from community pharmacy or elsewhere should be able to perform these activities.”

PSA is advocating for more funding for pharmacists to deliver on the range of medication management services within aged care facilities, saying in its submission to the Royal Commission that the limited funding currently available is “grossly inadequate”.

However the Guild’s Mr Twomey is not as hopeful that funding will come forward for such a service delivery model.

“Put simply, there is no funding for such a model, and no likelihood that funding will materialise any time soon. And even if funded, it would still be the wrong approach,” he said, adding that the focus should be on local community pharmacists.

The majority (77%) of AJP readers who responded to a poll said they too believe non-dispensing pharmacists should be embedded in aged care facilities.

In our poll run over less than 24 hours, we received 235 votes (as of 4.45pm 18 July) to the question: Do you think there should be specific roles for non-dispensing pharmacists embedded in aged care facilities?

77% of AJP readers who responded to a poll said they believe non-dispensing pharmacists should be embedded in aged care facilities.

Forty-two percent (99 votes) said “Yes, I think it’s a good idea and should be implemented immediately.”

Thirty-five percent (82 votes) said “Yes, I think it’s a good idea but only if there is appropriate funding for it.”

Seventeen percent (40 votes) said “No, I think local community pharmacists should be playing a bigger role in this space instead.”

Four percent (10 votes) said “No, I think off-site accredited consultant pharmacists should be providing more RMMRs and QUM services instead.”

And four people voted for “other”, “none of the above” or “no changes changes need to be made to the current system”.

One “other” comment was that: “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.”

PSA doesn’t preclude community pharmacists from its actions for change in 2023, stating that community pharmacist roles should be enhanced to have a greater level of responsibility for medicines management.

It also calls for the accessibility of community pharmacies in primary care to be utilised and built upon.

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6 Comments

  1. Jim Tsaoucis
    19/07/2019

    Quite simple really, nothing money can’t fix. Doctors have an item number for everything, so why not pharmacists, and I say pharmacists as the person, not the business. Each and every pharmacist has there own practitioner number and every task we do outside our regular pharmacist role ( what ever that may become) has an item number and pharmacists get paid accordingly.
    Now that’s some food for thought
    Jim

  2. Kevin Hayward
    19/07/2019

    I spoke with a GP today, furious (as I understand it) that the review of medication requested had been done as a remote review of the patient notes by a pharmacist who had not seen or spoken to the patient or GP or even visited the ACF. Surely an embedded pharmacist would make a huge difference?

  3. Adele Tahan
    19/07/2019

    Fragmentation of care, significant medication management disconnecting the patient from the dispensing pharmacy. In addition the question remains where would the funding comes from? would the source of funding comes from the ACFs? or Medicare. If it’s not related to the Community Pharmacy model then it must not come from the CPA! Whoever calling for embedding pharmacies must show the economic model showing value in the proposal. Health economists needs to prepare the value proposition. Funding can be sought once the value has been determined.

  4. Debbie Rigby
    21/07/2019

    The discussion should be about how pharmacists can create safer medicines use in aged care facilities. Recent reports and media, as well as previous studies, have highlighted suboptimal use of medicines, in particular psychotropic medicines, in aged care facilities. Everyone in the medicines management pathway has a responsibility to improve this.

    Community pharmacists can contribute under the current funding mechanisms for dispensing (dispensing fee provides for safety and efficacy check and counseling). Why are concomitant use of cholinesterase inhibitors and anticholinergics dispensed without question? Why are multiple benzodiazepines dispensed without intervention? Why are antipsychotics dispensed year after year to residents without intervention? How often do deprescribing interventions occur in a retail setting?

    An independent pharmacist with advanced knowledge, skills and experience in aged care can fill the gap in care that clearly exists now across many RACFs. We have the evidence to support this role. There is strong support from those organizations and facilities who have already implemented the model.

    • Jarrod McMaugh
      21/07/2019

      I support a lot of what you say here Debbie, except this line

      “How often do deprescribing interventions occur in a retail setting?”

      Pharmacist’s who provide medication services to a RACF don’t do this “in a retail setting” – pharmacies have dedicated facilities to undertake this role.

      Community-based pharmacists are as capable of providing this service as any other pharmacist.

      It is as unhelpful to suggest that a community pharmacist can’t undertake this role, as it is for Trent Twomey to say the model won’t work.

      The primary issue is the disconnect between the pharmacists role, and the expectation of this role from the facility and visiting medical sraff.

      From personal experience & an understanding of the practice of pharmacists working with RACF (Community, QUM service providers, RMMR service providers) there are interventions carried out regularly that are ignored, overlooked, or reinstated when the medical practitioner next reviews the chart. The issue is communication & setting… being in the facility when reviews occur, being funded to attend case conferencing, being “part of the team” rather than seen as nothing more that a supply or retail pharmacist…. these are the areas that need attention.

      Having a pharmacist in the facility achieves this, whether that pharmacist is employed to be there by the facility, or employed to be there by the community pharmacy under contract by the facility.

      “Embedding” describes the need very effectively

      • Dr Phil 42
        21/07/2019

        I think something like an MBS item 58 – at a stretch item 59. With a requirement to document advice in the medical notes. Maybe an item 5260 ….

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