19.09

2018
Increasing the role of pharmacy in primary care
Written by Dr Niamh O’Reilly

Arthritis, asthma, back pain, cancer, cardiovascular disease, chronic obstructive pulmonary disease, diabetes and mental health conditions are the eight most common chronic conditions affecting Australians. In 2018, half of Australians are estimated to have at least one of these eight conditions (1). Chronic conditions account for 61% of Australia’s total disease burden and 37% of hospitalisations (1). These conditions are long lasting, cause persistent negative effects on people’s quality of life and require ongoing care from multiple healthcare professionals (HCPs). Here we will look at how the role of pharmacists is expanding to involve more patient centric activities aimed at easing the burden of chronic disease management.

Pharmacists are highly skilled yet often underutilised in the primary health care sector (2). Recognising this untapped potential, many countries including Australia have started to equip community pharmacists with additional patient-centred responsibilities (3). In recent years Australian pharmacies began to offer a broader range of services to the public including smoking cessation and weight management programs, as well as administering flu vaccines. There is now growing support to further extend the role of pharmacists in primary care. Community pharmacists with relevant experience and training could potentially provide a range of services to support treatment of chronic conditions including medication review, monitoring medication related side effects, managing adverse drug reactions and provision of additional patient counselling for people taking new medicines or with special needs (4).

 

A Successful Collaborative Healthcare Model

Countries with comparable healthcare systems to that of Australia such as the United Kingdom have made substantial steps to enhance community pharmacy services and pharmacists’ roles in primary care. For example, in 2015, England’s National Health Service launched a scheme placing clinical pharmacists in general practice (5). This scheme was developed to support GPs struggling to cope with unprecedented workloads causing some patients to wait weeks for appointments (5). Services provided by clinical practice-based pharmacists as part of this scheme include face-to-face review of all medicines, review of medicines over the phone, responding to questions about prescribed medicines and to have the supply of a repeat prescription reauthorised. The scheme has successfully demonstrated that collaboration between general practitioners and pharmacists can improve patient care resulting in it being extended to cover 40% of GP surgeries across England (6).

Canada is another country where pharmacists’ scope of practice has been significantly expanded over the past 12 years demonstrating that system change is possible (7). Canada has made significant inroads to introducing a range of new pharmacy services which allow pharmacists to provide more effective care to consumers. For example, pharmacists in all but two provinces can now renew or extend prescriptions. Additionally, Canadian pharmacists in some provinces can now make therapeutic substitutions, order and interpret lab tests, administer drugs by injection, change drug dosage and prescribe for minor ailments (7).

 

Evolving Primary Care Model for Australia

In 2016, the Australian government introduced the Pharmacy Trial Program, which focused in three areas: improved medication management for Aboriginal and Torres Strait Islanders through pharmacist advice and culturally appropriate services; pharmacy based screening and referral for diabetes; and improved continuity in the management of patients’ medications when they are discharged from hospital (8). The Victorian government has also implemented an ongoing 18-month pilot scheme to integrate pharmacists into four general practice teams allowing them to renew prescriptions and make dose adjustments to medication (9).

Another pilot initiative by the Capital Health Network in the Australian Capital Territory involved placement of part-time, non-dispensing pharmacists in three general practices for six months (10). This study aimed to describe the variety of activities undertaken by pharmacists. It was found the pharmacists’ activities related to quality of practice, administration, medication review and patient education. Importantly, these pilot schemes along with further large randomised controlled trials are required to collect clinical outcomes and determine which activities conducted by pharmacists are most beneficial, cost-effective and welcomed by GPs and patients (10). Collecting this data will add to the body of evidence to prove the value of expanding the role of pharmacists in primary care.

In Australia efforts are in place to ensure that by 2023 pharmacists’ roles are optimised, they are practicing to full scope and are more highly valued in the healthcare system (7).

CRC has the expertise to manage Medical Affairs projects involving the pharmacy channel, particularly where it represents a major role in client commercialisation plans.

 

References:

  1. Australian Institute of Health and Welfare. 2018. Australia’s Health in Brief.
  2. Freeman C. et al. Integrating a pharmacist into the general practice environment: opinions of pharmacist’s, general practitioner’s, health care consumer’s and practice managers. BMC Health Service Research.
  3. Mossialos E. et al. From “Retailers” To Health Care Providers: Transforming The Role Of Community Pharmacists In Chronic Disease Management. Health Policy.
  4. Paola S. 2017. SHPA calls for prescribing pilot, role in CPA negotiations. Australian Journal of Pharmacy. Available at: https://bit.ly/2CVGOQH
  5. Barnes E. et al. 2017. New role for clinical pharmacists in general practice. Medicines Optimisation.
  6. NHS England. 2018. More clinical pharmacists set to boost GP services for patients and practices. https://bit.ly/2DFcKW7
  7. Pharmacists in 2023: A discussion paper. 2018. Pharmaceutical Society of Australia. Available at: https://bit.ly/2NM79F8
  8. The Department of Health. Pharmacy Trial Program. 2017. Available at: https://bit.ly/2eHQFwp
  9. Paola S. 2017. Can pharmacists manage chronic disease? Available at: https://bit.ly/2jdsnw5
  10. Deeks L. S. 2018. What can pharmacists do in general practice? A pilot trial. Available at: https://bit.ly/2D4dEij