PSA proposes integrated GP-pharmacist model of care

The Pharmaceutical Society of Australia (PSA) has proposed a potential model for integrating non-dispensing pharmacists within general practices to deliver clinical support within a team care environment, based on the model in place for practice nurses under the practice incentives program.

Developed in association with the Australian Medical Association (AMA), the model would see a Pharmacist Incentive Payment (PhIP) introduced to support the cost of employing a pharmacist for the majority of general practices.

In its 2015-16 pre-budget submission, the PSA also calls for a similar model to integrate pharmacists within Aboriginal Health Services to deliver medication adherence and education services.

It says the cost of the two proposals would be offset by better medication adherence, fewer medication mishaps and fewer presentations to hospital through team-based medication management.

Pharmacists would also be able to assist in providing some health screening and educational programs within general practices such as point-of-care testing and monitoring, clinical audits, health assessments, immunisation, transitional care and facilitation of shared medical appointments.

The PSA suggests that the PhIP would pay $25,000 per year per standardised whole patient equivalent (SWPE) for a pharmacist working a minimum of 12 hours and 40 minutes per week. It suggests a cap of five incentives per practice, and that a loading of up to 50 per cent should apply for rural practices.

A similar model would see the proposed PhIP adapted to allow Aboriginal Health Services to improve medication adherence and reduce the progression of chronic disease.

“This would allow Australia’s 200 AHSs to access up to $125,000 per year to employ a pharmacist, in keeping with the general practice proposal,” the submission says. “This initiative would give AHSs around Australia much greater access to the expertise of a pharmacist and where required, to deliver essential medication adherence and medication education services in a culturally appropriate environment.

“Investment by the government in such initiatives would be offset by reductions in chronic disease expenditure and reduced hospitalisations for the population of Australians beset by the poorest health outcomes.”

PSA national president Grant Kardachi said the submission aligned with the key elements of Australia's quality use of medicines QUM policy, and focused on the safe and effective use of medicines.

“Our proposals underpin the government objectives of achieving a fiscally sustainable, efficient and quality healthcare system though a collaborative and cooperative framework,” Mr Kardachi said.

“Pharmacists are highly trained in medicines yet their skills, knowledge and expertise are often under-recognised and under-utilised.”

The submission says one of the benefits of integrating a pharmacist within general practice would be access to the patient's medical history.

“Practice pharmacists have noted that being able to access the patient’s medical file for a complete patient history enables meaningful, informed clinical interventions and enhances pharmacist–GP communication and collaboration,” the submission says.

“Full access by the pharmacist to the patient’s medical records is a necessity in order to provide optimal patient care.”

It says pharmacist-delivered medication management and education services are the missing link in most general practices and Aboriginal Health Services.

“There are opportunities in these settings for a non-dispensing pharmacist to work with other members of the health care team to improve medication use and reduce errors for consumers with chronic disease.”

It describes the role, which has been adopted in the UK and is also used in New Zealand, Canada and the US, as providing patient consultations, medication information and education, and drug use evaluation.

“Practice pharmacists assist with medication enquiries from patients and health professionals, conduct staff education, contribute to optimal prescribing, mentor new prescribers, participate in case conferences, liaise across health sectors, undertake medication management reviews, and evaluate drug utilisation to ensure optimal therapy.

“As part of their collaborative work, an important element of the practice pharmacist’s role is liaison with local community pharmacists, to ensure continuity of care.”

Posted in Allied Health

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