Publication Date 01/12/2009         Volume. 1 No. 7   
Information to Pharmacists

Editorial

From the desk of the editor

Welcome to the December 2009 edition of i2p - Information to Pharmacists E-Magazine.
When i2P first began in February 2000, it was decided that a fortnightly publication might prove to be the optimum publishing cycle.
This thought was soon dispelled as it was found that having sufficient content to maintain this cycle became a problem.
Oh for those quieter times!
The cycle then became monthly and has been maintained up to now.
The problem is now coping with the volume of news and opinion that is generated on a daily basis.
Very much the reverse of the year 2000 - a statement for our time and how the pace of pharmacy life has increased.

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Indigenous Health

Rollo Manning

articles by this author...

Rollo Manning has experienced pharmacy practice from all sectors of the industry – retail, administrative, policy and remote Aboriginal practice. He spent 10 years with Glaxo Australia and was the first Director of Public Relations at the Pharmacy Guild National Secretariat in Canberra.
He has also held the position of Pharmacy Policy Officer for Territory Health Services in Darwin.
Rollo is currently a Consultant working in his own practice with remote Aboriginal communities, in Northern Australia.

ABORIGINAL HEALTH

MOVING AHEAD WITH PHARMACY SERVICES FOR ABORIGINAL PEOPLE

Concerned about the quality in the use of medicine at an Aboriginal Medical Service? – Remote, urban or regional centre?

 The answer is simple – employ (or engage) a pharmacist.

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This conclusion is the major thrust for improving the Quality Use of Medicine (QUM), from ordering in to evaluating drug utilisation. Many hundreds of pages of reviews, analyses, research and conference transcripts have been written on the subject of needs analysis.

It all comes down to control – the control of the medicine supply from AMS to client must rest with the AMS so the process meets the modes of medical practice in the sector.

“Pharmacy” is renowned for being driven by regulatory process and adherence to professional standards with a reluctance to stray away from the mainstream model developed over the past 100 years. This model (paradigm) has been influenced by manufacturers and the enthusiastic protectionism heaped upon a retail sector renowned for its “four walled” syndrome. The vigour of the lobby for this retail sector has eliminated any aspirations other health service delivery agencies may have had for including a pharmacy operation in their service.

Aboriginal Medical Services are one such agency. Aged Care Facilities, Nursing homes, private hospitals, Primary Health Care Centres and GP Super Clinics are other examples of health facilities unable to own (and therefore control) the way pharmaceutical care is delivered to their clients.

The quest for improvements to QUM in Aboriginal Medical Services is really a simple matter of introducing a logical sequence of activities that enlightens each step of the path from acquiring the medicines into the pharmacy room, to dispensing to clients, informing them of likely actions and consequences of taking the medicine and evaluating the result. This simple process is at the core of the training for all pharmacy graduates from the 17 Universities around Australia that deliver the Batchelor of Pharmacy degree. So why is it so hard to introduce a registered pharmacist to the primary health care team at an AMS?

The answer to that question is simple too. The retail pharmacy lobby is adamant (some may say fanatical) about having all money derived from the PBS going through the cash register of the retail pharmacy.

There is the need for a paradigm shift. A shift away from this model to one that is under the control of the AMS itself so it can model the practice of pharmaceutical care in a manner that suits it and its clients.

That is after all what it is all about – good patient outcomes – better health for Aboriginal people – and thus prolonging life expectancy thereby closing the gap.

The past ten years has seen a significant improvement in the way pharmacy services have been delivered to Aboriginal Medical Services in both the urban/rural and remote areas of Australia. This was sparked by the introduction of the special arrangements for the supply of PBS medicines to remote health clinics.

To come is the involvement of registered pharmacists as a member of the primary health care team at the AMS.

The flow on was for the urban AMSs to ask “why not us?” The activity has focussed on the supply side of the pharmacy function. In remote this has resulted in an ample supply of “free” medicines listed on the PBS to be available directly to the health clinics with no audit trail on what happened after the arrival into the clinic pharmacy room. In the urban AMSs not much has changed and whilst the QuMAX Program has assisted to meet the costs of dispensing to clients (either as one off dispensing or dose administration aid packing) the understanding of the client towards the medicines being supplied has not had any concerted effort.

Some will argue that cost is the main factor for the client (Urbis Keys Young, 1998 and 2007)

This must now move on to improve the areas of clinical information and employment and training opportunities for young Aboriginal Australians.

The following chart describes how pharmacists can now move ahead in interacting with Aboriginal Medical Services and their primary health care clinicians.

A satisfactory supply at an affordable cost is the first plank of the National Medicines Policy (NMP) surrounding the use of Pharmaceutical Benefits Scheme (PBS) medicines at Aboriginal Medical Services. This is an operational function of ordering and supplying and its efficiency can be easily measured and quantified. The next step of supplying on to the patient is to some extent mechanical but should also involve the supply of information to help the patient understand why the medicine has been prescribed and the effects that can be expected.

The western medicine model of treatment needs to be explained alongside the desire to use traditional “bush” medicines.

The chart below shows the relative responsibilities in the continuum of the National Medicines Policy.

This qualitative aspect of the NMP is provided to all Australians having medicine prescribed by a doctor and dispensed at a local “community” pharmacy. This is not so for Aboriginal people visiting a remote health centre and obtaining free medicine through the special arrangements using Section 100 of the National Health Act. The local pharmacy supplies the medicines in bulk.

What then needs to happen is for the cost of dispensing to be recognised by the Department of Health and Ageing to bridge the gap between the fee paid to pharmacies to dispense Section 85 scripts ($6.42) and the fee paid for supply of Section 100 arrangement to ACCHOs ($2.69). It is believed in this $3.73 that should be available and paid to those ACCHOs which choose to go down the path of employing a pharmacist to improve the quality use of medicine in every respect. It is a matter of equity with mainstream Australians having access to a pharmacist whenever they have a PBS prescription dispensed compared to remote living Aboriginals who have no such access. The key to this happening will be closing the gap in the payment of a dispensing fee.

 

Questions or comments to the author at rollom@iinet.net.au

December 2009

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