Health Reform Opportunities for All in the Sector
Health Reform Opportunities for All in the Sector
Collaboration is key, says Grant Kardachi from the Pharmaceutical Society of Australia
Australia’s health-reform process is providing people throughout all areas of the health sector with opportunities to demonstrate their capacity to lead the evolution of the new health system.
For pharmacists, one area of great promise is the development and implementation of a broader range of professional services to improve patient care.
However, I firmly believe that if we as pharmacists are to offer more professional services, then GP-pharmacist collaboration is critical to ensure the sustainability these programs and ensure the best possible health outcomes for all Australians.
But there are barriers to collaboration, and some of these were very clearly articulated during the international World Health Care Networks conference in Cairns by Professor Jeffrey Braithwaite of the Australian Institute of Health Innovation who identified that the only way to move forward is to have a shared vision. In fact he likened some of these barriers to a form of ‘tribalism’ where people are more comfortable in their own environment.
He also pointed out that there is a very clear reluctance on the part of some health-care professionals to integrate. He used the analogy of “birds of a feather flock together” to highlight how despite all the recent developments, the health profession is made up of separate clusters of doctors, nurses, pharmacists and so on.
Of course, none of these problems or barriers to greater collaboration is insurmountable and at the Pharmaceutical Society of Australia we are already doing a lot of work in the area of collaboration with other health professionals, in particular in regard to Medicare Locals.
With medication forming an important part of health care treatment pathways, pharmacists are key members of the primary care team. An obvious starting point for GP-Pharmacist collaboration is within the domain of quality, safety and accountability in medication management.
Clearly, there is great value in exploring a collaborative GP-pharmacist role in medication management in the context of Medicare Locals and the broader primary health care strategy including community pharmacies and GP practices.
Medication management in this context could include GPs and pharmacists working collaboratively on promoting prevention via primary and secondary control of risk factors through the use of medicines with liaison with local health networks where relevant.
Pharmacists can also work collaboratively in reviewing medicines used within Medicare Local catchment areas and providing in-service education and quality or medication safety audit activities.
GPs and pharmacists should also work together in quality improvement activities such as Drug Use Evaluation and in promoting evidence-based use of medicines and development of drug protocols within each Medicare Local.
We should also be liaising with outreach and hospital avoidance services from Local Hospital Networks to ensure integration with the primary health care system, including enhanced systems for follow-up calls from pharmacists to GPs when patients with complex medication regimes are discharged.
Over and above the work in the area of medication management, and bearing in mind the scope of Medicare Locals, it is worth considering how enhanced collaborative GP-Pharmacist models could help to address the key planks of the primary health-care strategy. For example:
- GP-pharmacist liaison within each ML region to promote better GP – pharmacist coordination.
- Development of flexible and collaborative GP-pharmacist models of care (e.g. funding models, referral pathways);
- Joint advice and support for patients in understanding complex medication regimens
- Joint participation in assessment of population health needs;
Provision of clinical pharmacy advice and support to general practice and allied health care providers with respect to medication safety, drug protocol management and drug use evaluation
- Exploring collaborative GP – pharmacist/community pharmacy roles in the promotion of healthy lifestyles and in the delivery of prevention programs (e.g. smoking cessation, immunisation etc)
- Joint GP-pharmacist managerial/administrative roles within MLs (e.g. clinical governance and other committees).
- Promoting more collaborative GP-pharmacist models in the primary health care system (e.g. medication management services, pharmacists acting as a resource to GPs about quality use of medicines, etc.);
- Formalising the role of the pharmacist in the post-discharge environment to foster improved GP-pharmacist communication and information flow;
- Exploring the benefit to patients, GPs and pharmacists regarding roles for clinical pharmacists in the general practice setting; and
Collaboration is one of the keys to the future growth and development of our profession, and also to the sustainability and viability of our health system. The ‘tribalism’ that Professor Braithwaite so clearly identified has to be put behind us as we move forward.
We are not alone in pursing collaboration. The Royal Pharmaceutical Society of Britain and the British Royal College of General Practitioners recently issued a joint statement that “sets out the background, summarises the evidence and makes recommendations for the benefits to patients of improved liaison between community pharmacists and general practitioners”.
The British statement is in many ways relevant to the environment in Australia.
The statement reads, “Patients may be surprised when they discover that their community pharmacist and their GP do not share the same clinical record and that the local community pharmacist is not always an integral part of the primary care team (while recognising that patients have free choice of pharmacy and may use many pharmacies whilst being registered with a single practice). Pharmacists play a key role in the long-term management of patients with chronic disease and can see the patient as often as a member of the general practice team. Many members of the public and patients see the pharmacist as a first port of call for advice, not just on their medicines but also on their underlying health problems. This is particularly true for men seeking advice on health issues.”
“Whilst many GPs do work closely with their local pharmacist, a culture change is recommended between GPs, pharmacists and the public to allow the collaborative partnership between general practice and community pharmacy to deliver its potential.”
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