Reviewing the professional role of pharma

Keeping people out of hospitals is an important part of a pharmacist’s role, and ensuring the quality use of medicine is one of the most effective ways of helping to minimise hospital admissions.

The quality use of medicines is paramount to the ongoing sustainability of Australia’s health system and pharmacists use a range of tools to help them ensure medicines are taken correctly and appropriately.

Two of these tools have recently been the subject of intense media speculation as to their appropriateness.

The first was a deal – which became known as the “coke and fries” deal – under which pharmacies received a computer prompt when dispensing medications; the prompts urge the pharmacist to consider recommending a particular Blackmores ‘companion’ product to go with the prescription medicine.

Pharmacists have long recommended supplementary products to patients, but Pharmaceutical Society of Australia (PSA) has always insisted that any products recommended be evidence-based.

What the Blackmores issue raised was the need for pharmacists to be very aware of their responsibilities. The potential opportunities for pharmacists to increase their roles as clinicians has been given great impetus by the current health reform process, but with these opportunities comes great responsibilities. With the opportunity for new roles developing, the potential for greater involvement in the healthcare team has now presented itself, but issues such as those mentioned above must be addressed to maintain the credibility of pharmacists.

To this end, PSA launched a revised Code of Ethics in October which is designed to underpin the professional role of pharmacists as healthcare clinicians. This code reinforces the principle that pharmacists should ensure that medicines and products they recommend are evidence-based and will have positive health outcomes for consumers.

In recommending complementary or other medicines as part of a consumer’s health regimen, pharmacists also need to work closely with the consumer’s GP to ensure their advice meets the needs of the current care plan for the patient.

I also hasten to point out that under a Ministerial Determination from the Federal Minister for Health and Ageing, pharmacists are required to abide by the PSA Code of Conduct and the Professional Practice Standards, and these stress the wellbeing and health outcomes of the consumer as being paramount considerations.

The second subject of a lot of media attention was a deal with Pfizer under which pharmacists were urged to sign patients up to the company’s patient support program.

PSA’s main concern with this deal is that patient support programs which rely on pharmaceutical companies providing a patient with advice and information clearly usurp the role of the pharmacist in providing professional support, advice and ongoing monitoring of the consumer.

Patient support programs should see a pharmacist supported in providing professional advice to the consumer in the pharmacy on issues around adherence, correct use and the benefits and adverse effects of medication, and lifestyle interventions.

But to make this model work, we need to change our practice and the way we do business. The most efficacious patient support programs involving pharmacists need a pharmacist in the health services area of the pharmacy to provide the advice and counselling that the program demands. We need to develop ways to give the consumer a better service that is more appropriate to the pharmacy as a healthcare destination.

For many years, PSA has focussed much of its work on the development and implementation of professional services in the knowledge that the traditional reliance on dispensing will not be sustainable in the pharmacy of the future.

There is also a very pragmatic philosophy behind the need for changes to our business models, and that is the saving that we can provide to the Federal Government by changing our practice procedures.

The exact same evolution in the hospital sector over the past 30 years has seen pharmacists emerge from their dispensing only role to one of delivering clinical services on the wards.

This shift has had startling results, with about six per cent of therapy changes or adjustments now due to the intervention of pharmacists in the hospital setting. The Dooley Study of some 25,000 patients over eight hospitals found that pharmacist intervention resulted in savings of some $4.5 million – or $23 for every $1 spent on a pharmacist.

However, as a profession we need to show that we are not only ready to provide such services, but have structured our businesses in such a way as to provide them to achieve the best health outcomes for consumers.

Grant Kardachi

President
Pharmaceutical Society of Australia
Grant Kardachi has been elected President of the PSA, after serving as Vice-President and a Board Member for three years. He is a community pharmacist who recently sold his business interests but is still accredited to undertake medication reviews and sits on the Australian Association of Consultant Pharmacy (AACP) Board.