Medicines as a team sport

How pharmacists can respond to Aboriginal and Torres Strait Islander community needs in an integrated, collaborative way that uses their full set of skills.

There is no doubt that preventable medicine-related problems persist in Australia today. The prevalence of this issue has piqued interest at all levels of the pharmacy sector.

This includes the Federal Minister for Health, the Hon Greg Hunt MP, who has formally made a commitment to make the quality and safe use of medicines a National Health Priority Area. Something new and different needs to be done across health settings to enhance the impact that pharmacists can have on this issue. To compound the medicine-related challenges, Australia has an ageing and increasing population, where rates of chronic disease are likely to continue to rise.

Accordingly, there seems much discussion in the pharmacy community related to the future of pharmacy, and how future practice and programs may address these medication-related problems and the associated public health challenges. Over the last 12 months, there have been several noteworthy developments. Two major Australian pharmacy bodies – PSA and the Pharmacy Guild of Australia – have released their visions for pharmacy into the future (PSA’s Pharmacists in 2023 and the Pharmacy Guild’s Community Pharmacy 2025). Australia’s National Digital Health Strategy proposes that ‘better availability and access to prescriptions and medicines information’ is one of seven strategic priority outcomes to be achieved by 2022.

In addition, the 7th Community Pharmacy Agreement (7CPA) negotiations have begun, drawing our attention to what this future agreement may hold for the pharmacy profession and industry generally.

There is also a possibility that the National Medicines Policy will be reviewed in the coming year, after its launch 20 years ago in 1999. Aboriginal and Torres Strait Islander people are referenced in each of the five policy items named above.

There is clearly an intent within the Australian Government and pharmacy and health sectors to consider the medicine-related priorities for Aboriginal and Torres Strait Islander people and work with them to address these.

So, what is the vision?

Both PSA and the Guild’s future documents frequently reference integration and collaboration, and how pharmacists may have a bigger role within healthcare teams. Integrated team-based health care is an emerging theme globally and the Health Care Home model is one example of trialling such an approach in Australia.

How might this integration be achieved?

For nearly half a century, Aboriginal Community Controlled Health Organisations (ACCHOs) have been delivering comprehensive, collaborative and integrated services related to health and wellbeing that align with local Aboriginal and Torres Strait Islander communities’ needs.

Around 145 ACCHOs now operate in all states and territories, governed by elected local community members, and are therefore connected and accountable for the services that are being delivered. Their sizes and models of care vary greatly between services, but ACCHOs may offer some useful insights and lessons for the health sector generally.

In relation to integration and collaboration, ACCHOs have been innovative and dynamic, and have led this style of practice in the Australian health sector for some years. As such, several ACCHOs around Australia have prioritised how they deal with medicines by integrating pharmacists’ clinical and consulting services into their models of care. Such leadership dates back around two decades.

Interestingly, evidence from a recent large systematic review of pharmacists working within a primary care practice setting, demonstrates that the degree of integration was strongly and positively correlated with the patient-centred clinical impact of the pharmacist in the general practice or health service.¹ ACCHOs are commonly made up of highly integrated, multidisciplinary teams.

These teams may include a very broad range of staff, such as Aboriginal health practitioners, nurses, GPs, diabetes educators, specialists, youth workers, psychologists, dentists, pharmacists and more. Their activities are often managed and coordinated by a local executive team and ultimately overseen by the community boards.

In such a structure, substantive integration and collaboration can be well supported. ACCHOs often have organisational structures that support clinical and medicines governance and continuous quality improvement.

The organisation may have the will and capacity to develop comprehensive medicines policy and processes for all staff, external organisations and clients – for example, a standard medicines formulary for use across ACCHO clinics.

Full scope of skills

Ensuring pharmacists are utilising their full scope of skills and knowledge is also a key theme within Australian pharmacy organisations’ current policy. Pharmacists have a range of skills that sit well within those of an overall primary healthcare team.

This is demonstrated in the breadth of work they currently perform in the ACCHOs across Australia. Services delivered in ACCHOs are diverse, but may include counselling, providing GP registrar education, conducting prescribing audits, developing imprest policy, managing vaccine procurement and storage, improving discharge communication with local hospitals and more.

The pharmacists currently working within ACCHOs can discuss and review how their scope and individual skills can be best used or developed to deliver the outcomes most needed by the ACCHO and community.

As the burden of chronic diseases continues to increase, managing these conditions or multiple diseases can be complex and involve numerous healthcare staff and organisations.

Medicines will continue to be a critical component chronic disease management. Pharmacists can work within the ACCHO team, which often employs chronic disease care coordination staff, to ensure continuity of best-practice care and medicines use for chronic disease clients.

The current plans and commentary from pharmacy and health leaders are positive and healthily aspirational, but there must be ongoing and adequate support from governments and pharmacy bodies as plans become actions.

Plans and programs must materially capture the support needed for pharmacists to integrate into primary care teams, including ACCHOs.

Recent developments

National leadership and action related to Aboriginal and Torres Strait Islander medicines use is exemplified in several recent developments. For example, funding of two 6CPA Pharmacy Trial Programs, which investigate novel integrated and collaborative approaches involving Aboriginal and Torres Strait Islander patients and ACCHOs.² Also, recommendations made by the Medicare Benefits Schedule Allied Health Reference Group to allow pharmacists to provide medication management services to patients with complex care requirements as part of Team Care Arrangements.

Integration and collaboration must be done in a way that is responsive to communities’ and patients’ needs. For example, a general practice or ACCHO may be supported, scope and identify their own medicines needs and then recruit a suitable pharmacy or pharmacist to work within their clinic and team environment to address these issues.

In scoping and understanding communities’ medicines needs (e.g. diabetes medicines education, GP prescribing training, atrial fibrillation prescribing audit), the health service must consider how existing medicines players – community pharmacies, hospitals and specialists – will integrate into the work_ ow and team-based approach. How will medicines dispensing and counselling integrate with patient education sessions? How will community pharmacy DAA supply and systems integrate with a local Home Medicines Review program?

Pharmacists’ accountability to patients and communities can be supported by ensuring community and Aboriginal governance is enshrined within new and existing pharmacy programs.

How to go local

While systems change, such as pharmacy policy (e.g. the future documents and new MBS item), emerging digital systems and health programs offer many solutions. Individual pharmacists also need to have the initiative and confidence to address integration and collaboration challenges at a local level.

There are excellent resources related to Aboriginal and Torres Strait Islander health and medicines use on the PSA website and members’ portal (www.psa.org.au), the NACCHO website and the Pharmacy Guild of Australia website (www.guild.org.au).

Regardless of what the future may hold, I encourage all pharmacists to start (or continue) engaging with your local Aboriginal and Torres Strait Islander organisations and clinics today – you may find there are many ways that you can collaborate and integrate your services to improve the health of your community.

References

1. Hazen AC, De Bont AA, Boelman L, et al. The degree of integration of non-dispensing pharmacists in primary care practice and the impact on health outcomes: a systematic review. Res Social Adm Pharm 2018;14(3):228–240. At: https://www.ncbi.nlm.nih.gov/pubmed/28506574
2. For more information on both trials visit: health.gov.au/internet/main/publishing.nsf/Content/pharmacy-trialprogramme