Future health: Pharmacists in primary care

Featured
By
Andrew J McLachlan AM FPS & Parisa Aslani MPS
-
primary care

Any evidence-based vision of an efficient, patient-centred primary healthcare system places pharmacists in essential roles front and centre.

The future of global health care rests in patient and public-centred services delivered by multidisciplinary collaborative healthcare teams whose goal is focused on promoting and delivering health and wellness through patient and public engagement and evidence-based practice. Developing and implementing health services and training health professionals to focus on diseases remains the first step in this vision of the future, and is a solid foundation on which we have to build to ensure that people receive the best tailored and targeted, evidence-based health care, independent of the care setting and the healthcare professionals providing that service.

Most health care, including preventative health care, is provided in the primary care setting, where numerous healthcare professionals have the opportunity to work collaboratively to deliver optimal patient- and public-centred health services. The aim of this article is to explore the future roles of pharmacists in primary care by examining emerging healthcare trends, international models of practice, and the need for appropriate remuneration.

Understanding the future: global megatrends

The CSIRO Futures have identified so-called ‘megatrends’ that will have a major impact on Australia over the next 20 years.1 These global megatrends will change the way Australians live, health care is provided, and pharmacy is practised.

While the megatrends cover six social, economic and environmental trends, two megatrends have clear implications for pharmacy and health: ‘forever young’, addressing the challenges (and opportunities) of an ageing global population, and ‘virtually here’, a megatrend responding to the increased digital connectivity of individuals. An ageing population places increased pressure on the sustainability and effectiveness of health interventions.

The ‘forever young’ megatrend challenges health systems to provide quality care that has a greater focus on prevention while maintaining the importance of independence and function (as well as quality of life).

The increased digital connectivity of society has implications for the changing nature of information gathering, health services provision, digital disruption, and patient and public agency and empowerment.

Unmet challenges need renewed focus

In planning for the future of our profession, it is imperative that we build on the many achievements and successes, nationally and internationally, and ensure that we are resourced, not only to progress but also to address the ongoing challenges we face internally and externally to the healthcare system. The World Economic Forum mapped the future of health and health care to five broad key areas2:

  • Global health governance
  • Environmental health and climate change
  • Healthcare delivery systems
  • Healthcare technology
  • Keeping populations healthy.

In considering the above, key national health priorities that should form the future planning for Australian primary care have been outlined in Box 1. In each of these areas of unmet need in primary care, pharmacists have a vital role to be actively engaged and to lead, and are well placed to have the greatest impact.

BOX 1. HEALTH PRIORITIES FOR AUSTRALIAN PRIMARY CARE

Closing the gap on Indigenous health disparity – Pharmacists as trusted, skilled, mobile and visible members of the primary care team should continue to be active and lead in improving the health and well-being of our Indigenous populations. This can be achieved through increased awareness and systematic evaluation of the needs of the populations in partnerships with Indigenous communities; and provision of services and care developed and implemented in collaboration with the communities to ensure that needs are met, and practices adopted that are appropriate for the people.

Medication safety and addressing preventable harms – The WHO Third Patient Safety Challenge is entitled Medication without harm. This challenge aims to reduce the burden of preventable medication-related harms by 50% over the next 5 years. The main focus is on addressing inappropriate polypharmacy, supporting safer transitions of care (especially through medication reconciliation) and managing high-risk medicines (including antipsychotic medicines and opioid analgesics) in vulnerable people.

Compassionate, respectful, quality care for older vulnerable people – Globally, there is an increase in the number of older people; people are living longer, and with multiple co-morbidities. Thus, the effective care of older people, especially in residential aged care settings, continues to be a major challenge, and the inappropriate use of medication remains a contributing factor to poor quality of life.

Improving the life expectancy and better health outcomes for people living with mental health problems3 – Mental health problems remain prevalent and are predominant in women and the elderly. Resourcing appropriate services and treating mental health problems not only can result in better health outcomes and increase the life expectancy of people living with mental illness, it can also ensure that the unpaid carers (who are largely women) remain active and engaged contributors to the healthcare system.

Transition to greater emphasis on prevention and wellness rather than models of treatment – Primary care must continue to provide a strategic focus on approaches to improve prevention through public health awareness and screening for early detection and intervention in health problems (guided by the best evidence of effectiveness and value). The biggest challenge in this area is the management and prevention of obesity and metabolic diseases such as diabetes. The solution is likely to be multidimensional and will require a fundamental shift in the way pharmacists practise. Prevention will require pharmacists to reach out into the community to screen and prevent rather than ‘wait for people to walk into the pharmacy’. Furthermore, as a nation, we should consider capacity building in health education from an early age, such as school.

What we can learn from international pharmacy experience?

Australia is not alone in considering and planning for the future of health care. At a global level, the International Pharmaceutical Federation’s vision is to ensure that ‘everyone benefits from access to safe, effective, quality and affordable medicines and pharmaceutical care’,4 through supporting advances in pharmaceutical practice and services. In a recently published report on ‘Beating non-communicable diseases in the community’,5 the International Pharmaceutical Federation (FIP) provided a global overview of the role of pharmacists in non-communicable diseases (NCD), presenting best practice and examples of practices internationally, including Australia, which serve as evidence for the expanded role of pharmacy in primary care. The report provided four key messages: the need for multidisciplinary collaborative models of care which include the pharmacist; the importance of pharmacists’ role in screening, prevention and referral; pharmacists’ key role in providing health services that lead to better health outcomes; and the challenges to full utilisation of pharmacists in NCD care.

There have been further insightful considerations of pharmacists’ roles from an international perspective.

The 2016 Deloitte Access Economic report entitled Remuneration and regulation of community pharmacy6 identified opportunities for expanded roles for pharmacy in health care from international experience in countries with similar health systems. For example, Canadian pharmacies offer a wide range of professional offerings including prescribing for people with minor ailments, initiating prescription medicines, therapeutic substitution, ordering laboratory tests, and administering medicines by injection (not just vaccinations). Our pharmacy colleagues in New Zealand are also able to modify, initiate or discontinue medicines for patients under a team care arrangement with prescribers. These are just a few examples of expanded (and appropriately remunerated, publicly and/or privately) roles for pharmacy in primary care.

The exciting opportunity for pharmacists in primary care

Pharmacists are well placed in primary care to take a lead role in collaborative healthcare teams. Systems and structures, now more than ever, provide a platform to be highly effective. The Pharmaceutical Society of Australia, through extensive consultation, has developed the strategic document Pharmacists in 2023.7 The 11 ‘actions for change’ in this document directly respond to the current global health challenges and align with developments in pharmacy observed internationally. Key themes such as pharmacists being the ‘custodians’ of medication safety, and the vital role of digital health (especially opportunities that come from the personally controlled My Health Record8), represent transformative opportunities for pharmacy.

Pharmacists in Australia are, by international standards, highly trained to have the appropriate knowledge and skills to provide effective patient-care.

Our pharmacist training programs have been enabled through the implementation of high accreditation standards and commitment to excellence by universities offering pharmacy programs around the country. Combined with the need to demonstrate continuing professional development, pharmacists represent a valuable asset for meeting the future health needs in primary care.

With the blurring of the boundaries of roles between different healthcare professionals, the future of pharmacy practice in primary care is most definitely going to be beyond the four walls of the pharmacy.

Funding brings focus and progress in primary care

A significant barrier to pharmacists achieving the high-impact contribution in the health system as effective and influential members of the healthcare team is the current state of appropriate remuneration for health services. There is a growing body of evidence supporting the value of health services provided by pharmacists, which need to be appropriately recognised. In line with remuneration models around the world, the accessibility of pharmacists, along with their skills and training, mean they are well placed to provide services that are cost-effective and add value.

There are several ways for remuneration, including directly from patients and the public, through third party payers such as private health insurance, and government remuneration. Remuneration for pharmacy services remains a key agenda item for the profession.

The next exciting era of Australian pharmacy

Our pharmacy graduates see a bright and exciting future for our profession. We owe it to the next generation to ensure that pharmacists secure their position in the healthcare team – leading and influencing health care in Australia. It is clear that the next 5 years will be critical to lay the foundation for change that is needed.

It is essential that pharmacy as a profession continues to develop and secure appropriate remuneration for health services that complement and expand existing models of care and provide access to health services led by or in collaboration with pharmacists where medicines are used in the health sector. It is an exciting future.

References

  1. Hajkowicz SA, Cook H, Littleboy A. 2012. Our Future World: Global megatrends that will change the way we live. The 2012 Revision. CSIRO, Australia. At: https://publications.csiro.au/rpr/download?pid=csiro:EP126135&dsid=DS2
  2. World Economic Forum future of health and health care. At: toplink.weforum.org/knowledge/insight/a1Gb00000038u3nEAA/explore/summary
  3. Hannah Ritchie, Our World in Data, Global mental health: five key insights which emerge from the data, May 16, 2018. At: ourworldindata.org/global-mental-health. At: https://ourworldindata.org/global-mental-health
  4. International Pharmaceutical Federation (FIP). At: fip.org/menu_about
  5. International Pharmaceutical Federation (FIP). Beating non-communicable diseases in the community The contribution of pharmacists. The Hague, International Pharmaceutical Federation, 2019. At: https://www.fip.org/files/content/publications/2019/beating-ncds-in-the-community-the-contribution-of-pharmacists.pdf
  6. Deloitte Access Economics, Remuneration and regulation of community pharmacy: Literature review, Department of Health, November 2016. At: health.gov.au/internet/main/publishing.nsf/Content/4E0B6EEE19F56A40CA2581470016D688/$File/deloitte-community-pharmacy- literature-review-2016.pdf (Accessed 11 April 2019)
  7. Pharmacists in 2023, Pharmaceutical Society of Australia. At: psa.org.au/advocacy/working-for-our-profession/pharmacists-in-2023/
  8. My Health Record Guidelines for Pharmacists, Pharmaceutical Society of Australia. Available at: my.psa.org.au/servlet/fileField?entityId=ka17F0000000yk9QAA&field=PDF_File_Member__Content__Body__s

This article is the first in a series looking at the future of health care in Australia – and the continued expansion of pharmacists’ roles as central to it.