PSA recommendations to improve medicine use in disability care

A critical lack of information about medicine use by people with disability prevents pharmacists from promoting the quality use of medicines within a vulnerable group.

This is a key point in PSA’s submission to the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability, for the commission’s issues paper on health care for people with cognitive disability.

According to the issues paper, ‘people with cognitive disability’ includes people with intellectual disability, autism, acquired brain injury or dementia. Roughly 4.3 million Australians have some level of disability, and for 1 in 5 of these people, the main form of disability is mental or behavioural.

‘People with cognitive disability may experience poor health outcomes due to barriers in the health system,’ according to the paper, with research suggesting people with cognitive disability are more likely to suffer an avoidable death that could have been prevented through appropriate care.

In its Medicine safety: take care report, released last year, PSA revealed a staggering 250,000 hospitalisations and an additional 400,000 presentations to emergency departments occur each year as a result of medication errors, inappropriate use, misadventure and interactions. At least half of these were preventable. 

The PSA subsequently released its Medicine safety: aged care report in February this year, which revealed 98% of people in residential aged care facilities have at least one medicine-related problem. 

While there has been policy reform to improve disability services, PSA National President Associate Professor Chris Freeman said the organisation was concerned similar patterns could be occurring among people with cognitive disability.

‘It would be a travesty if standards of care around medication management in the disability care sector was also found to be wanting,’ he said.

PSA made 13 recommendations in its submission, including:

• implementing appropriate data collection and reporting on medicine use and uptake of pharmacist-delivered medication management services by people with disability
• promoting the role of pharmacists in ensuring safe and quality use of medicines, working as part of a multidisciplinary healthcare team, helping to resolve medicine-related problems and improving quality of life for people with cognitive disability
• implementing mechanisms for disability care recipients to regularly access pharmacist-delivered services
• options for pharmacists to deliver education and training to disability support workers 
• funding for pharmacists to deliver quality use of medicines (QUM) services to support disability service providers and organisations
• providing people with disability access to pharmacist-delivered medication management services through the National Disability Insurance Scheme.

Lack of information

According to PSA’s submission, the contribution of pharmacists within the disability sector is not explicitly documented, nor is there readily available data on medicine use by people with disability.

As a result, issues such as the inappropriate or suboptimal use of psychotropic medicines, which has been uncovered in the aged care sector, can’t be quantified. However, PSA has ‘grave concerns’ similar trends could be occurring, A/Prof Freeman said.

There was a ‘critical lack’ of information on medicines use by people with disability, A/Prof Freeman said, which meant pharmacists were ‘in handcuffs when it comes to providing essential medication management support and services to people with disability’.

‘Without appropriate data it is not possible to help optimise pharmacological interventions for people with disability, nor improve their quality of life,’ he added.

‘Medicine-related data collection, with appropriate privacy and data security arrangements, is critical to enable co-design and development of robust policies for the disability care sector and to implement best practice medication management for people with disability.’

Use the medicines experts

Pharmacists can provide a range of services to support people with cognitive disability and improve medicine safety, including:

• tailored advice on how to take or use medicines safely
• a staged supply service
• dose administration aid service to support the safe and effective administration of medication, improve adherence and reduce misadventure
• MedsCheck and medication management reviews. 

In its submission, PSA called on state and federal governments to help promote these services and the role of pharmacists within the disability care sector. It also highlighted the need to explore mechanisms for disability care recipients to regularly access pharmacist-delivered services and options for pharmacists to deliver education and training to disability support workers.

Medication management frameworks and models of care developed by governments should integrate the role of pharmacists, PSA argued, and provide funding for pharmacists to deliver quality use of medicines services to support disability service providers.

‘Given their unique medicines expertise, pharmacists are key to improving medication safety and delivering high quality care for people with cognitive disability who may require medication management support,’ the submission states. 

‘Pharmacists must be involved in the care of people whenever medicines are included as a component of their health management plan.’

A/Prof Freeman said pharmacists provided essential patient-centred healthcare in a professional, ethical and compassionate manner.

‘Many people with cognitive disability rely on medicines, and PSA strongly recommends urgent consideration of mechanisms and arrangements to include pharmacists within the healthcare team to support everyone with disability, if support with their medicines is needed,’ he said.

‘Despite many established and funded medication management programs, it is disappointing that there does not appear to be a clear pathway for people with disability to access these in a considered and structured manner.

‘PSA urges the Commonwealth, state and territory governments to be more strategic and proactive in enabling partnerships between disability service providers and the pharmacy profession.’

Read PSA’s submission here.