PSA leads accreditation charge

After last month’s announcement that the Australian Association of Consultant Pharmacy (AACP) will close at the end of 2022, Australian Pharmacist examines why PSA has been and always will be the home of accreditation.

Medication-related harm and potentially inappropriate polypharmacy are all too common. As medicines experts, pharmacists have the power to make a difference by undergoing accreditation to provide medication reviews.

As joint owner of AACP, PSA has been involved in the accreditation process from day one, said Debbie Rigby FPS, who was among the first Australian pharmacists to become accredited in 1997.

Accredited pharmacists are an important cohort within PSA’s membership, agreed Grant Kardachi FPS, who served as PSA President from 2011–2015 and has been a Director on the AACP Board since 2005.

‘As the custodians of the professional practice standards, PSA has always seen it as its role to advocate for accredited pharmacists and their expanded roles in the vital area of medication review,’ he said.

This includes advocating for the evolution of Home Medicines Reviews (HMRs), Residential Medication Management Reviews (RMMRs) and Quality use of Medicines (QUM) services over the last 25 years.

‘The PSA commissioned the writing of the guidelines for HMRs and RMMRs to experienced practitioners and key opinion leaders,’ said Ms Rigby, who is also Chair of the newly formed PSA Accreditation Expert Advisory Group.

‘These guidelines have defined the process of conducting comprehensive medication reviews and shaped best practice.’

In March 2009, when the AACP HMR Mentoring Program was developed as part of the 4th Community Pharmacy Agreement, Ms Rigby was involved in the process of mentoring pharmacists to improve the quality of Medication Management Reviews.

‘Accredited pharmacists often practise in isolation, so having peer support was greatly valued,’ she said. 

‘That’s why I’m pleased to hear PSA will proactively set up support networks for accredited pharmacists and those undergoing accreditation in the near future.’

Advocating for increased caps and expanded roles

Back in February 2014, when a cap was introduced on the number of HMRs accredited pharmacists could provide, PSA fought hard against the restrictions.

The PSA CEO Mark Kinsela said it was almost solely based on PSA’s advocacy over 5-years that the cap was increased from 20 to 30 in March 2020.

‘The CPA has a capped budget, but we’ve also highlighted that consideration should be given to funding medication reviews out of the Medicare Benefits Schedule [MBS] as per the recommendations from the MBS Review Taskforce in 2020,’ Mr Kinsela said.

Meanwhile, PSA was an early supporter of the ‘Goodwin Trial’ in 2018, when the first AACP accredited pharmacist was embedded in Canberra’s Goodwin Aged Care facility, and ‘advocated heavily’ for an expanded trial in 2020.

‘The impact of that [trial] was extraordinary in terms of decreasing medication-related and administration errors, and improving knowledge of aged care staff around medication management,’ the PSA CEO said.

‘The program laid the foundation for PSA Primary Health Network (PHN) trials such as the Pharmacists in Aged Care project conducted in South Australia.’

A big year for accredited pharmacists

In 2020, the first year of the COVID-19 pandemic, a raft of changes was introduced to improve medication reviews.

Funding for the Quality Use of Medicine (QUM) Program doubled in January, following continuous calls from PSA for the investment to be increased.

‘For a 100-bed facility, the QUM payment used to be about $3,000 per year, which is about $750 a quarter.’ 

While the doubling was a start, PSA has continued to advocate for a further increase.

A few months later, in April 2020, the ability to provide two pharmacist-initiated follow-up services for HMRs and RMMRs came into effect.

PSA was the lead organisation in creating a ‘cycle of care’ for medication reviews, adding a new layer of accountability to medication review programs, said Mr Kinsela.

When referral pathways for HMRs and RMMRs expanded that same month, allowing other medical practitioners aside from GPs to refer patients for medication reviews, PSA was on hand to support accredited pharmacists.

‘The PSA is the custodian of the reformatted guidelines for how this could be conducted and we provided leadership around the implementation of [the expansion],’ he said.

It was also a key advocate around the telehealth option for HMRs, and provided additional information to accredited pharmacists around how to conduct the service digitally, including through the guidance document Telehealth medication review: use of digital resources.

‘These were the first clinical services that could be remunerated by telehealth for pharmacists,’ added Mr Kinsela.

When $345.7 million in funding for the on-site aged care pharmacist program was announced in March 2022, PSA Tasmania State Manager Ella Van Tienen MPS said the government had answered PSA’s calls for funding.

‘[After] the release of the first Medicine Safety: Take Care report in 2019, PSA has been calling for funding to embed pharmacists in aged care. We recommended $400 million be allocated and the government delivered,’ she said.

‘The report identified 98% of residents in aged care facilities have at least one medicine-related problem.’

A member’s perspective

Before COVID-19 hit, GP pharmacist and PSA Early Career Pharmacist of the Year for 2022 Deborah Hawthorne MPS didn’t fully understand how much PSA supported the profession.

After letting her membership lapse pre-pandemic, Ms Hawthorne was quick to renew it after seeing the value of PSA’s work in providing up-to-date information relating to her role as an accredited and GP pharmacist. 

‘The PSA not only advocated for follow-ups, hospital-initiated medication reviews and medication reviews [via] telehealth, it also provided education sessions and guides on how to apply these changes,’ she said. 

‘These initiatives allow pharmacists to be better integrated into the patient “cycle of care” more consistently and at points with potential for high medication errors such as in transitions of care.’

The PSA’s guidelines are also  handy referral documents, particularly 2020’s Guideline for comprehensive medication reviews.

‘I refer to this guideline consistently for my own practice and as a reference point for other pharmacists and GP referrers in my education and advocacy work for medication reviews,’ Ms Hawthorne said.

‘It’s also a great tool to use for self-reflection and self-assessment as well as continually driving me to create the best possible medication reviews with my patients and their care teams.’

Future focus

As the ‘new home for accreditation’, PSA will continue to advocate for fair remuneration for accredited pharmacists, who should be able to derive a full-time salary from medication reviews.

Along with removing caps on HMRs and RMMRs and establishing a career pathway for accredited pharmacists, a PSA spokesperson said remuneration for medication reviews should ‘increase as your skills and experience increase’.

‘The PSA wants to make sure that training and ongoing education is fit for purpose in terms of career progression,’ the spokesperson said.

In the Pharmacists in 2023 report, PSA coined the phrase ‘Embed pharmacists wherever medicines are used’. This includes in general practice, Aboriginal Community Controlled Health Organisations (ACCHOs) and disability care, where PSA will continue to advocate for expanded roles for pharmacists.

The PSA has also long provided support for emerging roles for accredited pharmacists in general practice, including through partnerships with PHNs in South Australia, Western Australia, Victoria and Queensland, Ms Rigby said.

‘Add-on training packages available through PSA for pharmacists in general practice and RACFs complement the accreditation process to conduct comprehensive medication reviews,’ she said. 

The PSA also recently launched the Deadly pharmacist foundation training program, co-designed with the National Aboriginal Community Controlled Health Organisation (NACCHO), to equip pharmacists with the skills to work in embedded roles within the ACCHO sector.

The Medicine safety: disability care report also adds weight to PSA’s argument that pharmacists should be embedded in disability care facilities. 

‘Some statistics in the report [indicate that] patients can be on sedating medicines for 5 years, which they shouldn’t be taking long-term without review,’ said Ms Van Tienen.

Another key area for PSA as a lead accreditation body is to ensure pharmacists can prescribe, administer and review medicines – regardless of location.

The PSA is already a leader in this space, said Ms Van Tienen, through involvement in the compilation of the Pharmacy Council Standards for Pharmacists Prescribing, helping pharmacists understand electronic National Residential Medication Chart (eNRMC) regulations through education, or advocating for partnered-pharmacist charting in hospitals.  

The PSA is also ensuring pharmacists have clear guidance in relation to their requirements in the challenging, transforming world of digital health. 

The Digital health guidelines for pharmacists were produced by PSA to outline the professional obligations of pharmacists when interacting with digital health systems in performing their professional clinical roles, including accredited pharmacist, non-dispensing roles.

‘More broadly, we’re advocating for pharmacist prescribing trials on a larger scale, whether through the UTI pilot or [collaborative pharmacist prescribing] in rural areas where there’s GP access issues,’ said Ms Van Tienen.

Lastly, PSA recently committed to continuing with an accredited consultant pharmacists conference by hosting a conference in Adelaide next year.

‘[The conference] has built a strong reputation as the premier clinical conference for accredited pharmacists, providing relevant education and skills development in a fabulous collegiate spirit,’ Ms Rigby said.

‘I am thrilled that the legacy of the annual conference continues.’