More expert pharmacists needed in the era of medicine miracles

As we live through the lengthening tail of a persistent pandemic, it is challenging to consider the simpler medicines landscape of 20 years ago.

In 2001, most medicines listed on the Pharmaceutical Benefits Scheme (PBS) were used for the management of lifestyle-related diseases, and the revered program was one-third of the size it is today.

In recent years, a large proportion of new medicines approved for subsidy are much more complex, carry higher costs and are overwhelmingly used or initiated in hospitals due to the serious nature of the conditions being treated.

Evidence of this shift in the medicines and healthcare landscape is clear in the steadily increasing proportion of PBS funds managed by hospital pharmacists, from zero at the turn of the century, where the PBS and hospital care were funded in parallel, to 23% today.

For this reason, hospital pharmacy input is essential to the reviews of two 20-year-old policies that shape how we pay for medicines and ensure they are provided safely and effectively to those who need them: the Pharmaceutical Reform Agreement and National Medicines Policy.

The challenge in the opportunity is our uniquely federated healthcare model, in which federal government engagement with the state-funded hospital sector cannot always delve into the detail given its size and complexity. However, it is at the coalface of patient care where even the smallest impacts are felt.

In 2019, a surprise $44m cut in PBS remuneration for hospital pharmacists appeared in the Federal Budget — this figure alone could fund extensive, nationwide early-career development programs necessary to support the workforce pipeline we need to deliver high-quality patient care into the future.

A troubling and unaddressed legacy of our shifting medicines landscape is that pharmacy is the only healthcare profession in Australia that ties the provision of clinical services to the value of the medicine prescribed. This is ethically inconsistent with the purpose of the policies under review, especially given growing knowledge of deprescribing as an intervention that can improve quality of life.

As a top priority, these reviews must place the patient at the centre of reform and fund clinical services separately.

The decoupling of funding for medicines and funding the unique expertise to safely deliver them cannot reduce other services within our already constrained healthcare sector. These constraints — exacerbated by the COVID-19 pandemic — are especially pronounced in non-metropolitan areas, an imbalance that national policy must always seek to correct.

The answer is greater investment in our next-generation pharmacy workforce, who are coming through with advanced literacy in the management of increasingly complex medicines.

Distinct pharmacist funding will see more hospitals meet national Standard of Practice ratios per patient bed, while meeting the Guiding principles to achieve continuity in medication management, developed specifically as part of the Pharmaceutical Reform Agreement.

These are added benefits, of course. Hospital pharmacists have been proven through research to reduce medication errors before, during and after hospital stays, reduce the risk of re-hospitalisation upon discharge and mitigate harm from sub-optimal use of medicines when back at home, in a residential care facility or moving in between.

An unintentional zero or a misplaced decimal point can result in a fatal tenfold overdose — it is these errors that hospital pharmacists are expertly able to detect and prevent harm to the patient.

On the national scale, we cannot afford to see the current figures of 250,000 medication-related hospital admissions per year, costing $1.4bn, increase any further.

To get there, we need to fund more hospital pharmacy internships nationwide, which lead into established SHPA Foundation Residencies and Advanced Training Residencies to rapidly develop complex skills in the hospital setting.

Backed by support and recognition for extended hours pharmacy services and optimal staffing ratios as outlined in national standards of practice, we can begin to build a stronger pharmacist workforce that can stay a step ahead of our medicines landscape.

Without our captains of medicine having a say, changes to the Pharmaceutical Reform Agreement could reduce the workforce size in real terms, leading to instances of less safe care, no supply of medicines on hospital discharge, poor medicines chart review and reconciliation, and no input into multidisciplinary teams that need to wrap around each and every patient.

Review of each of these policies presents a fantastic opportunity to align with the current reality of their impact on medicines access and medicines use.

We should be proud of our much longer list of life-saving PBS-subsidised medicines and determined to ensure they are always used safely and fairly in every corner of our country.

Image credit: ©stock.adobe.com/au/Blue Planet Studio