The role of specialty pharmacists and collaboration in improving outcomes

Just before we rang in the new year, the refreshed National Medicines Policy was released, governing every aspect of medicines use in Australia.

Reviewed for the first time since 2001, the updated policy provides an opportunity to see how we measure up against its three key aims: ensuring the equitable, timely, safe and affordable access to a high-quality and reliable medicines supply, ensuring medicines are used safely; optimally and judiciously with informed choice and well-coordinated person-centred care; and supporting a positive and sustainable policy environment to drive world-class medicines innovation and research.

So how are we faring?

While excelling in many areas of innovation and ongoing bipartisan support for the world-class Pharmaceutical Benefits Scheme, including recent cost of living relief through a reduction in the general PBS co- payment, we still see some 250,000 medication-related hospital admissions in Australia annually, costing the healthcare system over $1.4 billion each year. Evidence shows us these figures would be reduced if we addressed our ongoing workforce gap in expert and specialised pharmacist roles.

According to the National Skills Commission, both the community and hospital pharmacy workforces are in shortage in every single jurisdiction, sharpening focus on the urgent need for a national strategy to meet the immediate and future healthcare needs of the Australian community. In the refreshed National Medicines Policy, the healthcare workforce has been identified as a critical enabler to the success of the NMP.

Strong size, distribution and depth in our pool of pharmacists and pharmacy technicians is needed to uphold medicines safety, prevent hospitalisation and reduce preventable medicine-related harm. This is particularly important at transitions of care between the hospital, home and residential aged care, an intersection of increased risk that results in too many medication-related hospital admissions.

Another key issue that leads to the failure of equity and access of medicines — a fundamental principle of the National Medicines Policy — is the staggered uptake of the Pharmaceutical Reform Agreements (PRA) and the ongoing non-participation of ACT and NSW.

In their most recent ACT Health Services Plan 2022–2030, the ACT Government has committed to establishing a PRA with the Commonwealth. In December, the final report from the inquiry into ambulance ramping in New South Wales included a recommendation for NSW to also join, enabling NSW residents to access 30 days’ worth of PBS-subsidised medicines upon hospital discharge, instead of as little as three days’ worth of medicines, which is a grave medication safety risk at the transitions of care, particularly considering availability of access to GPs in many parts of the country.

The NSW report called for an increase in hospital pharmacy positions, the embedding of more expert Emergency Medicine Pharmacists into care teams and the expansion of innovative services and pharmacist-led prescribing.

For the last decade the frontier of pharmacist prescribing in Australia has been in the acute care setting, led by initiatives such as Partnered Pharmacist Medication Charting (PPMC). The Royal North Shore Hospital’s Emergency Department’s PPMC service has demonstrated a reduction in medication charting errors from 22% to 1%, with the overwhelming majority of Emergency Department medical staff supportive of this collaborative care model and very confident in hospital pharmacists — who undergo credentialing — to chart medicines safely.

Similar mature, collaborative models are now being embedded into practice across five states and territories, with others keen to follow suit (ACT Health are recruiting dedicated PPMC pharmacists from next month) and have been shown to improve patient safety and quality of care by reducing medication errors and delays to critical treatment, as well as increasing the job satisfaction not only of pharmacists, but of medical staff too.

Collaborative models allow both professions to practise at the top of their scope of practice, delivering true interdisciplinary synergy for the ultimate benefit of our patients.

However, with a lagging hospital pharmacy workforce, it is difficult to implement and expand these innovative models that are common overseas, and proven to improve quality, safety, bed flow and system capacity. While the NSW report and recommendations reflected one jurisdiction, the experience is similar across the country due to years of chronic understaffing.

The power of medicines, our most common health intervention, actually lies in the health professionals we trust to understand, administer and monitor them safely. Pharmacists are absolutely essential, but we need more of them, with advanced, specialty skills, where patients need them, if we are to meet the promises of the National Medicines Policy.

Image credit: iStockphoto.com/alvarez