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It is interesting
how quickly this has progressed in the UK since their government
released its report into pharmacy, and began the push for greater
cognitive services.
We are lagging a little behind in Australia (and I'm sure having
two tiers of government managing Health plays no small part) but
with the Fourth Agreement negotiations underway we can expect
community pharmacies to shift their focus even further into cognitive
services here as well.
Obviously, in a hospital setting, there are greater opportunities
for pharmacists to become involved in prescribing, in particular
as part of designated teams with medical officers and other staff.
The current community models in Australia don't readily support
this sort of interaction so how could it be made to work?
It is an interesting proposition, thinking about how a pharmacist-prescribing
model could be worked into our current community pharmacy system.
Here are two brief ideas, with some positives and negatives attached.
1. Pharmacist
located in the medical practice.
Maybe one pharmacist for every two or three doctors to assist
in ongoing medication management; tinkering with doses depending
on response; obtaining and maintaining a complete medication history.
Possible Benefits:
* More time for doctor to see patients as workload reduced?
* Less visits solely for new prescriptions
* Greater doctor/pharmacist interaction
* Allows for medication review from the medical practice, independent
of the retail pharmacy
* Easily reimbursed via Medicare to the practice.
Possible
Negatives:
* Creates another type of pharmacist, distinct from those in hospitals
and retail
(but could this be a positive for recruitment and retention?)
* Allows for medication review from the medical practice, independent
of the retail pharmacy
(this is good and bad)
* Dilutes the importance of pharmacist contact in the retail environment?
(Not a good thing in the current climate!)
2. Pharmacist prescriber in the pharmacy, receiving electronic
diagnoses from the doctor and a guideline for treatment.
Pharmacist then chooses appropriate therapy, dosing etc, and feeds
back to the doctor.
Possible Benefits:
* Could still reduce the number of visits to overworked GPs solely
for prescriptions
* Medication review and supply integrated
(good and bad)
* Allows for a tie-in for other pharmacist prescribing (e.g. S3s)
with possible PBS susbsidy, reducing further the strain on GP
hours.
* Further strengthens the professional role of the community pharmacist
(helping to fend off Woolworths and company)
Possible
Negatives:
* Removes some direct interaction with the doctor doing diagnosis
* Medication review and supply integrated
(good and bad)
* Can every pharmacy handle another pharmacist or extra work for
the existing pharmacist?
* Would reimbursement be tied up in the maze of HIC/Pharmacy interaction
like the MIC payment?
Editor's
Note: This is a very important development in pharmacy cognitive
services, and one that has taken quite some time to formalise.
Pre-NHS pharmacists in Australia would know that prescribing in
various forms has always been a component of pharmacy, but it
was little talked about, and very little training was offered.
It is, in some ways, quite a relief to see pharmacist prescribing
"coming out of the closet".
We will be reporting on this important development on a continuing
basis.
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