NACCHO Aboriginal Health and @PSA_National ‏#Pharmacy News : New @jcu research shows the potentially life-saving #Closingthegap benefits of integrating pharmacists within Aboriginal Community Controlled Health Services

” There’s good evidence that pharmacists in our ACCHO health services improve patient health,”

NACCHO Director, Medicines Policy and Programs, Mike Stephens (Pictured above ) says the pharmacists would also educate staff and liaise with external stakeholders, including hospitals, to develop strategic plans for more effective medicine use.

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James Cook University, the Pharmaceutical Society of Australia and the National Aboriginal Community Controlled Health Organisation (NACCHO) have joined forces to explore this potential by way of a project which will aim to embed pharmacists in 22 Aboriginal community-controlled health services in Queensland, Victoria and the Northern Territory.

Funded by the Australian Government under the 6th Community Pharmacy Agreement, the pioneering project will see culturally trained pharmacists working with clinical staff and patients to improve medication use. The first project pharmacists commenced in July this year.

Research by JCU Associate Professor, General Practice and Rural Medicine, Sophia Couzos, says the project is vital because the inability of many Aboriginal and Torres Strait Islander people with chronic diseases to access pharmacist support may be placing lives at risk.

Dr Couzos said these patients often struggle with medication regimes – including treatment for life-threatening conditions like diabetes and cardio-vascular disease.

“There is a higher burden of chronic disease in the Aboriginal community, and these patients are likely to be prescribed multiple medicines, which also place them at greater risk of drug-related complications,” she says.

“Yet they have limited access to appropriate pharmacist advice across Australia, particularly in remote areas. We know that ‘drugs don’t work if patients don’t taken them’, so finding ways to optimise this is a vital health system improvement.”

The project pharmacists, located within the primary healthcare teams of Aboriginal health services, will assist individual patients to overcome obstacles, and prescribers to optimise medication choices.

“These pharmacists will be providing advice in a culturally safe environment for the patient, where they can feel at ease,” Dr Couzos says.

But the practice only occurs on an ad hoc basis in Australia. Despite this, there is no shortage of pharmacists keen to play frontline roles within Aboriginal health services, he maintained.

PSA manager, Health Sector Engagement, Shelley Crowther, says the peak body has been advocating for a number of years that pharmacists play an active role in improving medication management for Aboriginal and Torres Strait Islander people.

“There is a lot of evidence to support that medication misadventure results in cost to the health system,” she says.

“The Australian Commission on Safety and Quality in Healthcare estimates medication-related admissions to hospitals Australia-wide cost $1.2 billion annually.

“The discrepancies in health outcomes for Aboriginal and Torres Strait Islander people give even greater weight to the importance of embedding pharmacists to reduce medication misadventure and improve medication management to try to achieve better health outcomes.”

Hannah Mann, a community pharmacist speaking on behalf of the Pharmacy Guild of Australia says that “There are many community pharmacists who already have experience working with Aboriginal community controlled health services, who have excellent relationships with them, and who are looking to further strengthen these ties between community pharmacy and health services to better the health outcomes of patients.”

The project is scheduled to run until early 2020 and JCU will measure the healthcare improvements in chronic disease sufferers supported by project pharmacists.

“If the quality of care improves, that will lead to health dollar savings down the track because we know that access to quality primary health care can prevent unnecessary hospitalisations,” Dr Couzos says.

“This project will give impetus to the Australian Government to explore how healthcare workforce innovation may enhance access to quality healthcare for Aboriginal and Torres Strait Islander people.”

Associate Professor Couzos is presenting a paper about the project at the Community Pharmacy Stakeholder Forum in Sydney on the 7th September 2018.

Aboriginal Health and Pharmacy Press Release : NACCHO @jcu @PSA_National embark on a pioneering project to embed 22 pharmacists in Aboriginal community-controlled health services in QLD, VIC and the NT .

“There is a higher burden of chronic disease in the Aboriginal community, and these patients are likely to be prescribed multiple medicines, which also place them at greater risk of drug-related complications, Yet they have limited access to appropriate pharmacist advice across Australia, particularly in remote areas.

 There are many, many reasons behind why Aboriginal patients are more likely to have adherence problems than other Australians, There are socio-economic reasons, such as the cost of medicines and access to transport to fill prescriptions.

 There are patient reasons; a person may have a poor memory – and the more medicines they have to take, the more difficult it is to remember them all. Some patients are very fearful of medications. They’re worried that it might make them feel worse.

 There are also prescriber reasons; the medicine may not be right for the patient, or the patient may not have been prescribed necessary life-saving medicines.”

The inability of many Aboriginal and Torres Strait Islander people with chronic diseases to access quality pharmacist support may be placing lives at risk, according to a James Cook University medical researcher.

Associate Professor, General Practice and Rural Medicine, Sophia Couzos, said Aboriginal and Torres Strait Islander patients often struggled to follow medication regimes – including treatment for life-threatening conditions like diabetes and cardio-vascular disease.

Download the Press Release HERE

JCU Media – Pharmacy

 Read all previous NACCHO articles Aboriginal Health and Pharmacy HERE

JCU has joined forces with the Pharmaceutical Society of Australia (PSA) and the National Aboriginal Community Controlled Health Organisation (NACCHO) to embark on a pioneering project to embed 22 pharmacists in Aboriginal community-controlled health services in Queensland, Victoria and the Northern Territory.

The Integrating Pharmacists within Aboriginal Community Controlled Health Services to improve Chronic Disease Management (IPAC) project will see culturally-trained pharmacists working with both clinical staff and patients to address issues which lead to poor medication use, including under-utilisation and over-utilisation of drugs. These issues range from socio-economic obstacles through to fear.

The IPAC project pharmacists, located within the primary healthcare teams of Aboriginal health services, will be ideally placed to assist patients and prescribers.

“The IPAC pharmacists will be providing advice in a culturally safe environment for the patient, where they can feel at ease,” Dr Couzos pointed out.

NACCHO Director, Medicines Policy and Programs, Mike Stephens,pictured above )  said the pharmacists would also educate staff and liaise with external stakeholders, including hospitals, to develop strategic plans for more effective medicine use.

“There’s good evidence that pharmacists in health services improve patient health,” he said.

The United Kingdom is investing heavily in programs that place pharmacists in primary healthcare teams, according to Dr Couzos. But the practice only occurs on an ad hoc basis in Australia. Despite this, there was no shortage of pharmacists keen to play frontline roles within Aboriginal health services, she maintained.

“There are many pharmacists who have already had some experience working with Aboriginal community controlled health services, who have excellent relationships with them, and who have wanted to be part of the primary healthcare team,” she said.

PSA Manager, Health Sector Engagement, Shelley Crowther, said the peak national body for pharmacists had been advocating for a number of years that pharmacists play an active role in improving medication management for Aboriginal and Torres Strait Islander people.

“There is a lot of evidence to support that medication misadventure results in cost to the health system,” she said. “The Australian Commission on Safety and Quality in Healthcare estimates medication-related admissions to hospitals Australia-wide cost $1.2 billion annually.

“In terms of Aboriginal and Torres Strait Islander health, obviously the discrepancies in health outcomes for them give even greater weight to the importance of trying to reduce medication misadventure and improve medication management to try to achieve better health outcomes.”

The first IPAC pharmacists will begin work in June this year. JCU will evaluate the project, which is scheduled to run until early 2020. Among other elements, the evaluation will measure healthcare improvements in chronic disease sufferers who have been supported by a practice pharmacist.

“If the quality of care improves, that will lead to health dollar savings down the track because we know that access to quality primary health care can prevent unnecessary hospitalisations,” Dr Couzos said. “This project will give impetus to the Australian Government to explore how healthcare workforce innovation can enhance access to quality healthcare for Aboriginal people.”

 

 

 

 

 

NACCHO Aboriginal Health News: PTP an opportunity for our pharmacies to help improve Aboriginal health and wellbeing

Pharmacy

NACCHO is participating in the Pharmacy Trials Programme (PTP), a $50M initiative of Minister Sussan Ley to sponsor transformative and innovative delivery of pharmacy services.

From our NACCHO Aboriginal Health Newspaper out on 6 April as insert in 14,000 Koori Mails : Photo Danila Dilba Health Service Darwin ACCHO (Aboriginal Community Controlled Health ) pharmacy 

Aboriginal and Torres Strait Islander people are a focus of the PTP.NACCHO is represented on the Trials Advisory Group of the PTP.

The Trials Advisory Group (TAG) beings together national stakeholders to consider Trial proposals.  Approved Trials that are evaluated as cost effective can go on to access another $600M of new pharmacy services funding.

Clearly the PTP initiative has significant potential for strengthening the scope and the quality of pharmacy services within and delivered in collaboration with ACCHOs.

NACCHO is working with the Pharmacy Guild of Australia as well as with the Pharmaceutical Society of Australia to submit Trial proposals.  NACCHO is also consulting with a range of stakeholders, experts and reviewing recent literature.  This ensures that NACCHOs interests are fully represented and that the most relevant and up to date methods and ideas are incorporated into Trial proposals.

The $50M PTP is part of the Australian Government’s Sixth Community Pharmacy Agreement (6CPA) with the Pharmacy Guild of Australia.  It will be interesting to see how transformative and innovative Trial proposals approved by the Trials Advisory Group will be.

NACCHO is especially keen to trial a range of solutions for embedding pharmacy services within ACCHOs with the aim of identifying which solutions deliver the best value for money to clients.

At one end of the spectrum, legislation in the Northern Territory allows ACCHOs to own, set up and operate their own pharmacies. Elsewhere, some ACCHOs have installed a pharmacy in their clinics and they have it stocked and staffed by an outposted pharmacist employed by a Community Pharmacy in town. Some ACCHOs have banded together to employ a full-time pharmacist – as with the Institute for Urban Indigenous Health in south east Queensland.

Occasionally a single ACCHO employs its own full-time pharmacist – as in Galambilla in northern NSW.  Yet another model for pharmacy services is to contract a visiting pharmacist for a set number of hours per week.  About 50% of ACCHOs have no form of in-house or on-site pharmacist.

Minister Ley has also set up an independent Panel to review Pharmacy Remuneration and Regulation.  This is an opportunity for NACCHO to influence current federal laws to improve Quality Use of Medicines and access for ACCHOs and communities across Australia.  The Panel will be publishing a Discussion Paper and inviting submissions in May.

NACCHO has already advocated that the Panel do its best to progress the long-delayed reforms to Section 100 and CTG PBS Co-payment Measures.  A comprehensive set of changes have been agreed to by NACCHO and the Pharmacy Guild of Australia in a Joint Statement co-signed in October 2015. This is available on NACCHO’s web site under About Us – Resources/Downloads – Aboriginal Health.

 Clinical tips: Aboriginal and Torres Strait Islander health

There are many opportunities for pharmacists to help improve the health and wellbeing of Aboriginal and Torres Strait Islander Australians, but it’s a complex area to work in, writes Karalyn Huxhagen

The PSA Federal Budget Submission 2016-2017 titled “The role of pharmacists in Australian health reform–Improving health outcomes through cost effective primary care” highlights the opportunities for pharmacists to work in Aboriginal Health Services.

The activities that could be provided by pharmacists shadow the proposed roles of pharmacists providing services in general practice.

At a recent meeting with NACCHO, PSA and pharmacists who work in Aboriginal Health the following services were identified as being able to be delivered across Australia by pharmacists.

Areas of collaboration and opportunity include:

  • medication management services;
  • quality Use of Medicine services for consumers and health workers;
  • health promotion;
  • disease prevention programs;
  • chronic disease management programs;
  • culturally appropriate education and competency development programs for pharmacists and health workers; and
  • improvement in equitable and timely access to medication services.

This work would assist in:

  • improving adherence;
  • reducing medication misadventure;
  • tailoring medication regimes;
  • providing tools to assist consumers and carers;
  • Identifying areas that require research and data analysis; and
  • Improving the health literacy of the patient, carers and Aboriginal community elders.

The employment of a clinical pharmacist in an AHS may also assist in research and drug utilisation activities.

Programs provided by organisations such as National Prescribing Service could be initiated in the health service under the project management portfolio of the of the clinical practice pharmacist. Issues identified when prescribing, dispensing and administering medication to Aboriginal people require more intense research to be undertaken.

The response to medications by this cohort can differ significantly to other ethnic groups. In my own work in aged care facilities I often encounter major issues with metabolism, distribution and elimination of medications due to advanced kidney diseases and differences in skin penetration kinetics.

For example the use of ‘patch’ therapy e.g. Durogesic, Norspan, Transiderm Nitro, smoking cessation patches is complicated by the hot and humid weather encountered in Aboriginal communities.

The application of large pieces of strapping tape or electrical PVC tape to keep the patch attached to the body can alter the kinetics of the medication. It is very difficult to keep the patches attached.

In the regional and rural areas where I perform medication management services I am often faced with the situation of:

  • limited access to GPs;
  • limited access to allied health professionals;
  • lack of resources to adequately support the health needs of the patient;
  • long distances to travel;
  • poor health literacy; and
  • low income families.

The care of these patients often falls to the community care centre or the domiciliary nursing service as the doctor is only available for short periods of time. Often these communities are without a regular GP.

The employment of a clinical practice pharmacist in the Aboriginal Health Service could provide a significant partner in improving patient health outcomes. The reduction in costs to the Medicare and health system could be measured in areas such as compliance and adherence: improved wound care, chronic disease management and general parameters such as blood pressure and glucose control.

In the budget submission PSA recommends “that the Government consider an adaptation of the PGPIP to enable AHSs across Australia to improve medication adherence and reduce the progression of chronic disease, by utilising clinical pharmacists in the AHS service-mix. This would allow AHSs to access up to $125,000 per year to employ a pharmacist where required, in keeping with the general practice proposal.

The use of culturally responsive clinical pharmacists could improve medication adherence and reduce the progression of chronic disease.”

Areas such as Home Medicine Review, Medscheck and medication adherence programs such as dosage administration aids require different formats when they are being utilised in health programs for Aboriginal people.

There will need to be opportunity within program rules to adapt programs to suit the requirements and needs of the patient cohort. The use of a pharmacist within an AHS who can work with the various members of the health service to develop programs and initiatives to improve the primary health outcomes of the community is paramount to improving the longevity of the patients who use the AHS.

I recommend this document to all Australian pharmacists as it is a blueprint for where the practice of pharmacy could be implemented to gain improvement in patient outcomes while delivering more efficient and cost effective health care.