” 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.
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.
1.Would your ACCHO health service like to trial a pharmacist in your health care team ?
Closing date for the Expressions of Interest is 20th March 2018
We are now seeking Expressions of Interest in the Integrating Pharmacists within Aboriginal Community Controlled Health Services to improve Chronic Disease Management (IPAC) project.
This is a large project that will investigate if including a non-dispensing practice pharmacist as part of the primary health care team within Aboriginal community controlled health services (ACCHSs) leads to improvements in the health of Aboriginal and Torres Strait Islander peoples.
It will involve up to 22 ACCHSs invited to participate in the project from three jurisdictions- Queensland, Victoria, and the Northern Territory. The project will provide funding and support for the pharmacist to be embedded within an ACCHS.
The project aims to benefit the ACCHS sector by providing the evidence-base to better support quality use of medicines through integrated care models.
The pharmacist will provide education and shared decision making for patients and staff on appropriate medicines for people with chronic conditions.
Having a culturally responsive pharmacist integrated into ACCHSs should enable the building of relationships and trust between pharmacists, patients, ACCHS staff and the community.
This should ultimately improve medicines use and health for ACCHS patients who agree to be part of this project.
The IPAC project is a partnership between the Pharmaceutical Society of Australia (PSA), James Cook University (College of Medicine and Dentistry) the National Aboriginal Community Controlled Health Organisation (NACCHO) and its state Affiliates.
The Australian Government under the Pharmacy Trials Program of the 6th Community Pharmacy Agreement has funded the project.
Yours sincerely,
Pat Turner – NACCHO CEO
To express an interest please complete this quick scoping survey:
ACCHSs will be offered site agreements from April for gradual roll out of Pharmacists mid year
Closing date for the Expressions of Interest is 20th March 2018
For further information please contact NACCHO IPAC Project Coordinators ipac@naccho.org.au
Alice Nugent 0439873723 and Fran Vaughan 0417826617
2. Close the Gap Day March 15, 2018
Everyone deserves the right to a healthy future and the opportunities this afford. We are very lucky to live in a rich country with a universal health system.
However, many of Australia’s First Peoples are denied the same access to healthcare that non-Indigenous Australians take for granted. Despite a decade of Government promises the gap in health and life expectancy between Aboriginal and Torres Strait Islander Peoples and other Australians is widening.
This National Close the Gap Day, we have an opportunity to send our governments a clear message that Australians value health equality as a fundamental right for all.
On National Close the Gap Day we encourage you to host an activity in you workplace, home, community or school.
The aim? To bring people together, to share information — and most importantly — to take meaningful action in support of achieving Indigenous health equality by 2030.
If you register on or after March 9th it is unlikely you will receive your pack in time. But don’t worry, you can download all the resources online.
On National Close the Gap Day 2017, there were more than 1100 separate events held across the country from the tip of Cape York to Southern Tasmania, and from Rottnest Island in West Australia to towns along Australia’s east coast.
With events ranging from workplace morning teas, to sports days, school events and public events in hospitals and offices around the country — tens of thousands of people took part and made a difference.
Your actions can create lasting change. Be part of the generation who closes the gap.
What is Close the Gap?
Equal access to healthcare is a basic human right, and in Australia we expect it. So what if we told you that you can expect to die a decade earlier than your next-door neighbour? You wouldn’t accept it. No-one should.
But in reality, Aboriginal and Torres Strait Islander People can expect to live 10 years less than non-Indigenous Australians. Learn more about why the health gap exists.
Working in partnership with Aboriginal and Torres Strait Islander peoples is one of the critical success factors. With continued support from the public, we can ensure the Australian Government continues to work with Indigenous communities, recommit additional funding and invest in real partnerships.
‘There are a lot of different activities happening from ACCHO to ACCHO. The approach needs to be flexible and responsive to communities’ needs, as well as integrated into the holistic care models ACCHOs use, but the detail on what has the biggest health impact is unknown.
Current ACCHO pharmacist have shown an opportunity to bring players together and make medicines a team sport – this includes the pharmacist working the allied health, GPs, nurses, Aboriginal Health Workers (AWH) and a range of local community pharmacies, hospitals, PHNs and more to get the best results for their clients and community as a whole.’
Director of Medicines Policy and Program for the National Aboriginal Community Controlled Health Organisation (NACCHO) Mike StephensPictured centre below
Pharmacists working in Aboriginal health Services (AHS), with the support of recent government reforms, are playing a key role in closing the gap and helping Aboriginal and Torres Strait islander patients navigate Australia’s complex health system.
This year marks the 50th anniversary of the 1967 Referendum, when the overwhelming majority of Australians voted to include Indigenous Australians in the Census and allow the Commonwealth to make laws for them.
Next year marks the tenth anniversary of the Closing the Gap program, established by the Council of Australian Governments (COAG) in 2008 with the aim of eliminating the gap in health, education and employment disadvantages between Indigenous and non-Indigenous Australians.
In acknowledging of these important milestones, this year’s annual Closing the gap Prime Minister’s Report said : ‘While we celebrate the successes we cannot shy away from the stark reality that we are not seeing sufficient national progress on the Closing the Gap targets/ While many successes are being achieved locally, as a nation, we are only on track to meet one of the seven Closing the Gap targets this year.’
The health-related targets of halving the gap in child mortality and closing the gap in life expectancy are not on track.
Some of the targets will expire in 2018, so governments have’ agreed to work together with Indigenous leaders and communities, establishing opportunities for collaboration and partnerships.”
According to PSA CEO Dr Lance Emerson, ‘Aboriginal Australians are four times more likely to be hospitalised for chronic conditions compared with non-Indigenous Australians- and the life expectancy of Aboriginal people in this country is 10 years lower than non-Aboriginal people- and in fact below that of many developing countries such as Bangladesh’.
‘This reality is disgraceful in a rich country such as Australia, ‘Dr Emerson said. ‘Health professionals need to be doing all they can to work toward deeper understanding and meeting the needs of Aboriginal people, to support reconciliation and self-determination- and Aboriginal peoples ‘community control of services provided for Aboriginal people’.
The Government has implemented several programs to provide timely and affordable access to PBS medicines and Quality Use of Medicines (QUM) (listed opposite). However, the review of Pharmacy Remuneration and Regulation Interim Report noted in June that ’although they are related, these programs operate independently with differing eligibility criteria applied for each. This raises difficulties for both consumers in terms of access and for pharmacists and other health professionals with respect to administration.
‘In considering how pharmacy options may contribute to improved health outcomes for Aboriginal and Torres Strait Islander people, the Panel has questioned whether currently arrangements are sufficient and how might they be improved.
Integrating pharmacists
The Federal Government has committed to implementing reforms and investigating new funding models to help pharmacists continue to improve health outcomes of Indigenous patients.
In his opening speech at PSA17 in Sydney in July, Federal Health Minister Greg Hunt announced a trial, funded through the Pharmacy Trial Program (PTP), to support AHSs to integrate pharmacists into their services.
The trial has strong stakeholder support amid growing evidence that pharmacists employed by Aboriginal Community Controlled Health Organisations (ACCHOs) can help increase patients’ life expectancy and health outcomes.
As a country, we will not have fully succeeded unless and until Indigenous health outcomes are the same as non-Indigenous health outcomes, ‘Mr Hunt said. ‘That’s our very simple shared goal.
‘We will work immediately to have Indigenous specific medication reviews available and we will fund and support that as part of tranche 1 to make sure they are culturally specific.
‘We want in these Aboriginal Health Services to ensure there’s a pharmacy presence. The first line there is to see if we can have a direct link and an offer to community pharmacists to participate, but where that’s not possible, the breakthrough agreement… is that the Aboriginal Health Services will be able to directly employ a pharmacist.’
This announcement follows the Review’s Interim Report recommendation to trial the ability for AHS’s to employ pharmacists and operate a pharmacy because ‘the current inability of an AHS to operate a community pharmacy poses a significant risk to patient health in some rural and remote areas.
The Panel presented the option that: ‘All levels of government should ensure that any existing rules that prevent an AHS from owning and operating a community pharmacy located at the AHS are removed.’ The Panel suggested that as a transition step, these changes should first be trialled in the Northern Territory.
PSA National President Dr Shane Jackson said having a culturally responsive pharmacist integrated within an AHS builds better relationships between patients and staff, leading to improved results in chronic disease management and QUM.
‘Integrating a non-dispensing pharmacist in an AHS has the potential to improve medication adherence, reduce chronic disease, reduce medication misadventure and decrease preventable medication related hospital admissions to deliver significant savings to the health system’, Dr Jackson said.
Director of Medicines Policy and Program for the National Aboriginal Community Controlled Health Organisation (NACCHO) Mike Stephens welcomes the announcement of the trial.
‘We know from recent studies, including systematic reviews, that pharmacists delivering services within a practice setting can have a significant impact on health outcomes,’ Mr Stephens said. ‘While there is some level of role translatability between ACCHO and non-ACCHO sectors, we really dont’ know where the “sweet spots” are in terms of health outcomes, community demand and value for money when embedding pharmacists in ACCHOs.
‘There are a lot of different activities happening from ACCHO to ACCHO. The approach needs to be flexible and responsive to communities’ needs, as well as integrated into the holistic care models ACCHOs use, but the detail on what has the biggest health impact is unknown.
‘Current ACCHO pharmacist have shown an opportunity to bring players together and make medicines a team sport – this includes the pharmacist working the allied health, GPs, nurses, Aboriginal Health Workers (AWH) and a range of local community pharmacies, hospitals, PHNs and more to get the best results for their clients and community as a whole.’
Mr Stephens said some ACCHOs are also hiring intern pharmacist and pharmacy technicians, allowing pharmacists to focus more on clinical, education and practice-based activities that work well in a general practice setting.
These pioneers are also promoting the newer roles of pharmacists. I see a lot of pharmacists focusing on systems based activities like clinical governance, DUEs and audits, as well as working across teams in and outside of the organisation, such as improving transitional care with local hospitals.’
Mr Stephens said there had been ‘a lot of interest’ in the trial from NACCHO’s Members Services.
‘Research has shown that access and acceptability of pharmacy services could be improved.
Feedback from ACCHOs indicates the benefits of embedding pharmacists can be diverse, but may include improvements in clinical governance and prescribing practices, internal and external workflow, MMR uptake and relationships with community pharmacies’.
Sharing ideas
In recognition of the growing number of pharmacists working in ACCHOs, PSA and NACCHO launched the ACCHO Special Interest Group (SIG) at PSA17.
Dr Jackson said pharmacists working in ACCHOs had specific needs and skills and developing a SIG to support them will help drive the growth of this career path.
‘In many cases, pharmacists working in these positions are providing innovative and diverse services that have the potential to be informative and relevant to the evolution of pharmacy services and inter-professional care,’ Dr Jackson said.
The ACCHO SIG will allow PSA and NACCHO to foster collaboration, inform relevant policy and consult with ACCHO pharmacists about their needs. The ACCHO SIG will also support pharmacist participating in the Aboriginal health organisations trial.
Mr Stephens, who convened the ACCHO SIG, said the key aim was to share resources and ideas and give each other support in a relatively niche area.
‘I have learnt a lot from each of the participants and their input has definitely shaped my clinical practice and policy output. I hope the SIG can evolve organically as needs and issues develop.’
Mr Stephens said optimising medicines use for Aboriginal and Torres Strait Islander people has been an ongoing challenge.
‘Despite some great programs, policy and resources, Aboriginal PBS utilisation is still only about two thirds of non-Indigenous Australians’use. Most pharmacists would have heard of Closing the Gap prescriptions but how is that delivering outcomes ? How could it be improved ? We have responded to this question and more in a recent submission to the Review of Indigenous Pharmacy Programs. There is a real sense of goodwill from many industry players in this area at the moment.’
Mr Stephens said that, in addition to the SIG, a more informal network has been set up for any pharmacist or other health professional with an interest or expertise in Aboriginal and Torres Strait Islander medicine issues. NACCHO shares a monthly medicines bulletin with the network, including practical resources and links.
Mr Stephens describes his previous workplace, Danila Dilba Aboriginal Health Service in Darwin, as a dynamic multidisciplinary environment.
‘It opened my eyes to the details of how a large holistic health service works, and how general practice and other primary care services fit into that. I did everything from HMRs to pharmacy accounts, board briefings to Drug Use Evaluations (DUE) and clinical governance, GP education and much more. The team vibe was great and I had a lot of fun with colleagues from different disciplines and backgrounds.
‘The challenge was the complexity and nuances of community relationships and systems, and learning where your skills will work best. Engagement is critical and I saw some programs struggle because clients and employees were not driving the change.’ Mr Stephens is a strong believer in lifelong learning and found PSA’s Guide to providing pharmacy services to Aboriginal and Torres Strait Islander people invaluable.
‘It has a lot of detail but is applicable for pretty much all pharmacists across Australia, and it has some great case studies. It was developed by a range of organisations and people with lots of experience.
‘There’s never been time to upskill and get involved, with PSA’s support modules for Aboriginal Health Services Pharmacists, the ACCHO SIG and the network. NACCHO can also provide support for pharmacists looking to get involved.’
PSA provides CPD, training, practice support tools and recommended external resources to support AHS pharmacists. This includes an essential guide as well as guidance on networking and advancing within this career pathway.
Building rapport
Vanessa Bickerton MPS, a hospital pharmacist from Perth, previously worked at Wirraka Maya Health Service in South Hedland in the Pilbara region, 1600 kilometres north of Perth. She said it was a challenging but uniquely satisfying role.
‘Though it took some time to establish relationships and build rapport with patients, the pharmacy service was integral to the organisations,’ Ms Bickerton said.
As part of diverse team of doctors, nurses, AHWs, pharmacists and other allied health professionals worked closely with patients in communities that sometimes had limited access to medical care.
‘This included supply to even more remote nursing stations, such as Marble Bar, Nullagine and Yandeyarra- where due to geographical challenges the Royal Flying Doctor Service only visits once or twice a week,’ Ms Bickerton said.
“For too long Aboriginal people have suffered shorter lifespans, been sicker and poorer than the average non-Indigenous Australian, however, highly trained pharmacists have a proven track record in delivering improved health outcomes when integrated into multidisciplinary practices,” Ms Turner said.
“Strong international evidence supports pharmacists’ ability to improve a number of critical health outcomes, including significant reductions in blood pressure and cholesterol and improved diabetes control. A number of studies have also supported pharmacists’ cost-effectiveness.
Some ACCHOs have already shown leadership in the early adoption of pharmacists outside of any national programs or support structures. NACCHO and PSA are committed to supporting ACCHOs across Australia to meet the medicines needs in their communities by enhancing support for those wishing to embed a pharmacist into their service.”
NACCHO CEO Pat Turner said disparities in the health between Indigenous and non-Indigenous Australians are confronting.
The Pharmaceutical Society of Australia (PSA) and the National Aboriginal Community Controlled Health Organisation (NACCHO) have welcomed the announcement of a trial to support Aboriginal health organisations to integrate pharmacists into their services.
The trial was announced today by the Federal Minister for Health Greg Hunt at PSA17, PSA’s national conference.
Both PSA and NACCHO thank the Minister for supporting this innovative project that will improve the health of Aboriginal and Torres Strait Islander people.
This practical new trial measure has strong stakeholder support and there is growing evidence pharmacists employed by Aboriginal Community Controlled Health Organisations (ACCHOs) can assist to increase the life expectancy and improve the health of Aboriginal and Torres Strait Islander patients.
PSA and NACCHO celebrate the Federal Government’s initiative to implement these important reforms and to further investigate the development of new funding models to help close the gap between the health outcomes of Aboriginal
PSA National President Dr Shane Jackson said having a culturally responsive pharmacist integrated within an Aboriginal Health Service (AHS) builds better relationships between patients and staff, leading to improved results in chronic disease management and Quality Use of Medicines.
“Integrating a non-dispensing pharmacist in an AHS has the potential to improve medication adherence, reduce chronic disease, reduce medication misadventure and decrease preventable medication-related hospital admissions to deliver significant savings to the health system,” Dr Jackson said.
“Additionally, pharmacists integrated within an AHS have a key role to play in assisting Aboriginal and Torres Strait Islander patients navigate Australia’s complex health system.”
“Local community pharmacies will be first approached to see if they are able to provide a pharmacist to work within the AHS according to service requirements of the AHS. If they are unable to or this is not accepted by the AHS in line with principles of self-determination, then the AHS may employ a pharmacist directly.”
A range of stakeholders, including the Pharmacy Guild of Australia, will be on the advisory group.
This trial has been funded through the 6th Community Pharmacy Agreement Pharmacy Trial Program. PSA and NACCHO wish to credit the Pharmacy Guild of Australia for supporting such an important initiative. This trial aims to improve equity of access for Aboriginal and Torres Strait Islander people and further demonstrate the fundamental role that community pharmacists play in primary health care, strengthening the future for all pharmacists and contributing to a sustainable health system.
” I have reached agreement with the PSA and Pharmacy Guild of Australia to allow Aboriginal health services to employ pharmacists if there were local areas problems in accessing pharmacy services. “
The Federal government is moving to give certainty to community pharmacy over location rules, Health Minister Greg Hunt said.
Rural and Indigenous health advocacy through the infrastructure of community pharmacy
” The standard of health care for rural areas should be equal to the standards available in metropolitan areas. The Pharmacy Guild of Australia (the Guild) is guided by the principle that all Australians have a right to equity and access to community pharmacy services.
The Guild represents pharmacists who are the proprietors of community pharmacies. Approximately 20% of the total 5,350 community pharmacies across Australia are located within Categories 2-6 of the Pharmacy Access/Remoteness Index of Australia (PhARIA). “
Speaking at PSA17 in Sydney today, Mr Hunt announced a raft of initiatives which he says will exemplify the “vital role” the profession plays in primary health care.
A key announcement is that the government will soon introduce legislation to remove the existing sunset clause on pharmacy location rules, a move that drew applause from the floor.
Mr Hunt said feedback from pharmacy owners on location rules was that:
“The threat of taking location rules away was a threat to their very existence” and had prompted the government to action.
Mr Hunt also announced he had reached agreement with the PSA and Pharmacy Guild of Australia to allow Aboriginal health services to employ pharmacists if there were local areas problems in accessing pharmacy services.
The Minister also provided details on recent 6CPA pharmacy trial announcements around asthma management and ensuring culture-specific medicine reviews in indigenous communities.
Funding would be provided for a pharmacist and consumer awareness campaign around biosimilar medicines, he also announced.
” The report on the evaluation of the opt-out trials for My Health Record showed that the approach would help ensure the full health benefits of a shared electronic health record could be realised.
CHF has been calling for an opt-out system backed by strong community engagement and education and the findings of this report endorse that position”
Consumer Health Forum CEO Leanne WellsPress release below
“The Guild has long supported an opt-out model for My Health Record as the clearest path to meaningful use of a national digital health record system .
“Community pharmacy, as the most accessible community health care destination, has always been at the forefront of digital innovation and an opt-out model for the operation of My Health Record will enable community pharmacies to enhance their patient care.
It will also foster better health professional collaboration between care settings and provide key clinical data at important points of care across a patient’s journey through the health care system.”
National President of the Pharmacy Guild, George Tambassis. See Full Press Release below
In July 2012, My Health Record (then called Personally Controlled Electronic Health Record) was launched.
This is a secure online summary of a person’s medications, diagnosed illnesses, treatments, allergies and tests.
Each person can control what goes onto their My Health Record, and who is allowed to see it.
For healthcare providers, knowing more about a patient’s medical history can lead to a better understanding of what is happening, and result in better treatment decisions.
In most parts of Australia individuals need to actively register for a My Health Record. From March to October 2016, trials of different participation arrangements were run.
The trials were of opt out arrangements in Northern Queensland and the Nepean Blue Mountains of New South Wales area, and innovative approaches to opt in in Western Australia and Ballarat.
The aim of the trials was to understand consumer reaction to different participation arrangements, as well as healthcare provider usage and upload of clinical information to the patients’ records, when most of their patients have a My Health Record.
These trials were conducted as a collaboration between the Department of Health (the Department), Primary Health Networks, the state health departments and relevant hospital and health services.
An independent evaluation of the trials commissioned by the Department of Health was conducted by Siggins Miller Consultants to look at the outcomes from these trials.
The Evaluation of the Participation Trials for the My Health Record is available below.
It will be used to inform future recommendations to the Government about the participation arrangements to best bring forward the benefits of the system to healthcare in Australia.
Consumer Health Forum CEO Leanne WellsPress release
Making My Health Record Work for Everyone
“We support a national opt-out roll out and support the report’s recommendation that this should be done in one national step. This would ensure a nationally consistent campaign would be rolled out and built on.”
“It is no surprise to us that once people have the benefits explained to them and their concerns around privacy and confidentiality addressed that they are happy to have and use the My Health Record. It is good to see that people not only do not opt out of the record but have started to use it” said Ms Wells.
“People are using their My Health Record because they recognise benefits of information bring shared, care being connected and duplicate tests bring avoided “
“The report shows that more work need to be done to raise awareness of the benefits of electronic health records. We support the report’s call for a comprehensive nationally driven but locally supported communication strategy that is targeted at consumers and health care providers. “
“This needs to be properly resourced and should be developed with consumer and health care provider input. It also needs to involve local community leaders who can be strong agents for change and champions of the roll-out.”
“We need to anticipate and avoid roadblocks to use of this vital new piece of our health care system future. We welcome the report’s acknowledgement that there is a need to streamline and improve access because consumers in the pilots found this to be a barrier. Whether this is through improving My Gov or moving away from it completely, the important issue is that it makes it easier for consumers to use.”
For a national roll out to be successful we need the Government to commit to further investment in their consumer facing infrastructure so that the system is reliable, accessible and resourced appropriately into the future” said Ms Wells ‘
We believe that if implemented the report’s 31 recommendations would deliver a world class system. It is important to remember that this is the first stage and the system will evolve.”
“Such major, deeply needed, change cannot be done on the cheap. To this end we reiterate our call that the government move away from the current budgetary requirement for all new health expenditure to be offset by savings in the health portfolio.”
My Health Record should be opt out, says the Guild
The Pharmacy Guild of Australia has welcomed the success of the My Health Record trials which it says have confirmed the overwhelming benefits of the ‘opt out’ model involving automatic creation of patient records.
The formal evaluation of the trials, published today, has recommended that the Federal Government proceed to a national opt-out approach – a recommendation which the Guild says it fully supports.
The evaluation report says in part: “Taking all the data into consideration we can see no reason not to proceed with an opt-out approach in one national step rather than any progressive staged approach.”
The opt-out trials were conducted in the Northern Queensland PHN, and in the Nepean Blue Mountains PHN, with the final report on the trials completed in November last year. The opt-out trials included community pharmacists among the healthcare providers who took part.
When compared with two opt-in trials conducted in Ballarat and Perth, the opt-out trials achieved better outcomes in terms of participation, understanding and some aspects of use of the My Health Record system.
“The Guild has long supported an opt-out model for My Health Record as the clearest path to meaningful use of a national digital health record system,” said National President of the Pharmacy Guild, George Tambassis.
“Community pharmacy, as the most accessible community health care destination, has always been at the forefront of digital innovation and an opt-out model for the operation of My Health Record will enable community pharmacies to enhance their patient care.
“It will also foster better health professional collaboration between care settings and provide key clinical data at important points of care across a patient’s journey through the health care system.
“An opt-out model with also provide a greater opportunity to further realise community pharmacies’ digital health potential within the patient-centric care model,” Mr Tambassis said.
The Pharmacy Guild has been working with the Australian Digital Health Agency to explore ways to maximise the utilisation of community pharmacy as a vital component in the My Health Record system.
The My Health Record Participation Trials Evaluation Report is available on the health
Press Release AHHA : Trial shows ‘opt-out’ model favoured for My Health Record
‘We are supportive of the “opt out” model for My Health Record, but with some important provisos’, says Alison Verhoeven, Chief Executive of the Australian Healthcare and Hospitals Association (AHHA).
Ms Verhoeven was commenting on today’s release by the Australian Government Department of Health of a government-commissioned evaluation of participation trials for My Health Record, involving ‘opt-in’ as well as ‘opt-out’ regimes.
My Health Record is a way of securely sharing an individual’s health information between registered healthcare providers involved in a person’s care. Currently, both individuals and healthcare providers have to opt in, that is, register to participate.
‘The report released today comes down overwhelmingly in favour of the opt-out method’, Ms Verhoeven said. ‘Under this model, a My Health Record is automatically created for individuals.
For individuals, not having to do anything to create the record was seen as a major plus, while for healthcare providers, assisting in creating My Health Records, which would have been needed for some patients under the ‘opt-in’ model, was seen as impractical without additional funding and ultimately would be unsustainable.
‘Once the system and its benefits were explained, individuals had minimal confidentiality or security concerns. ‘And, interestingly, most consumers were strongly of the opinion that healthcare providers should not be able to opt out of the system. ‘We support the opt-out model, while acknowledging that the government has no obligation to take on what has been recommended in the report released today.
‘We are however concerned that the existing infrastructure may not have the appropriate capacity to support the recommended change—anecdotal evidence indicates that the current system is already operating at close to capacity and will need to be significantly upgraded to effectively manage the millions of additional records.
‘It would therefore not be wise to rush into this if we want to get this important change right. ‘Given a national rollout is likely to require support by the PHNs, they must be afforded adequate time to undertake collaborative planning, local mapping of digital capacity and capability and the flexibility to respond to local issues and contexts. The phase-in should be well-planned, with comprehensive training and a very strong communications strategy—both to consumers and healthcare providers. ‘Communications cannot be emphasised strongly enough.
The report found that there was very low awareness in the community of the current My Health Record arrangements, and very low awareness among all types of healthcare providers of the online training available for the current My Health Record system.’
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.
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 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.
“Chronic diseases are one of the major reasons we still have a gap in life expectancy between Aboriginal and other Australians,” Mr Cooke said.
“Improved access to medicines is critically important if we are to see generational change in the health outcomes of Aboriginal and Torres Strait Islander people.”
NACCHO Chair Matthew Cooke pictured at todays signing with The Pharmacy Guild of Australia National President, George Tambassis.
See copy of signed agreement below
A range of practical changes to Australia’s Pharmaceutical Benefits Scheme will boost the numbers of Aboriginal and Torres Strait Islanders accessing appropriate medicines and help close the health gap between Aboriginal and other Australians.
Introduced in 2010, the Closing the Gap Co-Payment measure reduces or removes the patient co-payment for PBS medicines for eligible Aboriginal and Torres Strait Islander patients living with, or at risk of chronic disease.
Some of the key points the position paper raises are the need for the measure to:
Link CTG eligibility to the patient’s Medicare Card to improve privacy, and so that the patient is eligible regardless of who the prescriber is or where their medicine is dispensed;
Expand the PBS listing to include more common medicines;
Include Dose Administration Aids for better management of medicines; and
Better communication for patients and health professionals of the CTG Co-payment measure.
NACCHO Chairperson Matthew Cooke said it was important that everything is done to ensure Aboriginal and Torres Strait Islander people have access to appropriate medicines.
“Chronic diseases are one of the major reasons we still have a gap in life expectancy between Aboriginal and other Australians,” Mr Cooke said.
“Improved access to medicines is critically important if we are to see generational change in the health outcomes of Aboriginal and Torres Strait Islander people.”
The Pharmacy Guild of Australia National President, George Tambassis, said it was pleasing that more than 258,000 Aboriginal and Torres Strait Islander patients were accessing the more affordable PBS medicines through the measure but more could be done to ensure greater take up.
“A range of practical enhancements would assist those in remote areas to get better access to the medicines under the scheme and ensure they have access to it wherever they fill their prescriptions. We want this vital scheme to be sufficiently flexible to improve the health of people wherever they live and wherever they travel,” he said.
“These relatively simple improvements will help in the management of chronic disease within the Aboriginal and Torres Strait Islander people.”
All services are invited to register to participate in the QUMAX Program. The QUMAX (Quality Use of Medicines Maximised for Aboriginal and Torres Strait Islander Peoples) Program provides services with funding to assist with improving the way medicines are used to maximise the benefits to the client.
A range of initiatives may be eligible for funding under all or some of seven categories.
Possible initiatives may include;-
the supply of delivery devices such as spacers for asthma medications,
transport to collect medicines,
dose administration aids to help with compliance,
education tools such as Ibera software licences and medicines reference texts,
medication education for staff,
cultural training for pharmacists and pharmacy staff and
facilitation of medication reviews for clients.
The QUMAX program has been running since 2008 and has guaranteed funding to 30th June, 2015 under the Fifth Community Pharmacy Agreement. Administration of the program is shared between NACCHO, The Pharmacy Guild of Australia and the Department of Health and Ageing.
Participation in QUMAX requires an annual registration process. This is done online using the NCN a custom built program for the administration of QUMAX. Patient numbers and the number of services registered are used to allocate the annual QUMAX budget.
Services will be notified of their budget and be asked to complete a workplan shortly after the close of registrations.
You may access the NCN through NACCHO’s website. Most services will already have staff that have been provided with usernames and passwords that enable them to logon and complete the registration form.
If you are new to the NCN or QUMAX please contact the QUMAX Program Manager at NACCHO to arrange access to the NCN. See contact details below
If a service is auspiced the auspicing body must register and include the auspiced service’s patient numbers in their registration. A budget allocation will be made to the auspicing body.
If you have any queries or require further information about QUMAX or the registration process
