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.