The roles of various health professionals, including pharmacists, within patient management and care have been subject to controversy over scope of practice.
This month, Retail Pharmacy explored the benefits of healthcare integration – the importance of working together for the greater good of the patients served by community pharmacy, particularly in the area of respiratory health.
“We [pharmacists] play an important role with asthma management care plans – diagnosis, as well as management,” Pharmacy Guild NSW Branch President David Heffernan said. “And because of that, we’re somewhat taken for granted.”
He highlights pharmacies’ role in advising patients on how to use asthma medications, including correct use of inhalers, and in helping patients find appropriate interventions.
Asthma isn’t the only respiratory condition where pharmacies can help, he adds, pointing to pharmacies’ contribution to the management of chronic obstructive pulmonary disorder (COPD) plans – for example, in spirometer use, which is typically conducted by a health professional – as well in testing lung capacity and strength, and understanding “ways a patient can improve their health with regard to [COPD]”.
“A lot of respiratory conditions are related to lifestyle choices,” he said, “through obesity, smoking, diet, exercise – a lot of things. So, it’s not only advice [that we provide] but also real tangible interventions that make a big difference in people’s lives. It’s what we’re trained to do.”
Integrating healthcare and involving community pharmacies as integral members of the healthcare team has many benefits, including reducing the number of avoidable hospitalisations due to medication mismanagement, says Mr Heffernan.
“There are things that could be intervened at the pharmacy,” he said. “There are things that could be avoided if [we all worked together].”
He gives the example of medication adherence as a space in which pharmacies could make a difference.
“An asthma attack doesn’t wait around for a doctor’s appointment,” he said. “And these are little things that are in the patient’s interest – in public interest … that won’t affect anything except to benefit the patient’s condition.”
Clearly passionate about putting patients first through collaboration, Mr Heffernan said: “There’s always room for improvement, better integration between the health professions.”
He adds that for a long time the various professions have been working solo, but it’s time to work together. It’s about the patient’s journey, he says, “rather than working on different sides”.
“The Pharmacy Guild is working hard in this space,” he said, “and we’ll be actively working on this into the future. With respiratory health, some of it can be complex but some of it can be easy. The more complex stuff may require further training – it may require integration of training into university pharmacy courses. That’s a longer-term goal but there are a lot of short-term goals that could bring real tangible benefits to healthcare into the future. And we’re mapping out a lot of that right now.”
Mr Heffernan says the goal is having an “integrated network in the community where the patient has an easy path to recovery or better health”.
Building relationships
One of the keys to integrating healthcare is the professional relationship and rapport built between pharmacies and other healthcare professionals, including GPs.
Consultant pharmacist Dr Jenny Gowan, a member of National Asthma Council Australia’s Guidelines Committee, says that when it comes to integrating care – specifically, working with GPs, “it depends on where you’re working and what space you’re working [in]”.
“I work as a consultant and I have a very close relationship with GPs,” she said. “I do home medicine reviews and residential medications in aged care, so I have a lot of GPs I work closely with.”
However, Dr Gowan says a challenge in community pharmacy is being able to form meaningful professional relationships with doctors that go beyond prescriptions, which she says may be easier to establish in country pharmacies or in smaller areas.
“The relationships vary,” she said. “In the country and smaller areas, they’re often better, but in the larger shopping centres, they may not know the doctors particularly well, which is one of the barriers to actually communicating and referring back to the GP.”
In addition to playing a key role in health management plans, she adds, pharmacies can “focus on self-management strategies such as correct use of devices and adherence to prescribed medication, as well as symptom recognition” that patients can use, which she says is a good place to start.
Pharmacies, says Dr Gowan, can also help translate health information and address any literacy issues.
An allied healthcare team
When we think of allied health, the health professionals that might come to mind may include dietitians, speech pathologists, occupational therapists and physiotherapists working in acute and sub-acute health settings. But according to Claire Hewat, CEO of Allied Health Professional Australia, “all pharmacists are considered to be ‘allied health’”.
“Pharmacists play a key role in managing medications for people with any condition, including respiratory conditions, making sure they’re safe, providing advice about medications and looking for any interactions or adverse reactions, and making sure people get sound advice on how to use their medications to manage their conditions,” she said.
Ms Hewat adds that while a current issue is primary care being “extremely fragmented”, it’s important to put the patient at the centre and ask what they need to manage their condition.
“None of these conditions are just managed by one profession,” she said. “It’s about that integration.”
While acknowledging the current challenges – including funding – involved in improving integration and patient care, Ms Hewat said: “Everybody would really value the ability to work more closely. I think it needs to be said that all of allied health would greatly value the ability to work more effectively with pharmacy, with GPs – with each other.”
This feature was originally published in the August issue of Retail Pharmacy magazine. To read the feature in full as it appears in the magazine, visit: retailpharmacymagazine.com.au/magazine/retail-pharmacy-august-2022
