Pharmacist referral scheme for rollout?

Researchers say their evaluation is “proof of concept” for Australia’s community pharmacists to take on an integrated role in primary healthcare.

The team from the UTS Graduate School of Health in collaboration with Western Sydney Primary Health Network says the recently evaluated consultation service for community pharmacists to triage, manage and appropriately refer patients to doctors is ready to be rolled out.

Their report, ‘An Australian minor ailments scheme: Evaluation of an integrated approach by community pharmacists and general medical practitioners’, examines a service for pharmacists to make referrals to doctors – through agreed referral pathways – for common or minor ailments such as coughs and colds.

The service supports a structured and collaborative approach to consultation, seeks to standardise practice, focuses on increasing the quality and safe use of medicines and encourages patients to seek care at the appropriate level with greater accessibility.

Researchers said evaluation of the service demonstrated extremely positive results at both the patient and economic level and showed potential for significant impact if implemented on a larger national scale.

Chief investigator Sarah Dineen-Griffin says the service has been co-designed with GPs, adding that its piloting and evaluation have demonstrated doctors and pharmacists can work effectively together.

“Better patient care is achieved when community pharmacists and GPs operate collaboratively to improve the health outcomes for patients with common ailments,” she said.

“Patients seeking care from GPs and emergency departments with minor ailments are costing the Australian health system between $511 million and $1.67 billion per annum.

“Currently nine million to 27.5 million emergency department and GP services in Australia are for common ailment conditions.

The research was conducted between July 2018 and March 2019 with 894 patients recruited for a randomised trial that compared the collaborative service with usual pharmacist care. Fifty-five community pharmacists from 30 community pharmacies and 150 GPs from 27 general practices took part, with the following results:

  • Pharmacists were 2.6 times more likely to change the customer selection of a medicine for self-treatment to a safer, more appropriate alternative.
  • Patients were 1.5 times more likely to receive an appropriate referral by their pharmacist, and five times more likely to adhere to that referral advice and seek medical practitioner care within an appropriate time frame (20 per cent of all patients were referred).
  • Pharmacists identified that two per cent of all patients presenting to pharmacy had red flag clinical features requiring immediate referral to the GP or emergency department. These included shortness of breath, severe or disabling pain, fever and neck stiffness.
  • Pharmacists provided self-care advice in 98 per cent of consultations, compared with 62 per cent of patients receiving usual pharmacist care. For example, patients presenting with heartburn were recommended to quit smoking by their pharmacist.

Researchers have submitted a report with a number of recommendations for consideration by federal and state policy makers, primary health networks, professional organisations, the pharmaceutical industry and practitioners.

The research team said the recommendations demonstrate the significant opportunity for pharmacists, GPs and other health professionals to operate in a collaborative professional capacity to best meet the healthcare needs of their patients.

They hope the service can be included in the 7th Community Pharmacy Agreement now being negotiated.

A summary of the report can be seen here.

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