Integrated healthcare is understood to be the collaboration between health professionals to ensure a seamless care experience for patients.
NSW Health describes integrated care as the provision of seamless, effective and efficient care that reflects the whole of a person’s health needs, from prevention through to end of life, across physical, psychosocial and mental health, and in partnership with the individual, carers and family members.
GP staff shortages, particularly in rural and remote Australia, an ageing population, and an increase in medicine use are among the major challenges affecting healthcare.
This is an opportune time for a review of how health professionals could work more effectively together to improve the care Australians receive.
A more integrated healthcare approach may be the solution and is one being explored through an independent review recommended by the federal government’s Strengthening Medicare Taskforce.
‘Unleashing the Potential of our Health Workforce’, an independent review led by Professor Mark Cormack, will examine opportunities and obstacles in Australia’s health professionals working to the full scope of their practice.
The government recognises that health professionals working to their full capability can significantly benefit both patients and the healthcare system.
For pharmacists, working to their full scope of practice means they add to health system capacity through helpful services within their pharmacies and working with other health professionals across different health settings. Their accessibility in the community is also key to the effective integration of their services into primary healthcare settings.
Pharmacists are the custodians of medicine safety, not only in community pharmacies, but also in hospitals, aged care facilities, general practices, Aboriginal Community Controlled Health Organisations, and as independent consultants.
“We know that complex medicine use is on the rise, that more Australians are hospitalised due to medication misadventure, and that these trends will continue as our population ages,” PSA National President Dr Fei Sim said. “Allowing all pharmacists to work to our top of scope is critical to reducing medicine harm across the health system.”
According to the Society of Hospital Pharmacists of Australia (SHPA), collaboration is key to medicine safety.
SHPA Specialty Practice Chair Dr Minyon Avent says antimicrobials are life-saving medications, but not without risk.
“Pharmacists need to work with doctors and nurses to ensure they know how to optimise antimicrobials,” she said. “Every pharmacist has a role to play to ensure that the right antibiotic, at the right dose, for the right duration, is applied for every patient. Pharmacists play a vital role in optimising antimicrobial therapy, which can minimise antimicrobial resistance, preserving the longevity of antibiotics as a reliable and effective treatment.”
Dementia Australia CEO Maree McCabe says pharmacists play a critical role in the health of people living with dementia, adding that the organisation supports recommendation 38 (‘Residential aged care to include allied healthcare’) from the Royal Commission into Aged Care Quality and Safety, and the proposed measure of locating an on-site pharmacist in every residential aged care facility.
“As an important member of the aged care multidisciplinary team, we believe an on-site pharmacist will play a valuable role in ensuring the safe and appropriate prescribing, monitoring and administration of medications in residential aged care,” she said.
“Pharmacists play a role in creating dementia-friendly communities. This includes pharmacies that are accessible and welcoming to people living with dementia, their families, and carers. We encourage all pharmacists to find out more about how they can work towards becoming a dementia-friendly pharmacy by visiting our website or calling the National Dementia Helpline.”
Generally, a pharmacist provides a medication management review every two years. However, by being present in the aged-care facility, pharmacists can undertake on-the-spot medication reviews and follow-up based on resident needs, improving the safety and care of residents.
The PSA’s residential aged care pharmacist foundation training program is available as a short online CPD training course.
GP body backs collaboration on diabetes
The Royal Australian College of General Practitioners has urged the federal government to boost investment in general practice to provide more time to care for people with diabetes, with RACGP President Adjunct Professor Karen Price saying coordinating care with other health professionals is also important in such complex chronic conditions.
The Department of Health and Aged Care’s Workforce Incentive Program offers financial incentives to practices across Australia to do this, she adds, which could enable practices to work more closely with allied health professionals such as general practice-based pharmacists.
According to Professional Pharmacists Australia, the definition of ‘allied health professionals’ now includes non-dispensing pharmacists who may undertake a range of activities, including medication reviews, patient and staff education and responding to medicine information queries, but not dispensing.
“By incorporating the pharmacist role within the general practice setting, we can offer an alternative model that delivers integrated care, something that’s especially important for people with diabetes,” Professor Price said, adding that this would make a real difference in communities nationwide, especially those disproportionately affected by this condition, such as Aboriginal and Torres Strait Islander people.
Embedding pharmacists into Aboriginal community-controlled health services under the ‘IPAC Project’ has been effective in improving the health of Aboriginal and Torres Strait Islander peoples, including those with conditions such as diabetes, according to Mike Stephens, Director, Medicines Policy and Programs at the National Aboriginal Community Controlled Health Organisation.
Apart from GPs, pharmacists can collaborate with many other health professionals to support the continuity of education and messaging around health conditions.
Associate Professor Liz Marles, Clinical Director at the Australian Commission on Safety and Quality in Health Care, says this is important to dispel myths and support shared decision-making.
“Patients with low back pain are often treated across different healthcare disciplines and can receive conflicting advice,” she said. “Pharmacists can reinforce key messages and reassure patients.”
Adam Monteith, Director and musculoskeletal physiotherapist at Evoker, gives the example of bone health, where collaboration between healthcare professionals allows for a patient-centred approach – a comprehensive assessment through physicians, pharmacists, orthopaedic specialists, and nutritionists.
“In this way, every avenue and facet required to ensure a complete assessment and treatment plan is investigated,” he said. “This allows for early detection of any conditions affecting bone health and thus affords individuals the opportunity to intervene early. Early intervention via tailored treatment from nutritionists, physiotherapists, physicians and other medical professionals who openly collaborate allows for improved continuity of care, and a seamless transition for patients across various healthcare settings.”
Diabetes patients can access services in pharmacy such as the diabetes MedsCheck, a consultation that provides education and review on medications.
Another successful development in pharmacies has been the take-home naloxone program supporting patients taking prescription opioids. PSA notes that in its first year of national availability, beginning July 2022, the program saved around 3000 lives.
“The role of pharmacists has expanded significantly in recent years, from delivering a wider range of vaccines to the extended supply of oral contraceptives and pharmacist-initiated treatment for urinary tract infections,” Professor Sim said. “These initiatives are critical to ensure Australians can continue to access timely primary healthcare.”
- Screening and triaging
They can also play an important role in screening for conditions. For example, Professor David Hunter, Florance and Cope Chair of Rheumatology and Professor of Medicine at the University of Sydney, says pharmacists play a very important role when it comes to arthritis – by screening for the disease and triaging to appropriate health services.
In 2019, University of Technology Sydney researchers evaluated a consultation service for community pharmacists to triage, manage and appropriately refer patients to doctors for common ailments, such as coughs and colds, through agreed referral pathways for the first time in Australia.
It found that patients were 1.5 times more likely to receive an appropriate referral by their pharmacist and were five times more likely to adhere to that referral advice and seek medical practitioner care within an appropriate timeframe (20 per cent of all patients were referred).
- Lifestyle advice
Many health professionals agree that the accessibility of pharmacists in the community makes them a key point of contact for patients seeking help with their health conditions.
Aside from advising on dosage and educating about possible side effects of medication, pharmacists can offer lifestyle recommendations.
“With cost-of-living pressures, pharmacists have an important role to play in providing accessible, affordable frontline healthcare and healthy lifestyle advice for our community,” a Blooms The Chemist spokesperson said, adding that the group’s outlets can, for example, assist patients with their quit-smoking journey, with information on nicotine replacement therapy and to help create a quit-smoking plan.
- Health promotion
Pharmacists can also engage in health promotion within the pharmacy, for example by actively promoting wellbeing events and awareness events such as Bowel Cancer Awareness Month.
- Department of Health and Aged Care. ‘Have your say on how to unleash the potential of our health workforce’.
- NSW Health. ‘NSW Pharmacy Trial’. health.nsw.gov.au/pharmaceutical/Pages/community-pharmacy-pilot.aspx
- Society of Hospital Pharmacists of Australia. ‘Collaboration is key as hospital pharmacists spotlight medicines safety’.
- Dementia Australia. ‘Immediate coordinated action needed to save lives of people living with dementia’.
- Pharmaceutical Society of Australia. ‘Pharmacy Fact Sheet’. psa.org.au/wp-content/uploads/2023/09/2023-World-Pharmaicst-Day-Pharmacy-Fact-Sheet.pdf
This feature was written by Tracey Cheung and was originally published in the November issue of Retail Pharmacy magazine.