Doctors want PHNs to organize an on-site pharmacist program

The Australian Medical Association has recommended that funding go to primary health networks to implement the Aged Care Integrated Pharmacist Program rather than aged care homes.

The AMA argues that the PHN-funded approach would ensure the independence of pharmacists from eldercare providers. However, Juanita Breen, an academic associate at the University of Tasmania – who developed the successful RedUSe program to reduce antipsychotic use in elderly care – says that while pharmacists are to be truly onboarded, care homes for the elderly should use them.

WADA and Dr Breen are among 146 stakeholders who provided written responses to the government’s request On-site Pharmacist Consultation Document for Care of the Elderly before it closed on Sept. 16, a department spokesperson said Australian Aging Program.

Under the $350 million program announced in the Coalition’s May federal budget beginning next year, funding will be provided for one full-time pharmacist per 250 beds to be employed or contracted to provide services On-site clinics in senior care homes to meet the needs of residents and the facility and address any issues related to medication use.

Features of the proposed program

According to the consultation document, the on-site pharmacist:

  • ensure continuity of medication management
  • assist with medication management and communication during care transitions
  • undertake quality medicine use activities across the facility
  • advise, assist and report to the Drug Advisory Committee and help set up a MAC where it is not already done.

Where there is a pharmacist on site, the separate Institutional Medication Management Review and Medication Quality Utilization Program services will not be funded, which as noted above is a consideration. contention for some.

For their part, on-site pharmacists will need to undergo additional training specific to medication management in the elderly, while care homes for the elderly will need to adopt the eNRMC – national electronic residential medication tables – to access funding. .

Under the proposal, existing MACs will be given formal responsibility for monitoring and evaluating service delivery and outcomes against agreed standards and quality outcomes, such as inappropriate use of psychotropics and drugs. antimicrobials, falls and hospitalizations – which will be reported to the government.

In terms of potential implementation approaches, the government is considering directly funding aged care homes to employ or engage pharmacists or funding primary health networks to coordinate on-site pharmacists to carry out regular rotation between aged care homes in their catchment areas.

WADA advocates for a PHN-led approach

The AMA said it preferred the PHN-funded approach as it would ensure the independence of pharmacists from aged care providers and linking all pharmacists in the region to develop and supporting learning networks.

“If the PHN model is adopted, PHNs could create communities of practice in aged care homes, introduce a general practitioner liaison officer in aged care homes, and multidisciplinary teams,” WADA stated in its submission.

The AMA has raised concerns about giving funds directly to aged care homes, without any specific requirements. “If funding is provided directly to nursing homes for the aged, one would expect them to provide financial statements as proof that the funding was actually used to hire pharmacists on site. Reports should be itemized by hours worked and hourly rate of pay,” he said.

Elsewhere, the AMA has called for Medicare items for regular medication reviews for residents of nursing homes for the elderly to be maintained regardless of the approach, acknowledging that GPs are the primary healthcare professionals in the care for the elderly – with pharmacists providing support to general practitioners rather than replacing them – and the assurance that pharmacists will not prescribe anything.

“The AMA supports a model in which credentialed pharmacists work with senior care GPs to help with medication adherence, improve medication management and provide medication safety education. This is not a preference, but a condition. This collaboration will be particularly important during the admission of new residents to aged care homes, during any medication review or when a resident is discharged from hospital and brought back into the aged care home.” , said the AMA.

Funding for pharmacy services, not GP liaison officers, says Breen

Associate Professor Breen, who has worked as a pharmacist and then a researcher in the field of aged care since 1997 when drug reviews began, said she was not surprised the AMA used her submission as an opportunity to lobby for own funding for GPs to attend MACs, GP Liaisons and RMMRs.

Professor Juanita Breen

“They’re also advocating for the protection of their prescribing rights instead of commenting on what pharmacists can offer in the area of ​​elderly care and how that model can work,” Dr. Breen said. AAA.

“Unsurprisingly, the AMA says it prefers funding for this measure for aged care pharmacists to go to their own GP-led PHNs, saying it is wary of funding going directly to nursing homes. elderly care. They claim the houses will divert funding elsewhere.

“Similarly, I am wary of PHNs using funding unless safeguards and KPIs are in place. Ideally, funding should be allocated only to the pharmacy service; not used to employ GP Liaison Officers as suggested by the AMA, with high PHN administrative costs.

Dr Breen said she was also “deeply concerned” about how long it would take for PHNs to implement this program, as there were often long delays in rolling out PHN programs, citing the “uneven rollout best of the $82 million program for psychologists in care of the elderly, which took several years to start in some PHIs.

“If pharmacists want to be truly integrated, we need to be employed by the aged care provider, not a service provided or contracted out. This way a pharmacist is truly accountable to the department and the department has a say in who works for them. The homes currently employ physiotherapists, social workers and other paramedical practitioners; why not qualified pharmacists? As long as proper financial and oversight safeguards are in place then why not,” she said.

Marea O’Donnell

Marea O’Donnell – who is Chief Clinical Pharmacist at Mederev – also responded to the AMA’s comments in an opinion piece for AAA. She says tackling the barriers to GP presence in the nursing home for the elderly “must be one of the cornerstones of this model of care, otherwise no meaningful results for the integration of pharmacists will occur. for the resident”.

Department reviewing comments

It is proposed that implementation of the on-site pharmacist model will begin in 2023, with funding approved for the first four years and other services being phased out.

The program aims to have pharmacists on-site in 30% of nursing homes for the elderly in the first year of implementation, increasing to 60% in the second year and 80% in the third year. RMMR and QUM program services will be phased out where on-site pharmacists replace these services.

At this time, the department is reviewing “all comments to inform decision-making and the development of the measure and a summary of comments will be posted on the Department of Health and Aged Care website at a later date. “, a spokesperson for the health and aged care department said AAA.

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