15 August 2017
What pharmacists are allowed to do in other countries
Despite talk of pharmacists encroaching on GPs’ turf, Australia lags behind other Western countries in supporting pharmacy-based health services, ranging from smoking cessation programs to chronic-disease management.
The Pharmaceutical Society of Australia compared funding models for nine professional care services offered through pharmacies in six countries and regions.
The checklist, revealed at the society’s annual conference in Sydney late last month, showed Australia was the practice leader in only one area of care – medication reviews for patients with complex medication regimes.
But funding limits made that a bittersweet achievement, Dr Stephen Carter, a consultant pharmacist and lecturer at Sydney University, told The Medical Republic.
“The disappointing thing there is that, on the one hand, we are leading the world, but on the other there are artificial caps on the level of services,” he said. “Funding constraints are holding back a great program.”
This care model, developed from Australian research, had been picked up and progressed around the world. All six areas covered in the PSA report have adopted medication reviews, the others being New Zealand, Canada, the US, the UK and Ireland, and Europe.
But in Australia, the MBS supports only 20 reviews per pharmacy per month, and there is no means for a hospital doctor to order a review for patients coming out of hospital.
According to the society’s scorecard, Australia is alone in not providing government or third-party funding for pharmacy-based quit-smoking services, immunisations and chronic disease management.
It rates New Zealand as the leader in funding pharmacy for chronic disease management, while Canada is the trail-blazer for pharmacists prescribing under protocol. Europe leads for stop-smoking programs, driven by pharmacies in 20 countries.
Dr Carter said Canada and Scotland stood out for innovative funding models for pharmacists to treat minor ailments.
“When we compare ourselves to the UK and Canada, it’s just embarrassing that that there is no such thing as people being looked after in community pharmacies,” he said.
In Ireland and Scotland, regional health authorities paid pharmacists a fee for treating minor ailments such as wound dressing, and co-payments might also apply. In Australia pharmacists might offer the services, but there were no funding mechanisms.
“In past decades, the remuneration pharmacists have earned through dispensing has been subsidising these things. Now PBS funding has been shrinking, it’s not sustainable,” Dr Carter said.
He said the RACGP’s suggestion that GPs should be permitted to dispense medicines was “laughable” and at odds with a considered policy in Australia to keep the roles of prescribing and dispensing separate.
“I’m actually very disappointed in the RACGP’s continual mention of a turf war. Medical practitioners are meant to work in collaboration with other health providers, and this is not ethical. I think they should rethink their leadership in this area.”