16 June 2022

Another pharmacist-led trial in the firing line

AMA Pharmacy Political

The value of a pain-management study that excludes all other practitioners has been called into question.

Further funding of a pharmacist-led pain management trial should be denied, the AMA has told MSAC, in part because it excludes GPs and other practitioners from what should be a multidisciplinary approach.

The Chronic Pain MedsCheck Trial was designed to assess the effectiveness of a pharmacist service in supporting patients who were taking medication to manage chronic pain and who a community pharmacist identified as experiencing self-management problems or pain medication dependency.

The Pharmacy Guild and the PSA were lead organisations for the trial, in partnership with the University of South Australia.

However, the AMA, which has lodged a submission with the MSAC opposing further funding, said it was troubled not just by the service concept but also by the motives of the Guild.

“The AMA’s concern is that this application is part of a trend of the Pharmacy Guild seeking public funding for services which at best provide no value for consumers but get them through the door to spend more on unnecessary items of no or low therapeutic value,” the association said today. 

“The study saw pharmacists opportunistically discussing stepping down pain medication use with customers at the pharmacy … and did not follow up with participants on their engagement with GPs or other health services.”

Participating patients all attended a community pharmacy; had suffered from chronic pain for three months or longer; and had been taking prescription or over-the-counter medication for their pain. They had not received a home medicines review, MedsCheck, Diabetes MedsCheck or Chronic Pain MedsCheck within the previous 12 months, and were not a current client of a recognised pain management service.

The trial compared two service models of review, assessment and support: one model involved two clinical consultations, while the other had three consultations.

The Guild struck a grant agreement with the Department of Health to conduct the trial, according to the MSAC Consultation Summary. The Guild also contracted health industry management consultants HealthConsult to design and evaluate its effectiveness as well as establishing an expert panel to oversee it.

The Australian and New Zealand College of Anaesthetists (ANZCA) has also weighed in on the funding application.

Dean of the college’s pain medicine faculty Dr Kieran Davis wrote to the DoH health technology assessment team last week, noting ANZCA had been concerned about the trial ever since its announcement.

“We expressed concern that the scheme had been developed without appropriate input from medical specialists and did not adequately recognise that the successful treatment of chronic pain requires a multidisciplinary approach,” Dr Davis said.

“As anticipated, the trial has focused exclusively on pharmaceutical interventions. We maintain that while it is appropriate for pharmacists to concentrate on the pharmaceutical aspects of a pain care plan, it is inappropriate for that to occur in the absence of consultation with prescribers and other members of the patient’s treatment team.”

The consultation summary did not appear to indicate that any trial participants’ interactions involved the patient’s GP or other healthcare professional, including a specialist pain medicine physician, he said.

In our view, the study as presented shows only the possibility that a subgroup of pharmacists may be able to persuade a subgroup of patients to reduce their medication in the short term,” Dr Davis said. “Direct payment of public funds to pharmacists to support an unproven one-dimensional treatment intervention would be neither in the best interests of people experiencing chronic pain nor in the interests of the reputation of the pharmacy profession.”

The AMA said the association supported closer collaboration with pharmacists in a range of areas and would welcome funding for more “patient-centred pain management programs based on doctor-led, team-based care”.

“This model promotes the opposite of this,” the AMA said: “funding a pharmacist with very little training providing a service with little to no evidence in isolation of other health care providers.”