New recommendations on hospital pharmacists
The Society of Hospital Pharmacists of Australia (SHPA) has called for hospitals to be smarter about spending on medicines support and improve access to cognitive pharmacy services.
Ensuring people take prescribed medicines as intended
According to the SHPA, improving health outcomes and generating economic savings can be achieved by ensuring more people take prescribed medicines accurately and as intended, and by extending pharmacy services to more Australians.
In the SHPA’s Federal Budget 2018-19 Submission, the association also called for better measures to boost medicines compliance – particularly among people at high risk of non-adherence and hospital readmission, and patients taking high cost PBS medicines. SHPA also called for improving access to cognitive pharmacy services on weekends and in aged care facilities.
SHPA’s chief executive, Kristin Michaels, said funding a targeted medicines support service would combat medicines non-adherence, which is currently a well-documented and ongoing burden on Australian patients and the nation’s health sector.
“It is estimated two in five Australians have stopped taking prescribed medicine before they were meant to, on at least one occasion, and over one quarter of all hospital readmissions involve medicines non-use, misuse or abuse,” she said.
A new medicines support service for high-risk patients
According to Michaels, by echoing a successful model in the UK, a new ‘Medicines Support Service’ in Australia would more accurately identify on hospital discharge patients with chronic diseases on complex medicines regimens.
“And these are the costliest on the PBS – for follow-up face-to-face or telehealth pharmacist consultation to optimise medicines use,” she added.
Meanwhile, a more concerted effort should be made to identify, manage and support patients at high risk of poor medicines use, she stressed, particularly when it comes to opioid-related pharmaceutical incidents.
“More Australians die each year from pharmaceutical opioid overdose than illicit heroin use,” she said. “Opioid dependency often originates from unmonitored use of opioids after discharge from hospital”.
“Dedicated, funded Opioid Stewardship programs in hospitals, involving review, monitoring and de-escalation, would reduce risk of future harms from opioid misuse through improved prescribing and discharge processes.”
Michaels said SHPA has also called for a new care model for other high-risk patients, such as those being treated with long-term antimicrobials to treat severe infections resulting from antimicrobial resistance, or complex mental health patients.
“This could mitigate health problems related to unintended misuse of medicines and reduce readmissions, which costs the Australian health budget $1.2bn annually,” she said.
Long-term benefits and a stronger health economy
More comprehensive, seven-day clinical pharmacy services and embedding pharmacists’ expertise across healthcare settings would also provide both long-term health benefits and a stronger health economy, Michaels suggested.
“Embedding dedicated clinical pharmacist roles in Commonwealth aged care facilities and home nursing services would greatly assist the 60 per cent of older Australians with two or more chronic conditions, reducing aged care nurse visits – half of which are for medicine management – while returning $1.54 for every $1 invested,” she added.
To ensure safe, equitable, high quality hospital care is delivered seven days a week, the SHPA anticipates the funding agreement between the Commonwealth and the states and territories from 1 July 2020 should support seven-day hospital pharmacy services in order to lower the risk of medicine-related issues and reduce the mortality rate in Australian hospitals, which is currently higher on weekends.
SHPA recommendations for the 2018-19 Federal Budget
- Support compliance and maximise return on investment in high-cost PBS medicines.
- Reduce harm caused by opioid use initiated in hospitals
- Bridge the gap for high-risk patients leaving hospital and returning to care in the community.
- Provide additional funding to support seven-day clinical pharmacy services in hospitals in the National Health Funding Reform Agreements for Public Hospitals beyond 2020.
- Address safety and quality concerns in aged care by embedding pharmacists in Commonwealth facilities and home nursing services.
- Improve antimicrobial stewardship in all Australian healthcare facilities to address the threat of antimicrobial resistance.
- Fund hospitals to provide Closing the Gap Pharmaceutical Benefits Scheme Measure subsidies to Indigenous people.
- Develop a national pharmacy workforce reform strategy.