Is community pharmacy holding back health reform that might benefit patients? That is the question posed by Ron Batagol, a pharmacy and drug information consultant, from Nunawading, Victoria.
“It is interesting to follow the recent “turf war” between medical, pharmacy and nursing groups over the plans of the Revive Nurse Clinic chain to rapidly expand their service locations, which operate within a targeted group of community pharmacies.
Revive Clinic nurses diagnose and treat a variety of common conditions including colds, flu and urinary tract infections and administer vaccinations.
Medical groups say that differential diagnosis in primary care, without the input of a qualified medical practitioner, threatens quality health care because there is the potential for more serious conditions to be overlooked.
Peak pharmacy groups emphasise that pharmacists, with their specific professional expertise and training in medication advice and management, already provide high-quality primary health care treatment and professional services, including advice on correct use and safety issues for non-prescription medicines, plus referral on to doctors when appropriate.
Within the hospital environment, it is recognised that hospital pharmacists as a group have achieved a high level of professional clinical pharmacy practice, by building up watertight business cases through high-quality health outcome research and study over the years, demonstrating clinical benefits, more cost-efficient use of medications, and improved patient outcome when the expertise of clinical pharmacists is fully utilised.
By contrast, “official pharmacy” has never really seized the opportunity to systematically perform the dedicated patient outcome and follow-up studies that are needed to mount a credible case for recognition of community pharmacists as accredited Medicare primary health care providers.
Yet, day in and day out, community pharmacists routinely manage the primary health care needs of their patients, including expert advice on safe and effective use of prescription and non-prescription medicines, and medical referral when required.
It is, however, only quite recently that dedicated research groups have started to systematically tap into, and analyse, this hidden wealth of outcome data.
Is it any wonder, therefore, that another group of health professionals wants to “muscle” in on the action?
Nurses certainly do have special expertise in patient observation, and monitoring of vital signs and changing levels of health status, plus a host of other specialised and varied functions such as wound and skin care care, stomal therapy, administering injections and vaccines, and monitoring bowel management, special nutrition, fluid balance etc. Furthermore, “shopfront” access to their expertise in triaging, home nursing advice, and in preparing and monitoring Health Care Plans, would be of invaluable assistance to the family and carers of those requiring high-level nursing and medical care at home.
However, the co-location of two types of highly-trained health professionals, each providing, at least in part, overlapping primary care services,
does seem to be wasteful of precious human resources and hard to justify.
If we really want to provide a multidisciplinary primary care environment, in which everyone wins, including the patients, a better alternative would be to have individually Medicare-accredited pharmacists and nurses, practising collaboratively alongside doctors, in a community care location, such as a dedicated “super-clinic” setting.
Unfortunately, at least for individual pharmacists, with the PBS-registered community pharmacies holding all the funding chips on the antiquated, PBS prescription supply-based Medicare monopoly board, that option does not look like happening any time soon.”