Concerns raised over onsite pharmacist model

The Residential Medication Management Review service should co-exist with the onsite aged care pharmacist program, says an aged care industry CEO.

The government should allow the evidence-based Residential Medication Management Review service to co-exist with the onsite aged care pharmacist program, says clinical pharmacist Michael Bonner, whose company provides professional services to the aged care sector. 

Aged care’s RMMR experts could be tasked with mentoring the next generation of the sector’s pharmacists, he said.

The Federal Government intends to embed pharmacists in aged care homes to improve medication management and safety. Under the measure, funding will be provided for pharmacists to be employed or engaged to:

  • provide clinical services on-site in aged care homes
  • meet the needs of residents and the facility
  • address any issues around medication use.

The $350-million program was announced in the last Federal Budget and responds to recommendations from the aged care royal commission. It aims to give residents and their families confidence that medications are regularly reviewed, appropriate, and will provide continuity in medication management.

The Department of Health and Aged Care has outlined the proposed measure and how it will be implemented in the Aged care on-site pharmacists consultation paper

It says, aged care’s current Quality Use of Medicines and Residential Medication Management Review Program services funded under the Seventh Community Pharmacy Agreement will not be available where a residential aged care home has an on-site pharmacist to avoid duplication.

However, “RMMRs and onsite pharmacist services are not mutually exclusive,” said Mr Bonner, the chief executive officer and owner of Choice Aged Care, which provides professional medication-related support to around 445 aged care homes including QUM, RMMR and onsite pharmacist services.

Michael Bonner

“These two distinct tiers of input would provide complementary and symbiotic medication safety stewardship support to a residential aged care home and their care recipients,” Mr Bonner tells Australian Ageing Agenda

“Substituting the input residential aged care facilities and general practitioners receive from an aged care expert clinical RMMR and QUM pharmacist with a new-career non-accredited pharmacist will exacerbate a resident’s risk of medication-related harm,” he said.

RMMRs have been shown to reduce resident mortality by 5 per cent and reduce rates of antipsychotic use and polypharmacy” whereas the limited trials of onsite pharmacist models of service have failed to prove the same, said Mr Bonner, who made a 40-page feedback submission to the consultation. 

In addition to the replacement of the evidence-based RMMR medication review service, the pharmacist workforce – or lack of – to supply the department’s projected rollout of 60 per cent of aged care homes over the first two years, and an inbuilt metropolitan-bias are other concerns with the proposal, he said.

“The lack of any clarity on the credentialling and training required for an aged care onsite pharmacist is also a major oversight, especially given the program intends to start in just 10 weeks,” Mr Bonner said.

As “a health professional from the bush,” it is concerning the onsite pharmacist model appears likely to “exacerbate the disparity of medication management” support in regional and remote areas, Mr Bonner said. “The onsite model based on one full-time pharmacist per 250 beds will naturally favour larger and metropolitan-based residential aged care facilities. The department has not given any inclination as to whether rural [facilities] can hope to invoke technology to gain ready telehealth access to a pharmacist’s support.”     

RMMR experts could mentor next-gen aged care pharmacists

Retaining the current cohort of expert RMMR pharmacists in aged care to continue conducting high-impact RMMRs – which “would reflect less than 5 per cent of the total budget allocated for the onsite pharmacist service” – and mentor the 2,000 new-career onsite pharmacists required, would be a better model than the proposed one, Mr Bonner said. 

“Nurses and care providers are not equipped to provide supervision or mentorship to pharmacists and the sector certainly does not have capacity to add that to their workload. Without mentorship or support, onsite pharmacists who have limited industry preparedness will exacerbate the churn-and-burn workforce attrition experienced by care providers,” he said.

Mr Bonner also suggested “a slower and more realistic” rollout period of the onsite pharmacist model. “I would think an uptake of 10-15 per cent of the nation’s residential aged care facilities per year to be achievable and safer.”

Consultation closes this Friday

The department is seeking feedback from aged care providers, stakeholders and technical experts on the introduction of onsite pharmacists in aged care homes.

The department is particularly interested in feedback on:

  • funding models for employment of onsite pharmacists
  • the role of onsite pharmacists
  • training requirements
  • pharmacists and provider reporting, including the development of quality indicators
  • how to transition from current arrangements.

Consultation closes 16 Sep 2022. Find out more and access the relevant documentation details here: Aged Care on-site pharmacists.

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Tags: choice aged care, consultation, featured, michael bonner, pharmacists,

2 thoughts on “Concerns raised over onsite pharmacist model

  1. The Royal Commission identified many issues around medication management and safety in residential aged care Services. These include polypharmacy, overuse of psychotropics, lack of resident choice & limited involvement of relatives for consent and issues at transitions of care. Many Services do not have RMMRs, only 20% of residents get them overall and the quality and impact of this program is unknown because there are no KPIs, audits or checks.

    It is important to realise that the issues regarding medication were identified with the present RMMR program in operation – which it has for over 25 years.

    The RC concluded a new model was needed where the pharmacist was accountable, actually present to talk to residents, GPs, staff and relatives and that there was oversight into quality and outcomes. RMMRs will not stop – they will be able to provided more often by a single pharmacist who works at and for the Service. They can be performed more collaboratively, and the person that does them would be part of the RACF instead of an externally provided service provided for a few days every 3 months at best. Many smaller homes see their contracted RMMR pharmacist once a year – if they have one.

    The embedded pharmacist model is intended to address this as it is obvious the present model is not working.

    The new model will theoretically allow each home to have a pharmacist of their choosing and to have pharmacists doing RMMRs to get patient consent, get to know GPs, be able to talk to residents and to work collaboratively with staff – there would be some accountability around quality and provision of service – and KPIs. The new model would allow more assistance with medication audits, training, MACs, policy and liaison with allied health and prescribers. This is funded at the moment as QUM but again not audited, evaluated and often not provided at all.

    What would an embedded pharmacist do if there was another pharmacist there doing RMMRs? They would have 2-3 days a week funded in an average 100 bed service to do what?

  2. I agree with Juanita.
    In my opinion, the on-site aged care pharmacists role is just a natural evolution of the role accredited pharmacists can play in aged care. I think RMMRs and QUM services can roll over into the new model, and expand in output and outcomes, given that the on-site presence will enable better collaboration with prescribers, nurses and allied health; and a greater understanding of the complexity of aged care.

    I hope RMMRs will continue over the transition period, but don’t agree with separate providers doing RMMRs and QUM services, and OACP services at the same time. This is duplication, and won’t encourage integration into the aged care environment. They are not 2 distinct tiers of input in my opinion.

    In my submission to the consultation paper, I stressed that accreditation for pharmacists should be mandatory.
    And a couple of critical enablers: continuation of Item 903 for GPs (should be expanded to geriatricians, NPs etc), travel allowance for rural facilities and mentoring (either internal or external).

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