Drs want PHNs to run onsite pharmacist program

The Australian Medical Association has recommended funding go to Primary Health Networks to implement residential aged care’s embedded pharmacist program rather than aged care homes.

The AMA argues the PHN-funded approach would ensure independence of pharmacists from aged care providers. However, University of Tasmania academic Associate Juanita Breen – who developed the successful RedUSe program to reduce antipsychotic use in aged care – says if pharmacists are to be truly embedded, aged care homes should employ them.

The AMA and Dr Breen are among 146 stakeholders who provided written responses to the government’s Aged care on-site pharmacists consultation paper before it closed on 16 September, a department spokesperson told Australian Ageing Agenda.

Under the $350-million program announced in the Coalition’s May Federal Budget to commence next year, funding will be provided for one full-time pharmacist per 250 beds to be employed or engaged to provide onsite clinical services in aged care homes to meet the needs of residents and the facility and address any issues around medication use.

Proposed program’s features

According to the consultation paper, the onsite pharmacist will:

• provide continuity in medication management
• assist with medication management and communication during transitions of care
• undertake whole-of-facility quality use of medicines activities
• advise, attend and report to the Medicines Advisory Committee and help set up a MAC where not already established.

Where there is an onsite pharmacist, separate Residential Medication Management Review and Quality Use of Medicines Program services will not be funded, which as previously reported, is a point of contention for some.

For their part, onsite pharmacists will need to complete additional training specific to medication management in older people while aged care homes will be required to adopt the eNRMC – electronic national residential medication charts – to access funding.

Under the proposal, existing MACs will be given formal responsibility for monitoring and evaluating service delivery and outcomes against agreed standards and quality outcomes, such as inappropriate psychotropic and antimicrobial use, falls and hospitalisations – which will be reported to government.

Regarding potential implemention approaches, the government is considering whether to directly fund aged care homes to employ or engage pharmacists or fund Primary Health Networks to co-ordinate onsite pharmacists to regularly rotate between aged care homes in their catchments.

AMA advocates for PHN-led approach

The AMA said it preferred the PHN-funded approach because it would ensure independence of pharmacists from aged care providers, and the linking of all pharmacists in the area to develop and support learning networks.

“If the PHN model is adopted, PHNs could start communities of practice across aged care homes, introduce an aged care home GP liaison officer and multidisciplinary teams,” the AMA said in its submission.

The AMA raised concerns about providing funds directly to aged care homes, without any specific requirements. “If funding is provided directly to aged care homes, then they should be expected to provide financial statements as evidence that the funding was actually used to hire onsite pharmacists. Reporting should be itemised by hours worked and hourly pay rate,” it said.

Elsewhere the AMA has called for Medicare items for regular medication reviews for residents of aged care homes to be maintained regardless of the approach, recognition that GPs are the key medical care professionals in aged care – with pharmacists providing support to GPs rather than replacing them – and assurances that pharmacists will be non-prescribing.

“The AMA supports a model where accredited pharmacists collaborate with GPs in aged care on assisting with medication adherence, improving medication management and providing education about medication safety. This is not a preference, but a condition. This collaboration will be particularly important during the instances of intake of new residents into aged care homes, when any medication reviews are conducted, or when a resident is discharged from hospital and brought back to the aged care home,” the AMA said.

Funding for pharmacy services, not GP liaison officers, says Breen

Associate Professor Breen, who has worked as a pharmacist and then researcher in aged care since 1997 when medication reviews first began, said she was not surprised the AMA used its submission as an opportunity to lobby for their own funding for GPs to attend MACs, GP liaison officers and RMMRs.

“They also advocate to protect their prescribing rights as opposed to commenting on what pharmacists can offer in residential aged care and how this model can work,” Dr Breen told AAA.

“Unsurprisingly, the AMA states they prefer funding for this aged care pharmacists measure to go to their own GP-led PHNs, saying they are wary of the funding going directly to aged care homes. They claim homes will divert the funding elsewhere.

“Likewise, I am wary of the PHNs using the funding unless safeguards and KPIs are put in place. The funding ideally should be allocated for the pharmacy service alone; not used to employ GP liaison officers as the AMA suggests, along with hefty PHN administration costs.”

Dr Breen said she was also “deeply concerned” about how long it would take PHNs to implement this program because there were often lengthy delays to PHN program rollouts, citing the “patchy” at best rollout of the $82 million psychologists in aged care program, which took several years to get started in some PHNs.

“If pharmacists want to be truly embedded we need to be employed by the aged care provider, not be an externally provided or contracted service. In this way a pharmacist is truly accountable to the service and the service has the say in who works for them. Homes currently employ physiotherapists, social workers and other allied health practitioners; why not qualified pharmacists? As long as appropriate financial and oversight safeguards are put in place, then why not,” she said.

Marea O’Donnell – who is chief clinical pharmacist at Mederev – has also responded to the AMA’s feedback in an opinion article for AAA. She says addressing the barriers to GPs attendance into the aged care home “must be one of the cornerstones of this model of care otherwise no meaningful outcome for embedding pharmacists will occur for the resident.”

Department reviewing feedback

Implementation of the onsite pharmacist model is proposed to commence in 2023, with funding approved for the first four years and other services phased out.

The program aims to have pharmacists onsite in 30 per cent of aged care homes in the first year of implementation, increasing to 60 per cent in the second year and 80 per cent during the third year. RMMR and QUM Program services will be gradually phased down where onsite pharmacists replace these services.

For now, the department is reviewing “all feedback to inform further decision-making and development of the measure and a summary of feedback will be published on the Department of Health and Aged Care’s website at a later date,” a spokesperson from the health and aged care department told AAA.

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