Medicines review spotlight welcomed, but Hospital Pharmacists are key to safety and sustainability

Medicines review spotlight welcomed, but Hospital Pharmacists are key to safety and sustainability

The Society of Hospital Pharmacists of Australia (SHPA) has welcomed new national recommendations supporting affordable, universal and timely access to healthcare and medicines, while cautioning that reducing polypharmacy via medication reviews will be costly and ineffective without harnessing the full capacity of Hospital Pharmacists as medicines experts.

Released this week, the Grattan Institute’s Not so universal: How to reduce out-of-pocket healthcare payments report highlights the high out-of-pocket costs combined with variable bulk billing that is disadvantaging Australia’s most vulnerable patients – those belonging to lower socioeconomic groups and those who suffer from chronic conditions.

SHPA Chief Executive Kristin Michaels says the report’s recommendation to reduce pharmaceutical out‑of-pocket costs by using artificial intelligence (AI) software to trigger medication reviews solely led by General Practitioners (GPs) only tells half the story.

‘The report acknowledges AI could potentially reduce inappropriate medicine use for about 300,000 patients. Many public hospitals and Hospital Pharmacists are already using or are preparing to use in future, artificial intelligence and clinical decision aids to inform clinical decisions, determine patient risks and prioritise the delivery of healthcare services.

‘However, this does not ameliorate the need for an actual pharmacist to help lead this important work to deliver patient-centred medication reviews.

‘For example, the crucial role of pharmacy in aged care is undeniable, with Australian research indicating 91% of aged care residents take at least five regular medicines, and 65% take more than 10, every day.

‘In 2020 Home Medication Review (HMR) and Residential Medication Management Review (RMMR) Program Rules were changed to broaden the referral base beyond GPs and fund up to two follow-up encounters after initial medication review. SHPA’s Hospital-initiated medication reviews (HIMR): Hospital pharmacy practice update shows how this can be done.

‘The 2020 change was a win for medicines safety, which has been recently recognised as a National Health Priority Area, and we must now empower doctors and pharmacists to work collaboratively and deliver patient-centred medication reviews as patient need arises along their healthcare journey to reduce unnecessary medicines use and medication-related harm.’

Ms Michaels says the Grattan Institute’s report’s proposed solution to trigger medication reviews without any input from pharmacists is a missed opportunity to improve patient outcomes while minimising costs to the health system.

‘The Grattan report echoes what our members have long said: medication management reviews are not happening when and where they should in order to provide the best value and most positive impact on medication safety. It is when doctors and pharmacists work collaboratively – as they do in hospitals – that we can achieve improved health outcomes and reduce polypharmacy in a patient-centred manner.

‘On behalf of our members, SHPA is disappointed to see pharmacists were not mentioned in the proposed solution to increase the prevalence and delivery of medication reviews, despite currently offering home, residential, hospital, or GP-practise based medication review services.

‘The report also notes out of pocket costs are a barrier to treatment, resulting in delayed treatment and diagnosis, subsequently pushing patients, inefficiently, onto the public hospital system. Hospital Pharmacists see this everyday as patients end up in emergency departments after their health has deteriorated, despite hospitalisation being preventable.

‘Our Hospital Pharmacists treat patients at their most unwell and have a vital role in reducing the unnecessary use of medications which keeps overall out-of-pocket costs down, in and out of hospital.’

Ms Michaels added SHPA supports extending the duration of some prescriptions to reduce the number of times a prescription co-payment needs to be paid.

‘Our members report that hospitals already supply over a month’s worth of medicines for long-term, stable patients, or patients that have far to travel and can safely have over a months’ worth of medication dispensed at a time, as this improves their adherence over the long term.

‘We must apply this patient-centred thinking across all points of care and, when it comes to medicines safety, Hospital Pharmacists have the expertise and experience to intervene and make a difference.’