Harnessing hospital pharmacists: Smarter spending will improve lives

The twin goals of improving health outcomes and generating economic savings can be achieved by ensuring more people take prescribed medicines as intended, and pharmacy services are extended to more Australians, the Society of Hospital Pharmacists of Australia (SHPA) said today.

SHPA’s Federal Budget 2018-19 Submission details policy measures to boost medicines compliance – particularly among people at high risk of non-adherence and hospital readmission, and patients taking high cost PBS medicines – and improve access to cognitive pharmacy services on weekends and in aged care facilities, among eight key recommendations.

SHPA Chief Executive Kristin Michaels says funding a targeted medicines support service would combat medicines non-adherence, 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.

‘Echoing a successful model in the UK, a New Medicines Support Service in Australia would identify, on hospital discharge, patients with chronic diseases on complex medicines regimens – which are the costliest on the PBS – for follow-up face-to-face or telehealth pharmacist consultation to optimise medicines use.

Ms Michaels says a more concerted effort should be made to identify, manage and support patients at high risk of poor medicines use.

‘More Australians die each year from pharmaceutical opioid overdose than illicit heroin use. 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.

‘In addition, a new care model for other high-risk patients – such as patients being treated with long-term antimicrobials to treat severe infections resulting from antimicrobial resistance, or complex mental health patients – will mitigate health problems related to unintended misuse of medicines and reduce readmissions, which costs the Australian health budget $1.2bn annually.’

Ms Michaels says seven-day clinical pharmacy services and embedding pharmacists’ expertise across healthcare settings would also provide both long-term health benefits and strong economic return.

‘To ensure safe, equitable, high quality hospital care is delivered seven days a week, 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.

‘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.’

SHPA recommendations for the 2018-19 Federal Budget

  1. Support compliance and maximise return on investment in high cost PBS medicines.
  2. Reduce harm caused by opioid use initiated in hospitals
  3. Bridge the gap for high-risk patients leaving hospital and returning to care in the community.
  4. Provide additional funding to support seven-day clinical pharmacy services in hospitals in the National Health Funding Reform Agreements for Public Hospitals beyond 2020.
  5. Address safety and quality concerns in aged care by embedding pharmacists in Commonwealth facilities and home nursing services.
  6. Improve antimicrobial stewardship in all Australian healthcare facilities to address the threat of antimicrobial resistance.
  7. Fund hospitals to provide Closing the Gap Pharmaceutical Benefits Scheme Measure subsidies to Indigenous people.
  8. Develop a national pharmacy workforce reform strategy.