Medication and collaboration: Improving the quality and accessibility of pharmacy services for high-need populations

Thursday, November 5, 2015

One of the largest community health services in Australia, cohealth is the result of a merger between three long-standing Victorian community health services on 30 April 2014. Providing a broad range of prevention and treatment services — including medical, dental, allied health, mental health support and homelessness services — one of the unique offerings to date has been a not-for-profit pharmacy service. Located at cohealth’s Collingwood site, the pharmacy is the only one of its type in the country, and has been in operation for over two decades.

The service employs pharmacists to work alongside general practitioners (GPs) and other health providers within an integrated setting. It provides low cost medication, medication review, monitoring and education in collaboration with other health providers, to local community members from disadvantaged and marginalised groups. Annually, the service dispenses about 30,000 prescriptions.

Clients of the service are people living in significantly disadvantaged circumstances, with generally low levels of health literacy and often multiple chronic diseases. Around 40% of clients are from non-English speaking and low English proficiency backgrounds. The integrated service includes the use of interpreters with both GPs and pharmacists. This ensures that people actually get their prescribed medication, and that they actually understand what they need to know in order to take it safely and appropriately.

There are also large numbers of clients who are homeless or living in insecure housing, as well as those with other significant risk factors like drug and alcohol dependence. These clients require tailored pharmacy practice not available in standard pharmacy settings. Compared to those settings, the cohealth pharmacy service has enhanced capacity to review the appropriateness of medication, and to minimise the risk of over-medication or medication errors. This is achieved through close collaboration with GPs and other healthcare providers, use of interpreters where required, and a strong commitment to a person-centred response which meets the needs of people who experience difficulty in accessing services and also have high-level needs. For example, pharmacists often develop tailored dispensing regimes for at-risk populations, those with mental health issues, substance use issues and the elderly.

The integrated setting ensures a common electronic record is used, which facilitates visibility and promotes collaboration between health professionals. It includes simplified referrals and communication pathways between different professions, including GPs, pharmacists, alcohol and drug workers, mental health clinicians, and nurses. In addition to providing comprehensive care and enhancing access for vulnerable groups, the pharmacy service also operates a lower cost than the standard model of for-profit retail pharmacies. Department of Health data indicates that the average cost of a prescription through the cohealth pharmacy service is 31% lower than the average government cost per prescription for PBS medication. This represents a saving to the government of almost $250,000 per annum.

While the pharmacy service is currently supported by the Commonwealth, it has been announced that this funding may cease from 1 January 2016. Currently, cohealth is working with the Department of Health to progress approval under the Sixth Community Pharmacy Agreement (as suggested by the Department), but options under the existing legislative and regulatory frameworks appear limited. Still, cohealth remains committed to not only continuing the model at its Collingwood site, but also exploring opportunities to expand the model to additional sites.

The cohealth integrated pharmacy model is consistent with the directions promoted by the Australian Medical Association and the Pharmaceutical Society of Australia, towards developing an integrated model with pharmacists as part of the primary care team. This approach is echoed in the National Mental Health Commission’s National Review of Mental Health Programmes and Services, which recommends routine pharmacist involvement in the mental healthcare team.

A number of national reviews and inquiries are currently focusing on ways to improve the health system to better meet the needs of people with chronic and complex conditions. These include the House of Representatives Standing Committee Inquiry into best practice in chronic disease prevention and management in primary healthcare, and the Primary Health Care Advisory Group — better care and support for people with chronic and complex illness. The cohealth pharmacy model provides an operational example of integrated practice which is both efficient and effective in improving the quality and accessibility of pharmacy services for highneed populations.

This article was written by cohealth Chief Executive Lyn Morgain for The Health Advocate. To view the full publication, click here.