It’s not usually a topic Pulse+IT ventures down but the stoush between the pharmacy sector and the medical profession over the highly controversial scope of practice trial being planned for northern Queensland later in the year was brought home this week with the release of a tender for a software solution to support the pilot.
The solution is required to allow pharmacies participating in the trial to prescribe medications, their existing systems obviously not ever needing this capability beyond some of the professional services and vaccinations that pharmacists currently carry out. It is also very obviously required to overcome one of the main criticisms that the medical profession has about the trial, in providing immediate drug-drug and over the counter medicine interaction alert capability.
The development of the new pilot program has been kept under strict wraps by the backers, which includes the Queensland University of Technology and James Cook University, along with Queensland Health, the guild, and the Australasian College of Pharmacy. That has done nothing to keep the speculation down, with the RACGP, ACCRM and the AMA all furious about not just the scope of the trial but the secrecy.
It also comes as Queensland’s trial of prescribing for uncomplicated urinary tract infections looks likely to be replicated throughout the country, extending also into pharmacy prescribing for contraceptives and extensions to pharmacy vaccination programs and other routine primary care services, such as vitamin B injections. Perhaps there should be some middle ground found between routine treatments that pharmacists can take off a GP’s hands and the far more troubling diagnostic capability that the NQ trial seems to propose. If there was more information available on what it actually entails, the debate could perhaps proceed more cordially.
In more pleasant news this week, it’s good to see real progress being made in the implementation of technology for patient journeys, patient flow and patient access. SA Health has signed a two-year contract with local firm Personify Care to open up its services to local health networks that want to use the tech, which automates the patient journey from pre-admission to preparation to discharge and follow-up care. LHNs will be able to customise the technology for their needs under the program.
It comes on the back of an announcement from Alcidion that its patient flow technology has been rolled out at Alfred Health, providing staff with a real-time view of where the patient is and what is happening next. We’ve been following Alcidion’s progress with its Miya platform for years – here’s a rundown of its capability from almost a decade ago – and its good to see the platform doing so well in both Australia and New Zealand. It also has a pretty good footprint in the UK.
One of the other big stories of the week is the change of government in NSW, with the incoming Labor team promising to hold a Royal Commission into healthcare provision in Australia’s largest – and with a $33 billion annual budget, most expensive – health service. eHealth NSW’s single digital patient record program and NSW Health’s virtual care roll-out are likely to come under the spotlight should the RC proceed.
In last week’s poll, we asked: Is Woolies’ HealthyLife venture an appropriate vehicle for virtual care? Our readers are not fans: 10 per cent said yes, but an overwhelming 90 per cent said no.
We also asked what you thought the main problem was. Here’s what you said.
In this week’s poll, we ask:
Do you support the independent prescribing trial?
Vote here or leave your comments below.
I’m not opposed as long as there’s clear governance. It can take 2+ weeks to get into a GP, by which time a little issue can blow out to a big one requiring a visit to your local A&E and a potential hospital bed. RACGP, ACCRM and the AMA need to offer a solution to the current healthcare crisis. They’re pretty happy to have an opinion on someone else’s solution. I suspect the secrecy is because they’re seen as a roadblock.
So, do you support the independent prescribing trial? Most of our readers did: 62 per cent said yes, with 38 per cent against.
We also asked why you voted that way. Here’s what you said:
– Risks to women unacceptable – operating outside scope
– Conflict of interest and prioritisation of sales over patient care. No problem if pharmacist prescriber is external to pharmacist business that dispenses and there are no kick-backs
– Patient access, remove need for 4 weeks wait for healthcare
– Pharmacists have not been medically trained – their expertise lies in the management of medications. If they wish to prescribe then they should undertake medical training
– Ok for episodic care but major problem with multiple prescribers without full understanding of patients conditions. Specailists prescribe but write back to the Gp to ensure continuity of care. Lots of evidence to show having multiple prescibers results in medication errors and reduced qulaity of care at a higher cost.
– I think it will be a huge benefit to the health care system. Pharmacists are very capable, and the community is crying out for convenient, efficient health care.
– Fragmentation of health care. The pharmacists have enough on their plate trying to do what they have been trained for,supporting their customers and medical colleagues , making sure pts take medications as they should, when ,how,drug interactions etc.
We should be complementing our roles not everyone going their on ways.
It will cost more to the government
Pharmaceutical prescribing is complex, associated with high morbidity and mortality and is a major factor in readmissions with ADE. Clinicians have enough trouble getting it right and they are trained (?appropriately) to prescribe. Pharmacists us “what is in the manuals” to guide them. There are many cases where patient care has been compromised by this. A small part of the complexity. Also a more ‘cooperative’ model of pharmaceutical delivery needs to be designed and implemented
– No testing or feedback to GP
– Pharmacists practicing to full scope only benefits the patient, they can have timely access to quality healthcare, easing the pressure on an overworked system. It allows patients to have more choices about where they access their healthcare and ultimately will lead to better patient outcomes. Pharmacists have the knowledge of these conditions to be able to safely and appropriately treat or refer on to another prescriber when the patient requires it.
– Further lack of coordination of Care, Increasing Difficulty of work of GPs through lack of information from pharmacy prescribers, Will lead to more GP closures, will further reduce graduates electing to be GPs, Will hasten the elimination of medical graduates from primary care
– Convenience. Common sense.
– Worsening fragmentation of care and the assumption that prescribing is easy to learn.
– easier for patients to get their medication from their local pharmacy
– More convenient for patients and pharmacist are capable of doing it
– Pharmacist training does to suitably prepare them for this change to their role. It is being done because of a tactical pressure, rather than because they are trained to carry out this more complex activity. It may work 99% of the time but the risk to patient safety is too great without requiring clinical diagnostic training first.
– Their should be a separation between Prescribing & dispensing for medication safety & prevent conflict of interest
– Better patient outcomes and more timely access
– Will benefit patients
– better patient outcomes
– Setting the wolf to mind the sheep is never a good idea from the sheep’s perspective! It is highly unlikely, to put it mildly, that pharmacists who earns from selling prescription drugs will resist the temptation to over -prescribe. Australia already has a world record in antibiotic resistant bugs, due to over-prescription. This will only make it worse.
– Immediate past experience shows once implemented the controls and standards are diluted by the retail environment and pressure for realisation of extra sales.
Training is substandard, does not meet expectations for clinical training, assessment and experience, especialy
Style of delivery setting inapprpopriate for the complexity of what is being addressed.
Loss of continuity of care and ressure to short cut tested processes that ensure patient safety
– Not yet, as a consumer not a clinician, am not convinced about pharmacist having consented access to records of person’s (my) medical history, potentially from multiple practices and specialists, and current conditions including other medications hence what is the possibility of contraindication? Also, timeliness of notification of prescribed medication back to the person’s regular GP, and, what happens if the person does not have a regular GP? How will ED intake, or paramedic know if an adverse reaction occurs? How will an ACCHS be informed?
– pharmaicsts practicing to full scope means better access and outcomes for patients
– Doctors aren’t taking new patients in regional areas and pharmacists are seeing new patients. Doctors can’t manage drug interactions at all and they can’t prescribe medications properly. Doctors cause financial hardship to their patients as they don’t use the PBS correctly. Pharmacists already unofficially fix errors caused by Doctors bad prescribing practices, this trial officially recognises what pharmacists have been doing for years in the back ground
– With checks and balances in place. Occasional review for the patient with their GP/ specialist for some conditions (timeframe set according to type of medication). No section 8 drugs. Professional training required for pharmacist with a system in place to audit their prescribing, and the ability to remove their approval to prescribe if there are problems. I see no reason to see my GP for a repeat script for my dermatitis cream- with the gap fee ever increasing – and this being the treatment, for my occasional flares, for 20 years…..