Many rural Australians have no direct access to pharmacists or pharmacy services. In many rural and remote areas it is not viable to have a community pharmacy. For these areas, how do we ensure there is adequate access to medicines and to medications advice, monitoring and review?
Australians living in rural, regional and remote areas, have poorer health overall than urban Australians. Despite higher rates of chronic disease, in many rural areas there is limited access to health services and health professionals, and lower use of medications.
Although medicines contribute to significant improvements in health when used appropriately, they can also be associated with harm as a result of errors. Medication related hospital admissions have been estimated to comprise between two and six per cent of all Australian hospital admissions. For people aged 65 and over it is estimated that over 20 per cent of admissions are medication related. Medication related problems account for around 230,000 hospitalisations annually, costing an estimated $1.2 billion in 2011-2012.
Studies have confirmed that pharmacist interventions result in improved medicine adherence, reduced hospitalisations and reduced healthcare costs. Pharmacist interventions can also improve prescribing practices and therapeutic monitoring, simplify medication regimens, and optimise therapeutic outcomes. Pharmacy services such as patient medicine education, medicine reviews, drug interaction checking, and dosage and adverse effect monitoring have been proven to make valuable contributions to improving health outcomes.
Many rural patients may have little or no interaction with a pharmacist. They may receive their medicines by mail, bus, train, truck, boat or plane, or from a nurse at a remote clinic. Small multipurpose rural hospitals are often run by nurses and/or general practitioners and, despite having a number of aged care beds and patients with complex medicine regimens, they may have no pharmacy services. In many remote settings registered nurses (RNs), together with fly-in fly-out doctors, provide health care and medicines. In some remote areas standardised treatment protocols (such as the CARPA Standard Treatment Manual) support the legal supply of medicines by RNs and Aboriginal and Torres Strait Islander Health Practitioners.
Fewer than 4,000 of Australia’s 25,000 pharmacists work in rural and remote settings. Many pharmacy graduates are finding it difficult to gain employment in urban areas. While many are keen to practice in rural and remote settings, currently there are no employment pathways. The community pharmacy network is extremely important in the supply of medicines and professional pharmacy services to many Australians, however is not viable in many rural areas. In those areas where there are no community pharmacies, there is a crucial need for clinical pharmacists to be part of the primary healthcare teams.
Pharmacists, unlike some other allied health professionals, do not have provider numbers which allow them to claim for clinical services through the Medicare Benefits Schedule (MBS), other than for medication review. A variety of remuneration models needs to be explored. Innovative, flexible pharmacist service models adapted to a rural community’s needs should be considered. These could include salaried positions in fly-in fly-out teams, in community health, Aboriginal Health Services and GP practices. The Pharmaceutical Society of Australia, with support from the Australia Medical Association, is advocating for the Australian Government to fund positions for clinical pharmacists, under similar funding arrangements as practice nurses, in GP clinics and Aboriginal health services. Remuneration for clinical pharmacist services and tele-pharmacy services should be a priority in the revised MBS.
In addressing the health needs of rural Australia, the Government should take a broader approach to funding for clinical pharmacist services in settings other than community pharmacies.