Viability and sustainability of pharmacist input in chronic disease management in rural Australia

Abstract

Introduction Management of chronic disease patients is a complex continuum, led by doctors, but delivered by a range of health professionals at different levels of care, including primary care. Success is dependent upon adherence to the holistic therapy and on the accessibility and affordability of services. Aim The aim of this study is to investigate the sustainability of a proposed chronic disease management intervention in community pharmacy and the difficulties faced by pharmacists in implementation. Design This was a pilot study, designed to support future research. Community pharmacists provided feedback on the protocol, their communication with doctors and the cost of providing point‐of‐care (PoC) testing through two surveys. The data from both were thematically analysed. Results Completed questionnaires were returned by eight of nine sites. Sixty percent of pharmacists did not see the PoC component as sustainable without better levels of collaboration with doctors. All sites indicated that the cost of testing cannot be absorbed, and patients or government will have to pay for the service. All sites found that their current staff levels did not allow them to spend sufficient time with large numbers of patients (n = 84). Pharmacist intervention was well accepted by patients. It provided the pharmacists with job satisfaction, but the staffing level, cost and inadequate collaboration from doctors made the sustainability of the intervention doubtful. Conclusion Pharmacists found that unpaid services were afforded lower priority than those that generated income. All pharmacists agreed that PoC testing can be performed in the community setting at the same standards provided in doctors’ clinics.

Expanded practice in rural community pharmacy in Australia: pharmacists’ perspectives

“…A lack of GP support was also a reported barrier in a pilot study of a chronic disease management program in rural Australia, whereby inadequate collaboration with GPs in addition to program costs and insufficient staff levels made sustainability of the intervention unlikely. 24 Improved pharmacist job satisfaction and good patient acceptance reported as enablers concurs with the findings of this study. 24 Service viability was also described as a barrier, with concerns that patients would either not be willing or able to pay for services or that they would expect the services to be provided free of cost.…”

“…24 Improved pharmacist job satisfaction and good patient acceptance reported as enablers concurs with the findings of this study. 24 Service viability was also described as a barrier, with concerns that patients would either not be willing or able to pay for services or that they would expect the services to be provided free of cost. Pharmacists have traditionally provided free advice and service and thus a shift to a pay-per-service model is a barrier to be considered.…”

“…Expected resistance from GPs and other health providers was also described. A lack of GP support was also a reported barrier in a pilot study of a chronic disease management program in rural Australia, whereby inadequate collaboration with GPs in addition to program costs and insufficient staff levels made sustainability of the intervention unlikely 24 . Improved pharmacist job satisfaction and good patient acceptance reported as enablers concurs with the findings of this study 24 …”