Just before we start the new year, the refreshed National Medicines Policy was released, which governs every aspect of drug use in Australia.
Reviewed for the first time since 2001, the updated policy provides an opportunity to see how we measure up against its three key goals: ensuring equitable, timely, safe and affordable access to a high-quality and reliable supply of medicines; . Safely with informed choice and well-coordinated person-centred care with optimality and justice; and supporting a positive and sustainable policy environment to drive world-class drug innovation and research.
So how are we doing?
We still see around 250,000 drug-related hospital admissions a year in Australia, including recent cost of living relief through general PBS co-payment reductions, while in many areas excelling in innovation and ongoing bipartisan support for a world-class pharmaceutical benefit scheme. , costing the health care system more than $1.4 billion per year. Evidence shows us that these figures will decrease if we address our ongoing workforce gap in specialist and specialist pharmacist roles.
According to the National Skills Commission, every single jurisdiction faces staff shortages in both community and hospital pharmacy, underscoring the urgent need for a national strategy to meet the immediate and future healthcare needs of the Australian community. In the latest National Drug Policy, the healthcare workforce has been identified as a critical enabler for the success of NMPs.
We need strong size, distribution and depth in our pool of pharmacists and pharmacy technicians to maintain medication safety, prevent hospital readmissions and reduce preventable medication-related harm. This is particularly important in transitions of care between hospital, home, and residential aged care, the intersection of increased risk that results in many drug-related hospitalizations.
Another key issue leading to the failure of equity and access to medicines – a fundamental tenet of national drug policy – is the Pharmaceutical Reform Agreements (PRA) and the ongoing non-participation of the ACT and NSW.
In their most recent ACT Health Service Plan 2022-2030, the ACT Government committed to establishing a PRA with the Commonwealth. In December, the final report of an inquiry into ambulance ramping in New South Wales included a recommendation for NSW to join, enabling NSW residents to access 30 days’ worth of PBS-subsidised medicine after hospital discharge, down from three days. ‘ Drug prices, which are a serious drug safety risk during care transitions, especially considering the availability of access to GPs in many parts of the country.
The NSW report calls for expanding hospital pharmacy ranks, embedding more specialist emergency medicine pharmacists in care teams and expanding innovative services and pharmacist-led prescribing.
Pharmacist prescribing in Australia has been at the forefront of the boundary over the past decade in the acute care setting, led by initiatives such as Partnered Pharmacist Medication Charting (PPMC). The PPMC service at Royal North Shore Hospital’s emergency department showed a reduction in medication charting errors from 22% to 1%, with the majority of emergency department medical staff supporting this collaborative care model and high confidence in the hospital’s pharmacists — who are certified — to chart medications safely.
Similar mature, collaborative models are now being embedded in practice across five states and territories, with others keen to follow suit (ACT Health is hiring dedicated PPMC pharmacists starting next month) and have been shown to improve patient safety and quality of care by reducing medication errors and delays in critical care. , as well as increasing the job satisfaction of not only pharmacists, but medical staff as well.
Collaborative models allow both professions to practice at the top of their scope of practice, providing true interdisciplinary synergy for the ultimate benefit of our patients.
However, with a lagging hospital pharmacy workforce, it is difficult to implement and expand these innovative models that are common overseas, and proven to improve quality, safety, bed flow and system capacity. Although the NSW report and recommendations reflect one jurisdiction, the experience is similar across the country due to years of understaffing.
The power of medicine, our most common health intervention, actually lies in the health professionals we trust to understand, administer, and monitor safely. Pharmacists are absolutely essential, but to meet the promise of the National Medicines Policy we need more of them, with advanced, specialized skills, where patients need them.