hospital pharmacy and medication department
Besides being the most common intervention in health care, drugs are a particularly complex policy area. Primarily prescribed by physicians, administered by nurses, manufactured by industry, regulated by government, and reviewed, dispensed, managed, counseled and composed by pharmacists, drugs are a vivid example of the complexity of healthcare as many professionals interact to enable the treatment of a single individual.
Australians have high expectations for access to medicines, and rightly so. We should all be proud of the overarching policy framework that has evolved to support timely access to high quality medicines across a wide range of health care settings. People are no longer ready to accept that a pharmacy, hospital or senior care facility does not stock a particular drug. Even the highly regarded and independent Pharmaceutical Benefits Advisory Committee (PBAC) processes, which result in recommendations to the federal government on which drugs should be subsidized, have become the target of campaigns by consumers wanting to be entitled to access expensive drugs at greatly reduced prices. . Considering the rate of drug use in Australia, this is not surprising: nine million Australians take prescription drugs daily.
And yet, the leadership of drugs remains fragmentary; Drug use, funding, and clinical pharmacy care are rarely discussed in a collaborative conversation. Given the multiple roles played by pharmacists – from managing shortages to supporting prescribing in hospitals and treating patients – health policy has been slow to recognize the value of pharmacy care for those at risk. drug-related complications.
Even the Medication Safety Standard, the accreditation requirements governing medication management in our hospitals, makes little explicit mention of pharmacists and their in-depth medical expertise. Likewise, the 1998 National Medicines Policy places high priority on consumer access to medicines and a sustainable industry, but ignores the fact that without clinical pharmacy support consumers are at risk. increased undetected drug interactions and debilitating side effects. Over 250,000 medicine-related hospitalizations occur in Australia each year.
In recent years, the maturation of medical research and technology has changed the nature of the PBS drug lists. Since 2013, more than 2,100 new or modified registrations have been added at an overall cost of approximately $ 10.6 billion; these lists are increasingly intended for the treatment of small groups of critically ill patients in acute settings. About two-thirds of the new PBS drugs listed in the past 12 months are distributed primarily in hospitals. Commonly subsidized under the classification of “special arrangements”, these drugs are prescribed under specific conditions, provided only by hospitals, require specialized medical care and monitoring, and are expensive. Not surprisingly, they also require substantial clinical pharmaceutical care, including polypharmacy management, therapeutic drug monitoring, daily dosage adjustments, adherence support, and outpatient follow-up.
In addition, the range of drugs now available has created a specific need for pharmacists to facilitate effective prescribing as part of the multidisciplinary team in acute settings. In a high pressure and extremely busy clinical environment, an electronic medical record will offer more than 3,500 drugs to be prescribed on discharge, many with different brands of the same drug, resulting in 18,200 options. This, in addition to information about substituting biosimilars, modifying treatment to deal with shortages, reducing polypharmacy, and navigating various pathways to and subsidizing drugs, is an overwhelming amount of information that healthcare professionals should retain while they undertake their basic work of diagnosing, treating and caring for patients. Fortunately, hospital pharmacists already have the expertise to navigate this complexity effectively: a major Australian hospital study found that for every dollar spent on a clinical pharmacist to initiate changes in treatment or medication management, about $ 23 was saved over length of stay, likelihood readmission, medications, medical procedures, and laboratory monitoring.
The SHPA has long advocated for greater recognition of the importance of clinical pharmacy services in hospital and community settings. At our recent Drug Leadership Forum in Canberra, this was reaffirmed with calls to strengthen support for the crucial transition of care – as people leave hospitals to return to their communities – through the referral to a hospital for clinical examination for patients taking new drugs and are at high risk. negative impacts. In addition, we would be delighted with a renewed commitment to the founding document of the successful PBS Drugs in Hospital program. This statement, “Guiding Principles for Ensuring Continuity in Drug Management,” describes a path to high-quality drug management, including efficient clinical transmission and equitable access to drugs at discharge.
To ensure Australians get the most out of the use of drugs, medical leaders need to consider the workforce as well as the concerns of industry and consumers. The successful combination of effective, accessible medicine with appropriate pharmaceutical care is essential for the positive outcomes we all seek for patients. Increased collaboration and understanding of the role of each part of this puzzle will help achieve greater synergy in drug policy and high quality patient care. Alongside 118,723 health professionals and 378,325 nurses, 31,785 pharmacists have the knowledge and know-how to play their role.