Patient – Centred Patient Homes

We are reading a lot about aspirations in terms of attitudes to treatment of patients in transformational health spaces.
A culture change drives this thinking because we are aware that health costs as an integrated whole are far too high and that patients do not feel they are in control of their health in any significant manner.
It would seem that the health system is not currently giving value for money.

How come?

Isn’t the pharmacy sector leading the way with a sustainable PBS sector?
Doesn’t patient satisfaction rate extremely high with proven instances of support such as the signing of the 1,000,000 + signatures on the last PGA petition?

These positives certainly are a comfort for Pharmacy but that has to be measured against pharmacist access by patients, and the known need of patients to be involved in their health and wellbeing problems with pharmacists face-to-face.
And more recently, one extremely valued pharmacy product in the form of Home Medicines Reviews and other derivatives, are now at risk because of budgeting issues and insular attitudes, created by the PGA.
Patient access, especially those most in need, is severely curtailed because of PGA conflict of interest issues.

Pharmacy is not immune to the culture changes gradually overtaking major health segments, and those changes will increase when evidence based methods of economic health delivery become more widely known.
All evidence is pointing to multi-practitioner health disciplines, collaborating as a true partnership of skills, delivering a single and unified package to a patient and with a single bill of account.

The medical world talk about Patient Homes, which means an existing doctor-centred space employs other types of health professionals or leases space to them.
The objective being to offer a single health care package for their patients that will include pharmacists within their health practitioner mix.
And that is achievable. It is one version of a Patient Home, but it is not the only one.

Telstra, on the other hand is seeking to create an Internet-delivered health package offering video access to a range of doctors and health practitioners, possibly in alliance with private health funds and pharmacy Internet providers.
Their patient home will be the patient’s private home.
The “Pharmacy-in-the-home” concept described in earlier editions of i2P would go some way in competing with the Telstra product.
A lot of work and money goes into establishing an Internet type of service, and Telstra is vulnerable to privacy and security issues, already having demonstrated some very big holes. They can be competed with.
So trust has to be built and it will mean a slow uptake of services and it will generally embrace the younger demographic (Millennials), who have an almost addictive need to remain “connected”, particularly to their mobile phone content that increasingly builds their DNA that transforms the way in which they communicate and establish their needs.
They are a significant and little understood demographic, but their trait of “connectivity” is sure to be passed on to successive generations.
They are the “worried well” who are looking for wellness programs.

Pharmacy has not been particularly successful in tapping into this market demographic and is therefore vulnerable to the Telstra Health initiative because they will create or tap into an online pharmacy resource tailored to suit their offering.
Telstra Health is therefore a disruptive marketing initiative that should be countered and competed against with a pharmacy designed counter initiative.
Young pharmacists who themselves form part of this Millennial demographic are best suited to formulate counter strategies – but many of these talented people have been let go or not contracted, simply because pharmacy culture is in conflict with many of these people. And they are unemployed or employed at low hourly rates.
They simply wish to be employed first as clinical pharmacists then evolve to their own business structure and form alliance partnerships with pharmacies.
This has been denied to them, and as a result all types of pharmacists have been disrupted and dislocated, forcing them to seek alternative employment not suited to their needs – or leave the industry permanently.

So this leads me to the third aspirant for a patient home, and that is community pharmacies themselves.
Many pharmacies have aspired to provide a range of health practitioners under one roof.
Most suffered from the problem of not permanently designating suitable clinical spaces and themselves not having a separate leading clinical service that was distinctly pharmacy.
Some delegated functions to “pharmacist-like” practitioners such as naturopaths, but without taking steps to appropriately blend them in.
This created a total offering that was not a uniform one.
There have been many critics of pharmacies employing naturopaths, mostly unwarranted.
However, lack of integration remains a problem when inserting them into a pharmacy clinical environment. They remain a highly professional group, usually holding a Bachelor of Health Science degree, but culturally distinct.
Work on the culture and integrate to the extent that pharmacy staff understand how to match a patient to one or more health practitioners and you are under way to present a unified health service, under the supervision of a pharmacist, leading to a high score for patient satisfaction.
Pharmacy clinics originally evolved in the US under the control of nurse practitioners.
They were born a little over seven years ago but have become a vital segment of the US health system.
Some have developed to the extent that they have incorporated other health practitioners (including chiropractors and naturopaths) and some of the larger versions are now incorporating GP’s.
So it seems logical that Australian pharmacy will follow proven elements of the US system, including eventual incorporation of GP’s.
Independent pharmacist prescribers will also appear in this mix and a patient will have a multiple but unified choice to receive their healthcare in the most economical and efficient manner.
That is the vision and promise of a pharmacist-led patient home.
The reality will be there if conflict of interest is removed from the profession and proper pharmacist roles are developed and respected.
Also, all pharmacy groups that comprise the pharmaceutical industry – from academia, distributive, manufacturing and all pharmacy settings (hospital and community) must align in a straight line of thinking and harmonise and collaborate one with the other.

New pharmacist roles must be supported and delivered on.
How quickly that happens will depend on:

* Removing scope-of-practice barriers as they are progressively identified.
   This process has started for example, in the provision of pharmacist-led vaccine
* Expand opportunities for pharmacists to lead collaborative improvement efforts.
* Improve pharmacist intern programs and incorporate hospitals as a
   mandatory part of that program.
* Increase the proportion of pharmacists with a Masters level degree that best
provides clinical pharmacists able to deliver cognitive services.
* Increase and facilitate the number of pharmacists with a doctorate and ensure that
a community pharmacist research program is established and suitably funded.
* Ensure that pharmacists have access to decentralised education to support

   endeavours in skill improvement and lifelong learning.
* Prepare and enable pharmacists to lead change and advance health initiatives.
* Build an infrastructure for the collection and analysis of interprofessional health care workforce data.

Before I conclude however, just a brief word about the concept of “patient-centredness” – a term that is increasingly appearing in medical literature.
Being “patient-centred” means offering care to a patient in the fullest sense, individually or collaboratively in conjunction with other health professionals.
Delivering care involves becoming a mentor for a patient and engaging with that patient (mentee) in a holistic manner.

“Patient engagement” is the skill in being able to virtually bring a patient to a halt in their busy daily activities – long enough for you to deliver one or more health messages and position yourself to be patient-centred.
It is a highly individualistic skill and favours people with an amenable and empathetic personality.
It is a skill that must be continually worked on and relies on multi-levels of communication.

So being a clinical pharmacist practitioner in a “patient –centred patient home” would seem to be a vision for a pharmacy model to be progressively developed.

Which patient-centred home would you choose to work in?
The GP-led home; the Telstra managed care version home or the Pharmacist-led home.
It’s great to have such a wide choice!

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