Patient Navigation – An old-new Opportunity for Pharmacists

i2P has commented before that community pharmacy has (and still is) the epicentre for primary health care.
In many ways it was the original patient-centred home and it had a market share approaching 70 percent in the mid to late 1970’s when it was first surveyed.
The entry point to primary health care within community pharmacy was always through a system of “patient navigation” that was a firmly established process prior to the introduction of a National Health Scheme that originally provided a free doctor services, free prescription service and a free hospital service.

Pharmacists were always the first port of call before the introduction of these free services and they provided a form of triage, or patient navigation process which initially followed a pathway that was called “counter prescribing” that further involved some patient education for their condition sufficient for a patient to self-manage solutions (Self-Care) in the form of an over-the-counter medicine or a compounded formula devised by the pharmacists.
If the patient was thought to have a more complex condition beyond the expertise of the pharmacist, they were referred to other health practitioners.

These were mainly GP’s, but also included chiropractors, osteopaths and naturopaths, nutritionists and dieticians – anyone thought to be able to provide a complete solution.
Some of these types of referrals also included a form of patient advocacy by the pharmacist.

The advent of a National Health System also saw an attack by the medical profession on pharmacy that was both deliberate and relentless.
In the initial handbooks surrounding the free prescription service the language that was used for pharmacists always began in the style of “The pharmacist will….” Compared to the similar process for the doctors, which was styled as “The doctor may…”, which meant that pharmacists were initially controlled by a form of civil conscription.
Processes that evolved from that early date served to make the pharmacist an “invisible” component of public health or any activities that involved a “hands on” process with a patient.
In fact there was also a process to position pharmacists as only having customers – patients were only attached to doctors.
This deliberate health-engineering has always been a feature of the political side of the medical profession and did not just target pharmacists – it also involved other health professions such as chiropractors, homeopaths and naturopaths.

Health engineering is still ongoing with doctors still positioning themselves as the “head” service for primary health care, which is now set to be managed through primary health care networks.
I2P believes that this system will prove to be costly to taxpayers, will reduce accessibility and will exclude or limit health professions (including pharmacists and alternate practitioners) that may be favoured by patients.

Lobbying to remove government subsidies within health funds or Medicare for medical targets (mainly natural health practitioners) has already been successful in seeing reductions or disappearance of subsidies in recent times, for those modalities.

Since the decision to establish primary health networks and patient-centred homes we are able to draw on the US experience where these processes have already been initiated.
And it has been found that the patient-centred home is too costly and unworkable and that an evolution to a “patient-centred neighbourhood” works better, and that if coordinated by community pharmacies, works at an even more efficient level.

The original wheel is being rediscovered, but will filter its way through the Australian health system in its usual distorted and painfully slow manner.
We are, however, seeing the patient navigation process being reinvented through other health professionals, particularly by nurses.
An example being Medicoach  .
This company is an active participant in their local primary health network and is already negotiating with government for subsidisation of this service

Pharmacists, instead of being visible with viable propositions and solutions, have not evolved to build on existing systems.
This typifies the lack of leadership that has been a long-standing problem within the pharmacy profession.
Instead, they have been looking for something “different” as a means of progressing their core business, not recognising that they already hold the key and a proven patient navigation system that is the entry point to other service extensions and new services.
It is the basic building block for primary health care.
Recently, Harvard Business Review published an article titled “Patients make better medical choices with coaching”
and they say:

“The idea of patient navigators is a relatively recent phenomenon in health care. Harold Freeman pioneered the concept in 1990 in Harlem. Slowly but surely, navigation programs are cropping up elsewhere. Mount Sinai Hospital implemented a patient navigator program in 2010 in its general internal medicine service to help expedite treatment and clarify questions for patients and family. A similar program at Bellin Health Systems, based in Green Bay, Wisconsin, helps ensure the compassionate, sensitive delivery of services for highly emotional conditions like cancer.  At Metro Health in Cleveland, the patient navigation program helps patients, especially underinsured ones, through the logistical, emotional, and even cultural barriers that impede their ability to obtain care.”

Navigation, coaching, mentoring, triage, care – these are words that imply a similarity of processes already used within health services and patient education within Australian pharmacies.
And a pharmacy patient navigator could also be filled by a clinical service assistant who may be more mobile and fill gaps in a “pharmacy-in-the-home” program because the job does not require clinical skills – just a knowledge of the health system.
It can also be adapted to any other “outreach service”.

i2P has always promoted the word “mentoring” as the soft management skill that should be taught to all pharmacy personnel and extended to pharmacy patients.
It is probably now timely to segment out this activity in a systemised format called Patient Navigation, so that it can become visible and marketed as a service product.

It is a concept that would be easily recognised and supported by all pharmacists because it so closely parallels what we actually do as part of our daily patient contact.
It also represents a system that can be sold to government by pharmacy profession leaders, because it generates efficiencies within the health system in total and would lower overall costs.
Using community pharmacy as the fulcrum would place the profession at the centre of health – its rightful place to evolve and expand into its own collaborative version of primary health care.

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