The Huge Information Disconnect in Primary Health Care

The world is beginning to wake up to the resource that comprises pharmacy as the Medicines Use Review (MUR) program in the UK has just been “discovered” by health planners.
Australia, of course, has had Home Medicines Reviews successfully in place for well over a decade now, but they are a well kept secret between the GP’s that generate them and the skilled HMR pharmacists producing them.
Suddenly, health planners have become alerted to the valuable insights offered within these reports because they offer a detailed analysis of a patient’s condition and needs at a point in time.

They are a very rich data mine that planners are just discovering and finally uncovering pharmacy’s biggest secret – the skill of its practitioners that is understood by pharmacy patients but often disparaged by the medical profession, because it is seen as competitive to their claimed leadership role in primary health care.

The PGA has successfully built in what many consider a competing product in the form of Medschecks because their introduction coincided with a reduction in funding for HMR’s.
Medscheck data, for the moment, is privately contained within the patient’s pharmacy, leaving the patient to share details with whomever they wish,

MUR’s in the UK contain an automatic consent waiver, signed by the patient, to allow their data to be shared with “commissioning groups” as well as GP’s.
Some of this information is tracked and published in an NHS England’s Medicines Optimisation dashboard .
This particular data collection has identified that MUR’s increase patient compliance by 10 percent.
The most conservative UK studies state that 25% of patients with long-term conditions don’t use their medications as directed.

In diabetes, this can be as high as 78%.
It seems that Community pharmacies can offer the opportunity to identify and help people who are unable to use their treatments correctly – something that all Australian pharmacists know and that leadership bodies have trouble in “selling” to government health planners.

It would seem a distinct possibility that Australia’s pharmacy leadership bodies might be able to use this information to good advantage and that the official investigation into management of 5CPA funds should be alerted to add these benefits in  their own report.

However, there is also an urgent need to review the managing body for HMR’s and have it converted to a more democratic organisation, with consultant pharmacists being able to have direct input into policy directions.
Many consultant pharmacists have identified the need for an information database to publish outcomes, to account for public investment and create a firm evidence base, and one wonders why government funders have not demanded this information, given that the HMR program is totally funded by government.
Maybe this might now happen.

MUR data has now found its way into a study into the New Medicines Service which is the fourth advanced pharmacy contract to be added to the NHS in the UK.
It has been evaluated by the University of Nottingham that has found much to favour pharmacy efforts in this area of health analysis and planning.
An Executive Summary of this study follows:

To January 2014, over 90% pharmacies in England have delivered the New Medicines Service (NMS).
Our study shows the NMS to significantly increase patients’ adherence to their new medicine.
Delivery of this service will save the NHS money through better patient outcomes at overall reduced costs to the NHS.
The service was well-received by patients.
We show how NMS has been successfully introduced and adopted within community pharmacies.
Local staffing and resource issues impact on provision of NMS, pharmacies with higher numbers of staff are better able to manage and deliver the NMS service without placing excessive burden on staff.
The service benefits patients and the NHS by optimising the use of medicines.
It could be further improved by better integration into primary care by:

• Better engagement with GPs
• Pharmacists having access to GP records
• Improved training of pharmacists
• Expanding the range of medicines covered, for example into mental health.

It is obvious that health planners and funders will drive these new roles for pharmacists because they want access to the quality data.
Pharmacy negotiators will have to be alert to ensure adequate funding is provided and better income protection than has been received under Australian PBS agreements, due to the irregular and knee-jerk decisions government departments are capable of making, without reference to the damage they create to pharmacy practice.

What data do community pharmacies hold?

  • Levels of patient understanding of their medicines
  • Ability of patients to use medication or devices correctly
  • Adherence data such as dosage frequency and reasons for missing doses
  • Proportion of patients given a service such as a smoking cessation program or MUR/HMR

How can it be used?

  • To provide an evidence base for more interventions to increase adherence
  • Reduce needless hospital admissions
  • To calculate the return on investment for commissioners of MUR’s/HMR’s
  • To highlight the value of pharmacy as a research centre for many stakeholders.
    The PGA are endeavouring to convert at least some of the savings being made through PBS price transparency, into meaningful income from service generation through 6CPA negotiations
    This activity is certainly going in the right direction but you would have to wonder why all the delays and obstructions are placed in the way of HMR’s, when they are clearly the best argument pharmacy has for cognitive service development and for pharmacy remuneration streams. It is also very clear that unless some form of alliance partnership development between clinical service pharmacists and community pharmacies becomes a reality, our “best and brightest” will evaporate.
    Pharmacies need collaboration with independent consultant pharmacists that can only be achieved if pharmacies are at “arms-length” from a cognitive clinical service.

    It just cannot work otherwise, as the consultant pharmacists are not employees in the real world- they are contractors and they need to work with more than one pharmacy to generate a reasonable level of income. While there is a place for Medschecks within a pharmacy they can never replace an HMR which is performed mainly outside of a pharmacy. Now is the time for all the collective voices to bombard the PGA with messages of the type that NHS England are publishing and actively using. There is a need for pharmacists to become part of the data-gathering process, provided the data is useful for health planners.
    Cognitive pharmacists need to be nurtured into accepting part of this role for they are the pharmacists capable of analysis and interpretation.
    If pharmacy data becomes indispensable for public health planners, then pharmacists in that category will no longer become a threatened species.
    There is so much opportunity that can be converted to good and solid revenue streams that it is immensely frustrating to watch these opportunities being squandered.
    i2P has long recommended that local pharmacist associations could form the nucleus of pharmacy research, both management research and clinical research, built around a regional education services.
    These Institute-type organisations could very quickly be built into a national body that is not top-heavy, by appointing two or three members from each region to form a national management group for lobbying purposes.
    It’s a very easy proposition if existing leadership bodies won’t perform.
    i2P has been publishing articles recently along the theme of make your leadership organisation work for you.
    It is complacency that has allowed imbalances to occur within the pharmacy profession, and conflict of interest generated by executives within the leadership organisations that has compromised all pharmacists, irrespective of the capacity they work within the profession.
    We need to strengthen legislation pertaining to bringing the profession into disrepute, that shines a light on the behaviour of our leadership organisations.
    A move back to a collegiate style profession is badly needed.

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