The power to prescribe:
Who should have it?
 
 

The power to prescribe:
Who should have it?

A couple of weeks ago at a media conference, a Pharmacy Guild representative was photographed wearing a stethoscope over his white smock. The image triggered an adverse reaction among GPs; some asked how a pharmacist would use the instrument, others whether the event was a costume party.

The heated response suggests the national conversation over whether pharmacists should be able to extend their limited prescribing rights is gaining heat, rather than cooling. So what’s the debate all about? Let’s look at the key parties and what they say is at stake.

Party one: Pharmacists (represented by The Pharmacy Guild of Australia and Pharmaceutical Society of Australia)

Many pharmacies already offer vaccination services and support for chronic disease management. Trials have been conducted in several states, focused on providing assistance to people with conditions such as urinary tract infections (UTIs).

Pharmacists believe they can do even more to assist Australians who need help with common conditions and will be coming to them to collect medications anyway.

Backed by the Queensland government, the Guild initiated the North Queensland Pharmacy Scope of Practice Pilot, pencilling it for December 2023 and kicking it off in April 2024. Under the pilot, conditions pharmacists can now treat include acne, hay fever and eczema. For the full list, see About the pilot | Queensland Health

The Queensland Government has since moved to make the North Queensland pilot statewide.

Party two: Governments

Governments are trying to solve a supply and demand problem. It’s hard to get a GP appointment just about anywhere — and generally harder the further you are from a state capital.

Queensland Premier Steven Miles said: “Our Government is committed to making sure Queenslanders can access good quality healthcare, no matter where they live across the state.

“We know our hardworking pharmacists are more than capable to deliver these services – for common health conditions – and divert people away from our emergency departments and GPs.

“I am really proud that Queensland is leading the nation with this initiative.”

Queensland Health states: “Pharmacists are highly qualified and trusted members of our healthcare teams. Providing pharmacists with additional clinical training and supporting them to practice to their full scope, will enable them to help and support their local communities.”

Party three: General Practitioners (represented by the Royal Australian College of General Practitioners (RACP) and Australian Medical Association)

Doctors say that medications cannot be safely prescribed without a holistic, longitudinal view of the patient’s medical history, as best understood by their usual GP. They say the pilot puts vulnerable people at risk and that a previous trial allowing pharmacists to prescribe antibiotics for UTIs led to incorrect diagnoses and serious conditions going untreated, increasing overall healthcare costs.

Party four: Healthcare consumers (represented by you and I)

While most people prefer a long term relationship with a GP who knows you and your family, getting an appointment when you need it isn’t always easy or affordable. Some people go to hospital emergency departments (or virtual versions) for free help.

Other consumers are opting for convenience, using telehealth providers that offer quick access to scripts and more, but might not have time to hear your health history, (if you can remember it). For this group of consumers, getting help from the pharmacy you’re going to anyway, may be a no-brainer. However, the services are not free. Fees of up to $55 per pharmacist consultation may limit take-up.
Those with multiple or complex conditions are likely to have to wait for the next available appointment with their GP and hope for a cancellation to get in sooner.

Sparring partners

Back in March, the Medical Software Industry Association promised a ‘ding dong battle’ between the Guild, the RACGP and government, placing three key representatives on stage together in Melbourne.

Pharmacy Guild Victorian president Anthony Tassone said the prescribing issue was not about “pharmacists being GPs. It’s about pharmacists being the best professionals they can be…. solving problems for patient benefits.”

RACGP past president Dr Karen Price said she was concerned about the ‘taskification’ of general practice, which hindered longitudinal care. Dr Price said it can take 45 minutes to explore a patient’s medication history before writing an appropriate script. She said a UTI is a “retrospective diagnosis where there may be other issues that can’t be picked up by a pharmacist”.

Representing the Federal Department of Health and Aged Care, First Assistant Secretary (Medicare Benefits and Digital Health Division) Daniel McCabe said Australia faced “acute workforce challenges” and governments were trying to unlock the full potential of professionals who could deliver, “true multidisciplinary care”.

Dr Price said multidisciplinary care was great in hospitals and, while desirable, underfunded and challenging in general practice where, “the people who most need care can least afford it”.

Mr Tassone said doctors and pharmacists were all on ‘Team Patient’ but he and his peers were not rewarded for being part of multidisciplinary teams. “Are we part of the team or are we on the bench to make up the numbers?”

He said: “Patients don’t care. They care about getting care when they need it.”
It seems this conversation is far from finished.

Skin in the game

MediRecords provides secure, cloud-hosted electronic health records and prescribing functionality to healthcare professionals across Australia delivering face-to-face and virtual care.

Further reading:

Female-Friendly Federal Healthcare Budget
 
 

Female-Friendly Federal Healthcare Budget

Australians can look forward to a price-freeze on medicines, 29 new Medicare Urgent Care Centres, 61 walk-in Medicare Mental Health centres and a raft of cancer, HIV and women’s-health measures, as part of a $2.8 billion health package in the 2024 Federal Budget. 

More virtual care and hospital outreach services are also planned to avoid unnecessary hospital admissions — and enable older patients to be discharged sooner into medically supported, safe, comfortable environments. 

Older Australians will also benefit from an extra 24,100 Home Care Packages, which are intended to reduce wait times to an average of six months and provide greater access to in-home aged care. 

Other big-ticket items from the Federal Budget include: 

  • More affordable medicines via a price-freeze on Pharmaceutical Benefits Scheme (PBS) medicines to beat inflation: $318 million 
  • Life-changing and life-saving medicines added to the PBS, reducing costs to consumers: $3.4 billion 
  • Conversion and expansion of 24 existing Head to Health services into 61 walk-in Medicare Mental Health centres across Australia: $163.9 million 
  • 29 new Medicare Urgent Care Clinics, aimed to reduce waiting time at hospital emergency departments: $227 million 
  • Military veterans’ claims processing is prioritised with an additional $186 million for staffing and $8.4 million to improve case management and cyber security. The Government will also provide $222 million to overhaul legislation covering veterans’ compensation and rehabilitation. It will direct a further $48.4 million to Veterans’ Home Care and Community Nursing programs, and $10.2 million to fund medical treatment for ill and injured veterans waiting for liability claims to be processed. 
  • Free bowel cancer test kits for Australians aged 45-49, allowing them to join the over 50s ($39 million) 
  • New Medicare-benefit-scheme tests, including for suspected heart failure and rare cancers, to reduce waiting times and catch health problems sooner. A skin cancer prevention initiative is also included. ($25.3 million)  
  • Improved preventative health measures such promoting health and fitness, including $132.7 million for grassroots community and school sport to encourage participation. 
  • Spending of $44 million will further Australia’s goal of eliminating HIV (human immunodeficiency virus) transmission by 2030. Federal Health and Aged Care Minister Mark Butler said Australia aimed to be the first nation to wipe out HIV. 
  • A boost for alcohol treatment and prevention services, better nutrition programs and organisations supporting people with chronic conditions. 
  • $314.5 million in close-the-gap efforts include $164.3m towards First Nations health infrastructure projects, $54.3m towards training up to 500 First Nations health workers, $45m towards boosting renal services, and water infrastructure works.    

Women’s health is prioritised, including funding for breast cancer treatment subsidies, contraception training for practitioners, and development of a virtual contraception decision-making tool. Other initiatives aimed at women’s health include:  

  • Medicare: Longer consultations provided for complex gynaecological conditions like endometriosis, reducing out-of-pocket costs for women. 
  • Menopause Training: $1.2 million for health professionals’ training to manage women’s health during menopause. 
  • Breast cancer: Cutting the cost of a specific treatment from around $100,000 to $31.60. 
  • Funding for research on menopause, pregnancy loss, and fertility: $53.6 million over four years  
  • Miscarriages and sexual/reproductive health: $8 million for developing data sets 
  • Enhanced antenatal and postnatal care, including mental health screening: $56.5 million over four years 
  • Miscarriage: public awareness program, with support for affected women and families 
  • First Nations Women’s Health: Investments in prevention work for preterm births, stillbirth action plan, and free period products for First Nations communities. 

Breaking the Silence on Heavy Periods
 
 

Breaking the Silence on Heavy Periods

For many women, dealing with excessive menstrual bleeding is an unspoken struggle, often endured because it has been misunderstood as ‘normal’.

The inaugural International Heavy Menstrual Bleeding Day on May 11 aims to change that narrative.

This movement, propelled by shared experiences and expert insights, seeks to shed light on the challenges faced by women worldwide and encourage open conversations about heavy periods.

Some research has found that the issue affects one in four women.

Heavy menstrual bleeding isn’t just a minor inconvenience; it can significantly impact quality of life.

“It’s disabling,” said one 53-year-old lived-experience contributor to the campaign.

“On some heavy bleeding days, I could not leave the house.

“I became anaemic, which carries further health risks,” she said.

“But we do not have to suffer. Do not hesitate to see your doctor – treatment is available.”

More than half of women who experience heavy periods have not discussed treatment options with a healthcare professional, found a recent survey by marketing research company Two Blind Mice for medical technology company Hologic.

The survey also found that women experiencing excessive menstrual bleeding felt embarrassment and shame, which hindered help-seeking.

Doctors warn that heavy bleeding may be a sign of a medical condition.

Obstetrician and gynaecologist and campaign spokesperson Talat Uppal emphasises the importance of assessing whether heavy periods disrupt daily activities, rather than solely focusing on the amount of blood loss.

“”If a woman’s period is resulting in a compromised quality of life, then it’s heavy menstrual bleeding,” she said.

Treatment options for heavy menstrual bleeding are available and varied.

Reluctance to address the issue can delay access to timely care.

Dr Uppal stresses the need for more awareness and open conversations to empower women to take control of their reproductive health.

International Heavy Menstrual Bleeding Day’s – online event

Join Bleed Better tomorrow, May 11th at 10 am AEST for an online event featuring guest speakers who will raise awareness, offer management insights, and advocate for a shift in attitudes towards heavy menstrual bleeding. Register here: https://www.bleedbetter.org/ihmb-online-event

Further reading:

Bleed Better

Wear White Again

Heavy Menstrual Bleeding Clinical Care Standard

MediRecords wises up on CSIRO’s Smart Forms for Healthcare
 

MediRecords wises up
on CSIRO’s Smart Forms
for Healthcare

Leading cloud healthcare technology company MediRecords is deploying CSIRO’s open-source Smart Forms software to develop FHIR forms for rapid deployment into clinical use. 

The initiative will see Smart Forms technology deployed in the MediRecords platform, enabling faster access to new clinical assessment tools and patient surveys. 

The first Smart Form, a Falls Risk Assessment, is expected to be available in MediRecords this month. 

Commissioned by the Commonwealth Department of Health, Smart Forms technology was developed to improve health assessment procedures and clinical information sharing, leading to better patient outcomes. This was first demonstrated through the Aboriginal and Torres Strait Islander Health Check Assessment Smart Form. 

Standardised forms can streamline how clinicians capture patient data and simplify how this data is made available for research and other analysis. 

MediRecords Integrations Lead Sanjeed Quaiyumi said Smart Forms would accelerate the introduction of new health assessments within MediRecords. 

“MediRecords is laying the foundations for the adoption of Fast Healthcare Interoperability Resources (FHIR) in the broader health ecosystem, having developed and implemented an extensive library of FHIR and API resources. Smart Forms provide an exciting new way to gather and share data.” 

What are Smart Forms? 

Smart Forms conform to the HL7 FHIR Structured Data Capture and SMART App Launch Implementation Guides, ensuring seamless interoperability between clinical systems and applications. This standardised approach facilitates exchange of electronic health information across a diverse range of platforms. 

Key benefits of Smart Forms include: 

  • Interoperability: Facilitating seamless data exchange between FHIR-enabled healthcare applications and systems 
  • Adaptability: Customisable forms tailored to specific clinical contexts and user needs 
  • Standardisation: Adherence to standardised data formats and coding conventions for consistency in healthcare data representation 
  • Security: Robust security measures to safeguard patient data and maintain privacy 
  • User-Friendly Interface: Designed for accessibility across various levels of technical expertise 
  • Enhanced Workflow Efficiency: Streamlined data capture, retrieval, and exchange processes for improved decision-making and patient care coordination. 

MediRecords will use Smart Forms to expand its range of clinical templates, starting with the Falls Risks Assessment and extending to inpatient Admissions and Primary Care Assessments forms. 

This initiative underscores MediRecords’ commitment to driving innovation and enhancing healthcare outcomes through cutting-edge technologies. By harnessing the power of CSIRO’s Smart Forms, MediRecords aims to significantly improve data capture options, providing clinicians with advanced tools for delivering personalised patient care. 

MediRecords actively participates in the Sparked FHIR Accelerator community. Sparked is a collaboration between Department of Health and Aged Care, the Australian Digital Health Agency, HL7 Australia and CSIRO’s Australian e-Health Research Centre. 

Media inquiries:

For media inquiries or further information, please contact MediRecords Senior Business Development Manager Tim Pegler via tim.pegler@medirecords.com. 

References: 

Home – AU Core Implementation Guide v0.3.0-ballot (hl7.org.au) 

https://aehrc.csiro.au/wp-content/uploads/2023/11/2022_23-AEHRC-Annual-Report.pdf 

https://www.aihw.gov.au/reports/indigenous-australians/indigenous-health-checks-follow-ups/contents/timeline-of-major-developments-in-health-check-imp