Pharmacy-led study promotes minor ailments scheme

New research, conducted by the University of Technology and the Western Sydney PHN, evaluated a consultation service for community pharmacists to triage, manage and refer patients to doctors for common ailments, such as coughs and colds, through agreed referral pathways.
 
Chief investigator Sarah Dineen-Griffin said the study showed up to 21% of GP services and 12% of emergency department presentations could be ‘safely’ transferred to a structured community pharmacy service, and called for the scheme’s inclusion in the Seventh Community Pharmacy Agreement.
 
‘Better patient care is achieved when community pharmacists and GPs operate collaboratively to improve the health outcomes for patients with common ailments,’ Ms Dineen-Griffin said.
 
‘Patients seeking care from GPs and emergency departments with minor ailments cost the Australian health system between $511 million and $1.67 billion per annum. National implementation of a collaborative consultation service can alleviate pressure on the health system and save up to $1.3 billion a year.’
 
The research was conducted between July 2018 and March 2019, with 894 patients recruited for a randomised trial that compared the collaborative service with usual pharmacist care. Fifty-five community pharmacists from 30 community pharmacies and 150 GPs from 27 general practices took part.
 
Minor ailments were defined as ‘conditions that are self-limiting, with symptoms easily recognised and described by the patient and falling within the scope of pharmacist’s knowledge and training to treat’.
 
The study found pharmacists were 2.6 times more likely to change the customer selection of a medicine for self-treatment to a safer, more appropriate alternative, while patients were 1.5 times more likely to receive an appropriate referral. It also found patients were five times more likely to adhere to that referral advice and seek medical practitioner care within an appropriate timeframe (20% of all patients were referred).
 
According to the study, pharmacists identified 2% of patients had ‘red flag’ clinical features requiring immediate referral to a GP or the emergency department, and that those involved in the scheme provided self-care advice in 98% of consultations.
 
However, Associate Professor Mark Morgan, Chair of the RACGP Expert Committee – Quality Care (REC–QC), told newsGP it is important to consider exactly where the suggested $1.3 billion in savings would come from.
 
‘Interpreting this study requires care. The study selected 15 pharmacies [24 patients each] to provide the minor ailments scheme and 15 pharmacies to provide usual care. It was not a study to compare pharmacy care to GP care,’ he said.
 
‘What are the consequences? Will services to patients actually be reduced as a consequence of practices closing in marginal areas?
 
‘Overseas experiences demonstrate that minor ailments schemes struggle even in countries where there is greatly reduced access to general practice; such as the UK, where there are far more patients per GP.
 
‘The repeated history of schemes attempting to substitute general practice is that they look cheaper on first glance but end up being false economies.’
 
Associate Professor Morgan also said pharmacies have ‘an inherent conflict of interest’ insofar as they need to sell products to survive.
 
‘Who pays in the end? The patient does,’ he said. 
 
‘In the study the most common presentation was respiratory and 84% of patients were supplied at least one non-prescription medicine, mostly cough mixture or cold remedies.
 
‘Pharmacy shelves are stocked with substances that are very low value. Supplements, homeopathy, children’s cough mixtures are generally unnecessary – but they are sold to unsuspecting customers.
 
‘I would much rather see the interventions recommended in the Handbook of Non-Drug Interventions [HANDI] used. For example, honey for children’s cough, exercise for low-back pain, and diluted apple juice for rehydration in children.’
 
An RACGP position statement on retail pharmacy also details ‘significant concerns’ with any move to expand the role of community pharmacies, including the provision of ad hoc medical services such as health screening and prescribing.
 
‘[There are] concerns about the unique retail–health model of community pharmacy, which allows for the sale of non-evidence-based health products,’ it states.
 
‘When a patient receives health advice or screening in a retail pharmacy, they miss out on important medical services that would be offered by GPs, potentially leading to a delayed diagnosis or care.
 
‘Poorly targeted screening conducted outside the general practice setting can trigger patient concerns, a situation that often requires GPs to repeat tests or conduct additional tests … due to their central care coordination role, skills and knowledge, specialist general practitioners are best placed to provide health screening and prescribing services to patients.’

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