Friday, January 20, 2017

I Really Wonder How This Nonsense Proposal Ever Saw The Light Of Day.

I spotted this last week.

Trial to give pharmacists more power over scripts

| 12 January, 2017 |  
Pharmacists will be free to change medication doses, issue repeat scripts and perform point-of-care tests for patients with chronic diseases under a trial starting this year.
Running for 18 months, the Victorian trial is a way of freeing up GP time to deal with complex clinical issues, according to the state government.
Supporters argue the trial will not fragment care and GPs will retain control over what happens to patients.
The GPs taking part will write shared care plans that will guide pharmacists in monitoring and refining the medication regimen of patients with asthma, hypertension and hypercholesterolaemia, and those on anticoagulation medications.
Only pharmacists with an established relationship with a GP clinic will be able to take part.
But under the trial, they will perform blood pressure, spirometry, INR and lipid panel tests to monitor patients’ conditions.
They will be expected to report regularly to GPs and refer the patient back if their condition changes.
The state government says many GP visits for patients with chronic diseases merely involve renewing prescriptions or making dose adjustments, a view the Pharmacy Guild of Australia claims is supported by research.
AMA Victoria described the proposal as risky when it was first flagged in 2015.
Members of the AMA have since worked on the government’s advisory group to work out details of the trial, including the four chronic conditions considered suitable.
The trial will start off with just three pharmacies and three GP clinics, with one trial site in Melbourne and two in rural areas, and a cap of 30 patients at each site involved. 
More here:
The proposal is so controversial that it attracted 34 on-line comments in only 3 days!
To me the huge issue is just how complicated it will become when something goes wrong. Who is to blame and which insurer is liable.
Secondly with a tiny trial it might just work – but the scalability has to be pretty dubious.
Thirdly how will all this work with electronic medication record and dispensing systems? – there has to be a lot of risk for mistakes in this area.
This really should just be stopped before it starts in my view. If the pharmacist has an issue with a script – simply ring the prescriber!


Bernard Robertson-Dunn said...

Another question:
Who updates the patient's MyHR Shared Health Summary?

AFAIK, only the patient's nominated service provider (usually their GP) can do that.

1. GP prescribes Medicine 1 and uploads that fact to the patient's MyHR

2. Patient goes to a pharmacist who changes the script and dispenses Medicine 2 (or different dose).

3. Some time later the PBS system updates the patient's MyHR PBS data that says that a medicine different from the one prescribed by the GP has been dispensed.

Anyone heard of data integrity?

Or is the pharmacist supposed to call the patient's GP, tell them they've changed the script and get them to update the patient's MyHR? I don't even know if a script can be updated or only added. In either case it's an increased workload all round.

And when it comes to "issue repeat scripts and perform point-of-care tests", that's even more problematic.

It's almost as though the government itself hasn't taken MyHR seriously.

No wonder the government says that the system should not be relied on.

Andrew McIntyre said...

IMHO the best target for a centralized database would have been an atomic record of medications that could be accessed by GPs, specialists, hospital and pharmacists. Patients could have also accessed it to report compliance or non compliance and every script actually dispensed could have gone into it.

The current print out from GP systems is often very inaccurate, often containing every treatment the patient has ever taken and webster packs often have no legend and when a patient presents working out what they are taking is quite difficult at times. This is time consuming and often dangerous, except sometimes stopping drugs is the best solution to problems!

There were plans to do something like this >10 years ago, but it was abandoned. It would be 10x more useful than the PCEHR and would actually save lives and $$

I have certainly experienced frustration at pharmacists saying to patients "That is a big dose, take less" with no notification of this change and I think allowing pharmacists to alter scripts is nonsensical as they do not have the training to do this. I am happy to be questioned, but not overridden without communication. You have to break "rules" sometimes in specific circumstances and I am concerned the bureaucracy seems to think that medicine is simple and there are hard and fast rules. Decision support should be support, not a policeman. Pharmacists have a valuable role to play, but prescribing on patients with complex problems is not a role they were trained for.

The PCEHR lacks a role. Its like some grand plan where every component has been watered down over time to the point that the sum of the parts is negative to health care. Doing one small thing well could have added value, but now I am thinking like a developer and don't understand what makes sense to the bureaucracy. Trouble is its easy to have a negative effect by demanding GPs time for no return other that $$ from PIP. That will take away from patient care/

Oliver Frank said...

Well said, Bernard and Andrew.

Bernard Robertson-Dunn said...

Andrew "the sum of the parts is negative to health care."

I like that.