Will the Government's new precedent protect clinical pharmacist services in rural aged care?

To finish off a busy year, I wanted to get back up north into some of Choice Aged Care's more remote client facilities prior to the monsoonal rains (and cyclones). The day started with a pre-dawn 4:15am Uber to Brisbane airport and ended with a post-transit tropical twilight beverage on the deck of the Grand Hotel Thursday Island. The heat and humidity was stifling, yet as usual, I felt my energy levels surge with this opportunity to be back out in remote communities doing what I love to do.

Providing the Medication Safety Stewardship (via government funded RMMR medication reviews and QUM services) to most of Australia's remote RACFs is a pleasure and a privilege.

"Supporting the medication management needs for some of our nation's most culturally rich and diverse care recipients has many professional challenges and associated rewards."

This week alone, I attended to GP referred RMMRs for residents from the Torres Strait Islands (a vibrant people with a deep connection to the sea); Atherton Tablelands (residents of Italian migrant heritage who's post-war toil helped build Far North Queensland's modern communities); and Darwin (elders who are representative of the oldest continuing living culture in the world, having occupied these part for ~65,000 years). In the context of such unique and diverse medication management needs, the importance of last week's release of the new Guiding Principles for Medication Management RACFs, and the newly added Principle on Person-centred care was not lost on me.

"Providing advice to GPs, nurses and residents on the use of certain medications, such as psychotropics or analgesics, requires a culturally informed clinical expertise."

The disparity in quality and access to healthcare for our rural communities is well known. Care recipients in these communities, their family, nurses, care staff, GPs and care provider organisations benefit a great deal from the input of a consultant clinical pharmacist. Over the past year, I have expressed genuine and serious concerns regarding the unintended threat to clinical pharmacist services into rural facilities. My Department Consultation Paper feedback on the impending onsite aged care pharmacist program specified via in-depth analysis that:

"The proposed onsite pharmacist model will exacerbate medication safety inequality, with smaller rural facilities being further disadvantaged."

With those concerns in mind, I was delighted to hear this week that The Hon Mark Butler (Minister for Health and Aged Care) position himself as a champion of supporting access to health professional services for rural areas. When facing considerable media scrutiny on the Government's decision to slash Medicare rebates for psychologist mental health services, Mr Butler's primary justification was citing research and concerns that the increased COVID-era psychologist rebates had unintentionally "aggravated?barriers to access" for rural Australians. This rationale, justification and learning opportunity can (and must) be directly transferred to the onsite pharmacist program design.

"The increased tax payer funding ($345m) for aged care pharmacist services will inadvertently reduce rural and regional Australia's access to clinical pharmacist services."

Unlike the unintended psychologist outcome, research and government think tanks are not required to predict with certainty that an onsite pharmacist program that specifies one onsite pharmacist per 250 residential beds will completely derail clinical pharmacist services in all parts of Australia outside of major metropolitan cities. The increasing workforce shortage of Australian pharmacists (regardless of their scope or aged care preparedness) will ensure that rural aged care pharmacist services will virtually disappear upon implementation of the onsite pharmacist program. It will take 5-7 years for pharmacists to begin trickling out of the cities and into regional RACF onsite positions (assuming the Pharmacy Schools and clinical pharmacist Accreditation programs can significantly scale-up their output of aged care prepared pharmacists).

"Fortunately via the controversial psychologist rebate decision, The Hon Mark Butler has established an irrefutable precedent to protect rural Australia's access to health professional services."

Mr Butler is now required to deal with legitimate and major concerns resulting from his predecessor's (Minister Hunt, Coalition) decision to unexpectantly fund $345m for onsite aged care pharmacists (announced 2 weeks prior to PM Scott Morrison calling the election in a post aged care Royal Commission year...). The fact that basic details (e.g. the funding mechanism) for a Program that is supposed to start in 2 weeks are yet to be announced suggests that the new Government appears to be giving more due diligence to the onsite pharmacist program. Perhaps the new Government has given appropriate attention to the Australian Commission on Safety & Quality in Health Care’s recent QUM Roadmap (Priority Action 10b which recommended “further research” on embedding pharmacists in aged care). Perhaps even, the Government is giving due thought to the suitability of using $345m in tax-payer's funds on an inadequately researched model to discontinue RMMRs at a time when the new Guiding Principles for Medication Management in RACF, Royal Commission into Aged Care Quality and Safety and revised pending aged care Quality Standards all strongly promote the need to increase (not discontinue) resident access to comprehensive medication management reviews.

For the sake of care recipients throughout Australia, let's hope that this $345m tax-payer investment does not have the unintended effect of increasing medication risk and compromising quality care. After all, the decision to increase Medicare rebates for psychologist services from 10 to 20 consultations seemed like a good idea at the time!

By Michael Bonner (Clinical pharmacist and rural health advocate)