Integrating pharmacists into Aboriginal Community Controlled Health Organisations (ACCHOs) brings many benefits for patients with chronic diseases, according to Associate Professor Sophia Couzos, a public health physician with the Queensland Aboriginal and Islander Health Council.
In the article below, she makes the case for expanding funding and support for this model of care.
Sophia Couzos writes:
In March 2023, an arm of the Department of Health and Aged Care quietly made a major announcement about a brighter future for Aboriginal and Torres Strait Islander people living with chronic disease.
The Medical Services Advisory Committee (MSAC), an independent body within the Department of Health and Aged Care tasked with appraising new medical services for public funding, released its advice to the Albanese Government that it supported public funding to integrate non-dispensing pharmacists into Aboriginal Community Controlled Health Organisations (ACCHOs) to help improve chronic disease management.
As one of the researchers on the Integrating Pharmacists within Aboriginal Community Controlled Health Services to Improve Chronic Disease Management (IPAC Project), this was welcome news.
But for chronic disease patients in community, this better-integrated model of care, where pharmacists are embedded in ACCHO clinics, could be a step-change in their treatment and management of disease, allowing people to live longer, happier lives with fewer years lost to disability, morbidity and mortality.
We know that chronic diseases are the leading causes of illness, disability, and death among Aboriginal and Torres Strait Islander people, and are estimated to be responsible for 70 percent of the health gap.
This considerable loss of healthy life due to chronic disease burden occurs at 2.3 times the rate for Indigenous people, compared with non-Indigenous Australians.
In fact, chronic diseases made up the leading causes of healthy life lost in Aboriginal and Torres Strait Islander people aged 45-64 years, with coronary heart disease, chronic lung disease and lung cancer, liver disease and type 2 diabetes being leading contributors to this.
Other countries already use this integrated pharmacist model of care. New Zealand, Canada and the United States already have pharmacists working in many general practice settings. The National Health Service in the UK has invested heavily in such an initiative.
In Australia, the Australian Medical Association, general practice groups, and pharmacists have supported integrating pharmacists into general practices.
Public inquiries and independent statutory bodies such as the Australian Productivity Commission have also recommended exploring better ways to utilise the full scope of pharmacist roles within clinic settings.
Improved outcomes
So, when 26 non-dispensing pharmacists were integrated into 18 ACCHOs in Queensland, the Northern Territory and Victoria, with a comprehensive induction process to ensure they had an understanding of the ACCHO setting and of cultural safety, we saw improved outcomes in all the chronic disease categories measured.
The project evaluated over 1,400 Aboriginal and Torres Strait Islander patients with chronic diseases such as cardiovascular disease, Type 2 diabetes, kidney disease and patients dealing with miscellaneous chronic conditions who were at high risk of developing medication-related issues.
These patients all received support from a pharmacist working within the Aboriginal health service. There was an significant improvement in glucose control for patients with diabetes, and a slowing in the progression of chronic kidney disease.
There were reductions in blood pressure, cholesterol and triglyceride levels. Blood pressure reductions lessen the risk of developing hypertension and other cardiovascular events such as heart failure or stroke. Reductions in cholesterol also lessen the risk of major cardiovascular events.
These clinical benefits were explained because medicines were more tailored to the needs of the patient and medicines were much more appropriate for them with fewer prescribing errors.
Patients also benefited because they got the right medicines they needed that were sometimes not prescribed, and this was seen as a reduction in potential prescribing omissions. At follow-up there was a nearly 60 percent reduction in patients with any prescribing omission.
Patients were more likely to take their medicines, and there was a four-fold increase in the number of patients who had their medicines reviewed, compared to before the program.
As a result, patients said they felt better. They self-assessed their health to be generally better than it was at the start of the program. An extra 13 percent of patients were sticking to their medication regime and nearly 25 percent extra reported an improved health status after a median of 200 days follow-up.
Why is this important?
It is important to evaluate programs that aim to close the gap. This project has shown that integrating a pharmacist within an ACCHO can reduce chronic disease burden in patients who are at risk.
This was shown in 18 communities and was also judged to be “good value for money” by MSAC.
In addition, patients felt more respected and included in the control of their chronic disease, better understood their conditions, better understood their medications, and were therefore more likely to take them.
Doctors appreciated having an ‘in-house medicine expert’ who could provide them with support as well as the patients. Pharmacists were also able to assist with medication safety and quality use of medicines policies for their ACCHOs.
Finally, pharmacists enjoyed being part of the clinical care team. Integrating pharmacists within ACCHOs provides another career path for pharmacists, allowing them to work to their full scope of practice.
Community pharmacists who integrated with ACCHOs also saw increased home medicine review referrals, meaning they also saw economic advantage from the IPAC Project, and a better relationship with the ACCHOs and patients of their region.
Expanding the IPAC Project to any interested ACCHO in Queensland would improve the prospects of many more chronic disease patients. Queensland ACCHOs care for at least 54 percent of the state’s Aboriginal and Torres Strait Islander population, 46 percent of whom live with a chronic condition.
That’s nearly 59,000 Aboriginal and Torres Strait Islander people whose lives can be improved right now.
By expanding out these services, we can reduce the burden on hospitals and GPs, all through better care, and by better utilising the pharmacist workforce we have right now.
Further reading
Australian Government Department of Health and Aged Care: Integrating practice pharmacists into Aboriginal Community Controlled Health Services – Final report.
See Croakey’s archive of articles on the ACCHO sector
