Page 14 - Federal Budget Submission 2016-17

Current challenges
Despite the high burden of chronic disease, there has been longstanding under-use of medicines amongst Aboriginal and Torres Strait Islander people, especially in remote areas. Barriers to accessing medicines for remote Aboriginal and Torres Strait Islander people include financial and geographic constraints, failed patient-clinician interactions, poor healthcare delivery systems and complex therapeutic medication regimens.92
Other barriers include poverty, racism, dispossession, the stigma associated with a diagnosis of chronic disease, educational disadvantage, shared crowded households, increased patient mobility, and inadequate health professional support.93,94
There is often much confusion around medicines and many Aboriginal and Torres Strait Islander patients in all locations
still have low levels of medicine adherence relating to lack of appropriate or tailored information, and lack of health professional engagement and patient support.95,96
Initiatives already in place such as the Aboriginal Health Service Remote Access (AHSRA or Section 100) Scheme, the Quality Use of Medicine Maximised for Aboriginal and Torres Strait Islander peoples (QUMAX) program and the Closing the Gap (CTG) PBS Co-payment measure have removed some of the financial barriers to accessing medicines, and have resulted in measurable increases in medicine utilisation by Aboriginal and Torres Strait Islander people. In 2010-11 PBS expenditure for Indigenous Australians was 80% of the expenditure for non-Indigenous Australians.97 Whilst this has increased from 33% in 2001-02, there is still significant potential for improvement.
Proposed solution
PSA recommends that the Government consider an adaptation of the PGPIP to enable AHSs across Australia to improve medication adherence and reduce the progression of chronic disease, by utilising clinical pharmacists in the AHS service-mix. This would allow AHSs to access up to $125,000 per year to employ a pharmacist where required, in keeping with the general practice proposal.
Demonstrated benefits
Appropriate, effective interactions of Aboriginal and Torres Strait Islander people with culturally responsive clinical pharmacists could improve medication adherence and reduce the progression of chronic disease.101
Greater understanding and empowerment about medicine choices seem to be likely to improve medicine adherence. Dispensing protocols, the lack of pharmacist interaction, and the physical settings of community pharmacies have made it difficult for some Aboriginal and Torres Strait Islander patients to have productive relationships with pharmacists.102
Additionally, complex medicine regimens result in some Aboriginal and Torres Strait Islander people finding medicines confusing
and difficult to manage. Currently, communication from the doctor and/or pharmacist about medicines is often incomplete or ineffective. Dispensing protocols, the lack of pharmacist interaction and cultural training, and the physical settings of community pharmacies have made it difficult for some Aboriginal and Torres Strait Islander people to have productive relationships with their community pharmacists.98
An evaluation of the HMR program in 2008 noted that Indigenous Australians were most likely to miss out on effective access to HMRs, despite having the high rates of hospitalisation dues to medication misadventure.99 Currently, accredited pharmacists
are providing limited clinical pharmacy services to Aboriginal Australians due to barriers to service provision. These barriers include the absence of pharmacist-AHS relationships and prohibitive HMR business rules in the 5th and 6th Community Pharmacy Agreements, which require prior approval for HMRs to be completed at a site other than the patient’s home; a process that is not always possible nor culturally acceptable.
While changes to the HMR business rules may be one approach to overcoming these barriers, the HMR program as it stands, may in fact not be the most appropriate model to address medication management issues in Aboriginal and Torres Strait Islander communities.100
This initiative would give AHSs around Australia much greater access to the expertise of a pharmacist to deliver essential medication adherence and medication education services in a culturally appropriate environment.
These services could constitute a redesigned HMR program or other more culturally appropriate services such as group medicines education sessions or medication management services conducted in a setting of the patient’s choice.
Investment by the Government in such initiatives would be offset by reductions in chronic disease expenditure and reduced hospitalisations for the population of Australians beset by the poorest health outcomes. Making better use of pharmacists to improve QUM by Indigenous Australians must be an integral element in the Government’s efforts to achieve health equality between Indigenous and
non Indigenous Australians.
14 Federal Budget Submission 2016-17 I ©Pharmaceutical Society of Australia Ltd.