Page 15 - Submission to the 2015-16 Federal Budget

Appendix 2
A day in the life of a clinic pharmacist
» RURAL PHARMACY
A day in the life of a clinic pharmacist
BY LINDY SWAIN
As I enter the clinic, the waiting room is overflowing and I know it is going to be another busy day. Whilst logging on to Medical Director (MD) and sipping on a coffee, Dr K asks me to develop a pain management plan for a palliative breast cancer patient she is visiting this morning.
FEATURE
Already I am becoming a valued team member. The patients have complex needs and the GPs struggle to have time to address all their issues in one consult. Having a team approach to patient management is the only way to manage the case load. Many of my patient interactions are opportunistic. Being part of the team, being able to discuss the patient with other health professionals, and being able to access Medical Director for a complete patient history, enables me to conduct meaningful, informed clinical interventions.
“THERE ARE VERY FEW ABORIGINAL HEALTH SERVICES AND GP
CLINICS WHICH HAVE A CLINICAL PHARMACIST IN-HOUSE.”
There are very few Aboriginal health services and GP clinics which have
a clinical pharmacist in-house.
The pharmacist’s role is a diverse
one, including patient counselling around medication adherence, patient and health professional education, liaison with other pharmacists and health professionals, and decision making around medication choices. Although I am only in the clinic one day a week already I may have delayed or averted medical emergencies and hospitalisations. Salaried positions for pharmacists in these clinical settings would definitely save the Government health dollars.
One never knows what a day at the clinic will bring, but every day is challenging and rewarding. Now we just need
the government to value the clinical pharmacists’ role and start funding pharmacist positions in Aboriginal health services.
Lindy Swain is Clinical Pharmacist at Bullinah Aboriginal Health Service, Director of Rural Policy at PSA and a Pharmacist Academic, University Centre for Rural Health, Lismore, NSW.
Dr K wants the patient’s regimen to allow for easy up titration of dosage
of opioids as required. The patient has had multiple recent visits to hospital so
I read through all the progress notes, pathology and referral letters, and check the latest palliative guidelines. I type my recommendations into Medical Director, and catch Dr K between patients
to discuss.
Next the nurse brings me a patient she is worried about. The patient has her pockets stuffed with her many medicines and is confused about whether she took her tablets this morning. After much talking and listening, the patient agrees that
her medicines are important and
that a Webster pack may be of some assistance. We phone the pharmacy and organise it. Fortunately the QUMAX program will fund the cost of her Webster packs.
The practice manager comes by and asks me to assist her with the QUMAX progress plan and report. I phone a couple of local pharmacies to discuss the changes we are making to the QUMAX contracts. Dr C drops in to check what dose of insulin he should start Mr S on and the medical student comes by to discuss his diabetes project.
My 10.30am appointment, Mrs R, has arrived with her son, James. I contacted Mrs R last week as the pharmacy told me that she had not been picking up her Webster packs. James explains that his mum has early stage dementia and she volunteers that she has not taken
any medicines for about a month.
I take Mrs R’s blood pressure. It is 210/145. I make an appointment for
her to see the doctor. James agrees to pick up his mother’s Webster packs,
but is still worried that his mother
may forget to take her tablets. I make some recommendations for Mrs R’s medicines so that they will all be dosed in the morning. We organise for Mrs R’s granddaughter to visit her each morning to remind to take her tablets.
In the lunch room, Dr J and I discuss which antipsychotics, anti-epileptics and mood stabilisers might decrease the effectiveness of oral contraceptives. I email her a list for future reference.
The home medication visit I was planning for the afternoon has cancelled. There has been a death in the community. It may be a couple of weeks now until I get to see Aunty M. I am a little concerned that Aunty M has not had a lithium level done for two years so ask the nurse to follow up and organise for Mrs M to have some pathology tests.
The Aboriginal health worker brings one of his friends in for a yarn. Mr J tells me he is managing his medicines well, but is a bit tired and a cough is waking him up. I notice he has very swollen ankles. On looking at his history I see that he has chronic heart failure. I send him in to see the doctor, who orders him some frusemide.
It has only been a couple of months since I started working one day a week at the Aboriginal Health Service.
Australian Pharmacist October 2014 I ©Pharmaceutical Society of Australia Ltd. 25
Integratingpharmacistsintoprimarycareteams I©PharmaceuticalSocietyofAustraliaLtd. 15