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Australian Journal of Pharmacy : November 2006
pharmacy profe pharmacy professional updates Veterans’MATES: a model for future pharmacy practice For more than two years, the Veterans’MATES program has been developed and used to enhance the quality of healthcare received by veterans from their GPs and pharmacists. Professor ANDREW GILBERT* explains why this program is relevant to pharmacists and how it can be used in professional practice in the broader community (Veterans’ MATES) has been operating successfully for two and a half years. Based at the Quality Use of Medicines and Pharmacy Practice Research Centre (QUMPRC) at the University of South Australia’s Sansom Institute, the pro- gram is designed to provide patient-spe- cific prescribing feedback to doctors and medicines advice to veterans. So how is this program relevant to pharmacists and where is it leading phar- macy practice? V Perhaps the best way to answer the question is to revisit some of the pharmacy practice research in Australia over the last 10 or so years. Pharmacy practice research in Australia The environment for pharmacy practice research changed dramatically in the early 1990s. The Quality Use of Medi- cines Policy was brand new, as was the first of the Guild–Government agree- ments, and significant research funding was available for the first time. Energetic researchers including Char- lie Benrimoj, Louis Roller, Kay Stewart, Sue Tett, Jeff Hughes, Greg Peterson, Mike Roberts, Tim Chen and many oth- ers have made great contributions over that time. Projects such as the Models of Practice Project1,2 and to develop and implement standards of practice around pharmacist-only and pharmacy medi- cines3,4,5 were funded. Government and consumer groups asked pharmacy practice researchers how the contribution of pharmacists to health- care could be increased, particularly in the primary healthcare setting. Practice focus on patients The research conducted at the QUMPRC ETERANS’ Medicines Advice and Therapeutics Education Services demonstrates the logical extension of ideas from the original Models of Practice Project to the Veterans’ MATES program. In the Models of Practice Project, 15 owner pharmacists from across South Australia were selected from more than 40 applicants to work with the QUMPRC team to develop a new patient-focused practice in a professional area relevant to the needs of the community served by their pharmacy. As the pharmacists and their staff worked to develop their model of practice ...pharmacists were able to articulate the elements for success in this new style of practice the QUMPRC team enlisted general med- ical practitioners (GPs) and consumers onto review groups to critique and advise the pharmacy teams on their proposals. The pharmacy teams chose areas such as asthma, diabetes, wound care, primary care and medication review. What became immediately clear was that suc- cessfully working in this new style of prac- tice took the pharmacy staff a long way from their existing practice and comfort zone. Work practices and responsibilities were redefined; professional interactions with GPs and patients increased dramati- cally. At the end of the study the pharmacists were able to articulate the elements for 26 ? THE AUSTRALIAN JOURNAL OF PHARMACY VOL 87 NOVEMBER 2006 success in this new style of practice: patient-centred and clear process of care; a funding model that supported profes- sional service, not just product delivery; high level engagement with local GPs and their patients; supportive staff in the phar- macy; and ongoing facilitation and sup- port by the researchers. Other projects such as the Department of Veterans’ Affairs (DVA) Medicines Management Review pilot6 were funded to and the Qual- ity Use of Medicines in the Community Implementation Trial7 further explore the practicalities of engag- ing pharmacists to assist GPs in the man- agement of patients who were at risk of medication-related problems. The latter trial was one of five funded under the second Guild–Government agreement to help provide information for the funding and conduct of what are now called home medicines reviews (HMR). Veterans’ MATES The natural extension of this work was the Veterans’ MATES program, in which researchers have access, through the DVA, to veterans’ medication use data, which in turn enabled them to identify therapeutic areas on which to focus their attention. With the majority of veterans in the database being older than 80 years, chronic conditions such as diabetes, men- tal health problems, arthritis, cardiovas- cular disease, digestive systems disorders and respiratory problems are common. It is also common for these older veterans to have more than one chronic condition. As a result poly-pharmacy is widespread. We select relevant therapeutic areas, determine the issues in that area that we wish the GP to consider, develop appro- priate support materials and mail out to GPs who have veteran patients with the