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Australian Journal of Pharmacy : November 2005
medication management in review Expand your horizons and opportunities: take a step outside the pharmacy A supportive model, consisting of small learning groups and mentoring colleagues, suggests Dr JENNY GOWAN,* may provide the encouragement many pharmacists need to become accredited to perform home medicines reviews A N increase in the size of pharma- cies, together with extended trading hours, have seen a decrease in the num- ber of single pharmacy operators. The days of the ‘four wall syndrome’, no lunch break, or time to go to the bank, may be a thing of the past. Most small pharmacy operators now have part-time pharmacists to enable some ‘time off ’. But for pharmacy to survive, all phar- macists, including those who have suffi- cient staff to enable them to occasionally walk out the door, need time to explore the community environment and offer services where needs are apparent. Many health professionals other than pharmacists are becoming more involved in medication-related issues: education of consumers, medication management, selection, counselling, marketing, distri- bution, professional development and training of health professionals, health promotion, drug utilisation, pharma- coecomomics and research. Arguably, pharmacists are the most qualified to deliver these services. So expanding their role outside the pharmacy walls makes a lot of sense, both professionally and finan- cially. As the population ages, there is a grow- ing need for pharmacists to utilise their skills in delivering and being adequately paid for professional services. The oppor- tunity for pharmacists to become valued members of the healthcare team, not purely suppliers of products, is well and truly here.We can make a difference and be the focus for medication management. Providing cognitive services Since the home medicines review (HMR) program began in 2001, more than 85,000 HMR items have been claimed by pharmacists.1 There has been a slow but steady increase as more GPs find the ben- efit of not only pathology, but additional quantitative data about adherence, what patients are actually taking, and how and when, as well as invaluable qualitative data about attitudes, barriers, and cultural diversity. HMRs are integral to chronic disease state management and are emerging as part of cycles of care developed by gen- eral practitioners.2–4 Many GPs are most encouraging and appreciative of the reports to assist optimum medication management, and Quality Use of Medi- cine initiatives. Many pharmacists began providing cognitive services, even prior to federal funding, by attending the numerous phar- maceutical care courses based on the Strand and Hepler model,5 introduced in Australia by John Rovers and others in the early ’90s. Encouraged by Alistair Lloyd (then branch director of PSA (Vic)), a Pen- guins group was set up in Victoria with penguin emblems being presented to the first pharmacists who were brave enough to jump into the icy water. Many of the Penguins have progressed to become accredited pharmacists, surfing on the waves,while others remain in the comfort of where they know best. We must encourage them to take the jump quickly and move on. 872 ? THE AUSTRALIAN JOURNAL OF PHARMACY VOL.86 NOVEMBER 2005 Remuneration for delivering medica- tion management review (MMR) services was first provided in 1997. Since then, many thousands of pharmacists have attended weekend, and at times longer, training courses in preparation for this role. While some 1,600 have progressed to accreditation, many more have not. Reassessing the accreditation process There are many and varied reasons for this. Some pharmacists recognised that their clinical skills were challenged and did not wish to progress any further. Oth- ers started the assessment process but unfortunately time and motivation did not arrive in the envelope with the cases. Others were devastated by requests for resubmission of review cases to prove their competency, while others completed the requirements, became accredited, but did not subsequently receive enough referrals, on a regular enough basis, to maintain enthusiasm. Additional challenges to delivering HMRs and other services are presented by Australia’s cultural diversity, requiring pharmacists who have the appropriate linguistic skills and appreciation of differ- ent cultures. The most successful HMR interviews in these situations are con- ducted by pharmacists who can commu- nicate in the patient’s preferred lan- guage, both spoken and written, and are culturally competent, not with the use of interpreters or family members. In these situations, the trained interviewer phar- macist, preferably known to the person, is