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GP leaders have called on pharmacists to stick to pharmacology and leave medical care to doctors, after a study suggested pharmacists could make important contributions to the primary care of patients with type 2 diabetes.(1)
AMA vice-president and Brisbane GP, Dr Steve Hambleton, said while pharmacists were a valuable member of the health care team and could help patients with compliance and appropriate quality use of medicines, medical care should be left to the medical practitioner.
The study, published in Diabetes Care, comes at the same time as moves within Australia to make pharmacists more involved in the ongoing care of patients through diabetes risk assessments and through telehealth.
The Canadian study involved pharmacists who performed medication assessments, limited history and physical examinations, and provided recommendations to optimise medication management.
Among 153 patients with inadequately controlled hypertension at baseline, intervention patients (n = 82) were significantly more likely than controls (n = 71) to achieve the primary outcome of a 10% or more reduction in blood pressure and recommended BP targets of < 130/80mmHg.
“Significantly more patients with type 2 diabetes achieved better BP control when pharmacists were added to primary care teams,” the authors said.
Dr Hambleton said the pharmacists in the Canadian study were trained diabetic educators and therefore the results could not be generalised to any other pharmacist.
“Despite 3.5 times the number of health interventions [in this study], the only thing they managed to do during the time of the study was to reduce the blood pressure,” he said.
“There was no significant change in the blood glucose control or any other parameter that was measured in the trial, which I think is quite a disappointing outcome for the level of intervention.
“Usual care with the GP with less than one-third of the health contacts is looking quite cost effective.”
Dr Paul Mara, president of the Rural Doctors Association of Australia, said pharmacists did not have training in diagnosis or examination.
“I don’t believe circumstances in Australia would see pharmacists undertaking physical examinations on patients with diabetes,” he said.
“I think that would make GPs very uncomfortable.”
However, he did not have an issue with hypertensive patients having their blood pressure measured by nurses or pharmacists, as long as there was liaison with the GP.
Pharmacy Guild of Australia national president Kos Sclavos said the Guild welcomed evidence of the significant and expanding role community pharmacists could play in primary health care.
“It is our view that community pharmacies are an underutilised resource in the health system,” he said.
Last month, the Queensland government announced that from next March, diabetes risk assessments will be carried out at pharmacies.(2)
The aim is for all pharmacies to help patients complete the AUSDRISK (Australian Type II Diabetes Risk Assessment) tool, with referral to a GP for those identified as at risk.(3)
The Australian also reported last month on a proposal for remote video consultations between rural patients and city-based specialists to be centralised in a pharmacy or community centre in small towns; and a GP might not have to sit in on all the consultations.(4)
The proposal is part of a federal government discussion paper on its $400 million telehealth plan.(5)
Dr Hambleton dismissed the notion of using pharmacies for telehealth.
“The patient may be able to whiz down to the pharmacy and stand in full view of the public and go online with the relevant specialist in Brisbane,” he said.
“The reality is the best place for the patient to be is inside the general practice using the general practice infrastructure.”
1. Diabetes Care doi: 10.2337/dc10-1294.
2. The Pharmacy Guild of Australia. Media release.
3. MJA 2010; 192: 197-202.
4. The Australian, 30 November 2010.
5. A Discussion Paper on Connecting Health Services with the Future.
Posted 6 December 2010
I’ve been in practice for 22 years as a renal and general physician, 30 years as a doctor. Nan says we’re rare, and we appear to be getting rarer.
Studies have looked at various reasons why junior doctors are avoiding the more “cognitive” specialities (GP should be included), but the most obvious reason, the lack of reward for the time spent doesn’t seem to be high on the list.
Yet, I believe that modern medicine would benefit from an injection of time with the patient, particularly since they are becoming more complex, and there is more to be done. That time needs to adequately rewarded, and not fragmented amongst more and more subspecialities, and alternative pseudo-professionals.
I would welcome more access to good diabetic educators in the community, but my faith in community pharmacists is low having been on the receiving end of numerous “unfortunate comments” about the antihypertensive doses I’ve used in difficult-to-control patients, and having seen more than one sell useless OTC meds to elderly patients already overburdened by polypharmacy. Also, experience teaches one to have a healthy respect for potential complications when prescribing – something that the untrained newbies lack.
Should we let the biggest purveyors of quack medicines loose on the unsuspecting public? I hope not! Another problem would be that pharmacists would be selling the medication which they were prescribing, something that was judged a conflict of interest and inappropriate for the medical profession many years ago.
I am in total agreement with the likes of Dr. Hambleton
The politicalisation of health care by placing alternative less trained pharmacists or nurses in the role of doctors is worrying and disappointing. One of the most important aspects of health care is correct assessment and diagnosis of the whole patient at initial visit. This can best be done by a specialist-trained physician and as these people are rare like hens’ teeth in the community, the first assessment is done by a GP and referred to a specialist if there are complications ad other comorbidities. It is after complete assessment and diagnosis that medication and other lifestyle practices are recommended. How can persons trained only in pharmacy or nursing or psychology even dream of taking on this role without the training undertaken by doctors and then supervised by various organisations like Medicare, heath complaints commission and RACGP and RACP? The solution proposed by politicians to fill the gaps produced by lack of trained doctors is a knee-jerk reaction and also dangerous for the unsuspecting public.