Pharmacy medical care gets support

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