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© University of Otago, School of Pharmacy 2017.

International pharmacy practice research leader, Professor Ross Tsuyuki, Professor of Medicine (Cardiology) and the Director of the EPICORE Centre and COMPRIS at the University of Alberta, shared his pharmacy practice research on cardiovascular disease (CVD) presenting strong evidence toward expanding the scope of pharmacy practice.

Professor Tsuyuki’s well-designed randomised controlled trials presented strong evidence toward expanding the scope of pharmacy practice and as he mentioned in his talk “we have a societal responsibility to make these services available to our patients.”

Expanding the Scope of Pharmacy Practice

Disruptive Innovation

The effect of artificial intelligence on the profession continued to be a key focus throughout the symposium. Mr Geof Shirtcliffe, Corporate and Securities Lawyer at Chapman Tripp, agrees with Professor Gorman that virtual healthcare is the way of the future. Mr Shirtcliffe highlights the fact that artificial intelligence is already here causing disruptive innovation* in most professions.

The pharmacy profession is susceptible to disruption as it faces demanding side pressures to reduce health care costs and deliver better health outcomes. In a sector already, clearly on the radar of disrupters and their investors, the profession must adopt and adapt to this generational change and utilise technology.

“Do you have the right blend of skills for the future? Can you adapt, and are the pharmacy schools preparing the students with the right mix of skills and adaptability?”

* A disruptive innovation is an innovation that creates a new market and value network and eventually disrupts an existing market and value network, displacing established market leading firms, products and alliances. Wikipedia.

In the symposium’s opening presentation, Professor Des Gorman of Health Workforce New Zealand, Professor of Medicine and Associate Dean for the Faculty of Medical and Health Sciences at The University of Auckland, set out the rationale for cutting funding to undergraduate pharmacy education and the overwhelming reality that healthcare is increasingly unaffordable in New Zealand.

Alternatively, “will they go the way of the dodo because of artificial intelligence and robots?” asks Professor Gorman.

Reflections on the profession

For Professor Gorman there is a strong interest in return on investment in undergraduate pharmacy education as Health Workforce New Zealand moves to change its funding model. Now, instead of subsidising a service provider community, the ministry will fund education and training on a return on investment model.  “There are a number of professions in our spotlight, and you are one of them, unquestionably” states Professor Gorman. With only a small percentage of graduates going into areas of practice that see a high return of investment, it “makes sense to disinvest”.

 “If we were to disinvest, we would say we need to reduce the number of graduates that we have in that program that are moving into extended multi professional practise because we are training a large cohort of people for a role undertaken by a minority of them. That does not make sense.”

Professor Gorman suggested virtual healthcare is one way in which our floored healthcare system can move forward to be more fit-for-purpose, as well as both affordable and sustainable. However, what value do pharmacists add in this virtual world? Will pharmacists play an integral part?

Virtual healthcare is one way in which health systems can become more fit-for-purpose, as well as both affordable and sustainable. By using the tools that are already available to us, the virtual healthcare vision can be realised. 

We need to overcome the barriers present in today’s healthcare system in order to move pharmacy forward.

Moving Research into Practice

University of Sydney’s Professor Ines Krass illustrated the nexus between evidence and policy formulation in the Australian context with her presentation titled ‘Translating Research Evidence into Australian Pharmacy Practice: Successes and Challenges’.

Professor Krass traced the Australian experience for policy setting in relation to community pharmacy that has evolved over the past several decades. In particular, she focused on  investment through successive Community Pharmacy Agreements in research and development. This research has and will continue to inform the introduction of non-dispensing related remunerated professional pharmacy services.

District Health Boards implement change

Senior Manager Funder Support and Intelligence for the Southern District Health Board, Mr Glenn Symon recognised the pharmacist role is changing and the services DHBs contract will also need to evolve.

Pharmacists, together with other health care professionals, will need to work differently in the future to respond to the ever-growing demands on the health system. Over the past year District Health Boards have worked extensively with the Ministry of Health, PHARMAC, the pharmacy sector, and a range of stakeholders across the wider primary care sector, and consumers, to understand how pharmacists can best respond to those demands.

post-symposium REPORT

In Review: Forward Pharmacy Symposium

Dear Friends:

It is our great pleasure to present this summary of the inaugural Forward Pharmacy Symposium held in Wellington, 11 April 2017. We find ourselves in a unique time, as new technology, new funding structures, and an integration of services work to expand the potential for the delivery of a better primary health care system in Aotearoa New Zealand.

Our first Symposium explored some of the barriers to implementing a patient-focused model for pharmacy in New Zealand and explored means to address evidence gaps. The University of Otago and The University of Auckland Schools of Pharmacy initiated this symposium to present evidence to a multi-disciplinary forum with the aim of discussing barriers to moving pharmacy forward. In particular, the lack of remuneration and the lack of national evidence about the value for money proposition for pharmacist-based services were repeatedly mentioned.

Key action points were discussed throughout the day in a facilitated inter-disciplinary discussion, drawing on the vast experience available to us in the pharmacy sector. We believe that sector has started an important discussion around evidence generation and value propositions for pharmacist delivered patient care services that will propel pharmacy forward.

We will continue to have important conversations between key stakeholders to share ideas and examples of how they are providing evidence towards introducing a more patient-centred approach to primary healthcare in New Zealand. We look forward to our next gathering and are eager to hear more evidence from organisations taking the lead and moving pharmacy forward.

Sincerely,                                                                 

 

Carlo Marra

 

Professor Carlo Marra                                    

Dean                                                                         

University of Otago, School of Pharmacy              

Guest Speakers

—  Mr Geof Shirtcliffe, Corporate and Securities Lawyer at Chapman Tripp

“Do you have the right blend of skills for the future? Can you adapt, and are the pharmacy schools preparing the students with the right mix of skills and adaptability?”

“A key component of integrated care is integrated funding,” says Chief Pharmacist Advisor for PSNZ, Mr Bob Buckham. PSNZ and New Zealand Medical Association recently co-developed the pharmaceutical schedule to fund the provision of influenza vaccine to people 65 years and over, plus pregnant women in community pharmacies to help improve the uptake of the vaccine and offer another convenient and effective option for the community.

“The funding separates into general practice and primary care and now, wonderfully, it’s funded through community pharmacies. “

Unfortunately, this funding model has a negative effect towards integrating the profession “It actually sets up the two professions in competition with each other for the money and who gets it.  And that’s how the two professions see it because that is what it comes down to.”

“The challenge that Des set up for us this morning is probably the biggest one.  The resources are there now, there’s an enormous amount of ability, we just don’t use it,” said Robbie Hanning, Community Pharmacist in West Auckland.

Mr Buckham responded with “One of the things that I try and do for all submissions and discussions that we take part of and produce is trying to articulate the value of pharmacists.” The profession is not recognised for the services they currently provide. “The counselling the working out do you need to see the doctor or not.  None of that is actually captured or recognised therefore it is not actually valued.”

Victoria University PhD candidate in health policy research and pharmacist, Tara Officer questioned the panel “My impression is that the current cohort, including myself, are not a very future proofed profession; we are not able to cope with the changes that you are suggesting.  At least, not with our current skill set. What do you see, as being one way that we can future proof the undergraduate qualification?”

Dr Jeff Harrison responded with “Our programmes have always tried to prepare people for a future and a set of generic skills with a core set of knowledge. Yes, there are skills that students need to learn … that is the expert knowledge. We have always tried to prepare people with those broader skills so when they do get into the workplace they make the most of opportunities. We have always taken the view that we are releasing people into the world to go and effect change, not to do what has always been done.”

The University of Otago, School of Pharmacy is undergoing a Bachelor of Pharmacy curriculum review, moving to a more clinically orientated, patient care focused programme. The generic skills and the core set of knowledge remain the same, as that is what makes pharmacy unique.

Students need to be “adaptable” responded Professor Ines Krass from the University of Sydney “with a focus on generic skills.”

President of the Pharmaceutical Society of New Zealand (PSNZ) and the EVOLVE Advisory Board, Mr Graeme Smith asked “If we are going to have truly integrated pharmacist services in the community, I think that the debate needs to be widened to look at the whole provision of the model of care and funding for the entire primary care sector. What are your views?”

“Community pharmacy represents a valuable resource of trained health care professionals that should be leveraged to provide preventive and chronic care services as part of an integrated primary care sector approach. Internationally, there is a growing body of evidence supporting the benefits and cost effectiveness of a range of preventive and disease management support services offered in community pharmacy.  However, a systematic program of research to develop such evidence is pivotal to informing rational health policy.”

“The aim is to move from the current system of paying pharmacists from a transaction based medicine supply service to a menu of consumer-centric services.  These services will be flexible enough to meet local population need,  recognise pharmacists as medicines management experts, and support  pharmacists as part of the multi-disciplinary team i.e. integration of pharmacist delivered services with other primary care services to benefit the wider health care system and population health.”

PANEL DISCUSSION

LIGHTNING PRESENTions

Professor Carlo Marra, Dean of the University of Otago School of Pharmacy and Dr Jeff Harrison,

Head of The University of Auckland School of Pharmacy

In the opening presentation for our 10 minutes Lightning Talks, Professor Marra reminded the forum that “Not just community pharmacy. We are interested in all forms of pharmacy moving forward,” and “One thing we need to define is, what kind of evidence do we need to advance the profession forward?” A few suggestions where:

  • We need research that is based on , robust, unbiased design

  • We need to be able to produce evidence on programs that represent good outcomes and value and then, using implementation science, develop ways to integrate knowledge into practice

  • The key to funding is often economic research (the value proposition)

  • The universities have the research skills to help design, analyse and translate knowledge; however, without the broader profession’s partnership, the necessary evidence generation and uptake cannot occur.

Leanne Te Karu, Deputy Chair, Pharmacy Council of New Zealand

Leanne Te Karu describes how we might reach the utopia of optimal use of medicines in her opening slide saying, “Surely that is why we are here?”

Ms. Te Karu disagreed with Professor Des Gorman for calling this a “health system”.

“This is not a system. It is not systematic.  By definition, we have to have interacting units that function as a whole. We do not function as a whole. We need to collaborate more.”

Ian McMichael, Director Pharmacy 547 Limited

Mr Ian McMichael explained how innovation at a community level could have a dramatic effect nationwide for pharmacy services.

 

Mr McMicheal views Pharmacy 547 as a healthcare company that looks across various health disciplines and has led change in the healthcare delivery in New Zealand. Pharmacy 547 has pioneered such services like CPAMS and immunisation amongst others.

Billy Allan, Chief Pharmacist, Hawke’s Bay Health Sector

Integrating pharmacists into the general practice team works - it works for patients, the general practice, the system and the pharmacists.

The Pharmacist Facilitation Team in Hawkes Bay works within their general practices to increase best practice prescribing and medicine utilisation, encourage appropriate deprescribing, and actively works with patients identified as most at risk of medicine-related harm.

This integrated approach has improved health outcomes and reduced medicines use. It has been associated with a reduction in medicine-related presentations to the emergency department, a reduction in falls, delayed admission to rest homes, reductions in morbidity (reduced blood pressure, blood lipids and HbA1c}, a reduction in the community pharmaceuticals spend, and enhanced patient satisfaction.

Dr Linda Bryant, Clinical Advisory, Phoenix Consulting Pharmacists

“We need to work to our unique point of difference. We are unique in what we know,” says Phoenix Consulting Pharmacists Clinical Advisory and Professional Practice Fellow at the University of Otago, Dr Linda Bryant in her Lightning presentation titled ‘Clinical Advisory and prescribing Pharmacists in Primary Care’.

 

Dr. Bryant stated that pharmacists are going to be a specialty service using their in-depth knowledge and understanding of pharmacotherapy. An area, Dr Bryant says, that needs to be focused on at the undergraduate level.

Dr Caroline Morris, Senior Lecturer, University of Otago (Wellington)

Dr Morris provided an overview of the three and a half year research project ‘Exploring the development and impact of changes in community pharmacy services’ funded by the Health Research Council of New Zealand in 2016.

This study will investigate how changes in community pharmacy services in NZ are expected to influence health and health service outcomes, identify the context in which success is occurring or being hindered, and the mechanisms by which change is being achieved.

facilitated session & Key takeaways

As we plan for our next symposium, we took note of the big themes emerging from this year’s guest speakers, the panel and facilitated sessions. Some of the key takeaways include:
 
  • We must expand the scope of pharmacy practice in order to meet the primary health care needs of our community
  • We need integrated funding models to ensure integrated healthcare
  • We need to investigate in the value of pharmacist delivered patient care services
  • We need to investigate ways to improve communication with the primary health care sector to ensure patient centred care
  • We need to create business models that support positive disruption
  • We need to evaluate the risks and benefits of removing dispensing from the pharmacy profession
  • We must investigate what the health system (including consumers) needs from pharmacists
  • We need to maximise potential of new graduates to enable them to practice. Is there another way of training our students? Can we graduate practice ready pharmacists like other jurisdictions
  • We need to capture the most recent innovations and evaluate them, using robust designs and innovative methods (including health economics). e.g. Pharmacist prescribing, medicine management, oral contraceptive, and return on investment
  • We need a stock-take of all evidence focused on services of interest

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Looking Forward

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