Collaboration between doctors and pharmacists in the community

Editor, – In her recent article (Aust Prescr 2010;33:191-3) Ms Rigby provides a timely, succinct analysis of the issues confronting the medical and pharmacy professions striving for better medication management in an era of increasingly complex health care. The necessity for a team approach in this environment is obvious. The challenge is defining relationships and boundaries for each of these health professionals and the patient. Trust is the touchstone upon which effective primary care operates. Any system promoting collaboration develops trust, not only with patients but between health professionals.

The Home Medicines Review system is challenged by administrative issues and poor reimbursement for quality reports. Current business rules restrict access. Where patients have no relationship with a pharmacy, the system breaks down, placing a barrier between general practitioner and accredited pharmacist. The referral process also takes no account of the skills and expertise of an accredited pharmacist (for example palliative care, geriatrics, de-prescribing, post-discharge and cultural issues).

In the face of an ageing population and overburdened hospitals discharging patients early, accredited pharmacists could develop expertise in areas where there are gaps in medication management. Allowing direct referral from general practitioners and giving consideration to co-location of pharmacists within a general practice will allow the growth and development of this role for pharmacists. Any system is only as good as the people who participate in it. Trust and collaboration can only be achieved through patience, time and understanding while, above all, maintaining the interests of the patient.

Pradeep Jayasuriya
General practitioner
Cloverdale, WA

Deirdre Criddle
Consultant pharmacist
Dianella, WA

Debbie Rigby, author of the article, comments:

Thank you for your insightful comments and I agree that trust and confidence in pharmacists' clinical skills and knowledge is the key to collaborative patient-centred care. In July last year the Pharmacy Guild foreshadowed changes to the Home Medicines Review (HMR) model, including a direct referral model and post-discharge HMRs initiated by hospitals for high-risk patients. Direct referral to accredited pharmacists will provide greater flexibility to the HMR model and foster closer collaboration between general practitioners and pharmacists. This will be a welcome change to many general practitioners and accredited pharmacists. These proposed changes should not replace the existing HMR model which we know has produced many positive outcomes and satisfaction for patients. Ideally the direct referral model should always include the patient's preferred community pharmacy in the communication loop. This is especially important for hospital post-discharge medication reviews where medication reconciliation is a critical component.

For pharmacists to transition from the traditional role of dispenser to patient-centred practitioner, the culture of the pharmacy profession needs to move from a 'one size fits all' paradigm to allow role expansion for advanced practitioners in a collaborative environment.