Minor ailment services from community pharmacy

University of Technology Sydney. Graduate School of Health.: Governments including the United Kingdom and Canada endeavour to optimise health care systems through investment in primary care reform. Community pharmacists are moving, encouraged by policy, to deliver self-care support in pharmacy. International studies indicate the role and scope of pharmacists in primary care could be expanded with clinical and economic savings. : Chapter 1 presents a systematic review of randomized controlled trials evaluating self-management support interventions following the Cochrane handbook and PRISMA guidelines. Chapter 4 describes the qualitative research (a focus group with stakeholders, working meetings with general practitioners (GPs) to develop treatment pathways, and semi-structured interviews with community pharmacists) to co-design an Australian model minor ailment service (MAS) applicable to the Australian setting. Chapter 5 presents a protocol for a cluster-randomized controlled trial (cRCT) quantitatively evaluating the clinical, humanistic and economic effectiveness of MAS. MAS pharmacists were trained in treatment pathways pre-agreed with GPs and communication systems with GPs, and received monthly practice facilitator support. Control patients received usual pharmacist care (UC). Chapter 6 details the statistical analysis undertaken using modified Poisson regression. Chapter 7 details the cost utility analysis (CUA) conducted alongside the cRCT. Deterministic and probabilistic sensitivity analysis were performed. : A theoretical model was developed providing structure to self-management in practice (Chapter 1). Chapter 4 presents the community pharmacy MAS model with the following elements: (1) In-pharmacy consultation, (2) treatment protocols on a technology platform (HealthPathways), (3) communication channels between pharmacy and GPs (HealthLink), (4) educational training, and (5) practice change support. Chapter 6 highlights findings from the cRCT. Patients (n=894) were recruited from 30 pharmacies and 82% (n=732) responded to follow up. Patients receiving MAS were 1.5 times more likely to receive an appropriate referral (relative rate (RR)=1.51; 95% confidence interval (CI)=1.07-2.11; p=0.018), and were 5 times more likely to adhere to referral, compared with UC patients (RR=5.08; 95%CI=2.02-12.79; p=0.001). MAS pharmacists were 2.6 times more likely to perform a clinical intervention (RR=2.62, 95%CI=1.28-5.38; p=0.009), compared with UC. MAS patients (94%) achieved symptom resolution or relief at follow up, while this was 88% with UC (RR=1.06; 95%CI=1-1.13; p=0.035). MAS patients had a greater mean difference in EQ-VAS at follow up (4.08; 95%CI=1.23-6.87; p=0.004). No difference in reconsultation was observed (RR=0.98; 95%CI=0.75-1.28; p=0.89). The CUA revealed MAS as cost-effective. MAS patients gained an additional 0.003 QALYs at an incremental cost of AUD $7.14, compared to UC. The resulting ICER was AUD$2,277/ QALY. The probabilistic SA revealed ICERs between AUD -$1,150 and$5,780/ QALY. : Findings suggest MAS should be implemented within the Australian context. A series of recommendations are made including the development of self-care policy in Australia to provide a policy framework for MAS

Primary health care policy and vision for community pharmacy and pharmacists in Australia

There is evidence that the Australian Government is embracing a more integrated approach to health, with implementation of initiatives like primary health networks (PHNs) and the Government’s Health Care Homes program. However, integration of community pharmacy into primary health care faces challenges, including the lack of realistic integration in PHNs, and in service and remuneration models from government. Ideally, coordinated multidisciplinary teams working collaboratively in the community setting are needed, where expanding skills are embraced rather than resisted. It appears that community pharmacy is not sufficiently represented at a local level. Current service remuneration models encourage a volume approach. While more complex services and clinical roles, with associated remuneration structures (such as, accredited pharmacists, pharmacists embedded in general practice and residential aged care facilities) promote follow up, collaboration and integration into primary health care, they potentially marginalize community pharmacies. Community pharmacists’ roles have evolved and are being recognized as the medication management experts of the health care team at a less complex level with the delivery of MedChecks, clinical interventions and medication adherence services. More recently, vaccination services have greatly expanded through community pharmacy. Policy documents from professional bodies highlight the need to extend pharmacy services and enhance integration within primary care. The Pharmaceutical Society of Australia’s Pharmacists in 2023 report envisages pharmacists practising to full scope, driving greater efficiencies in the health system. The Pharmacy Guild of Australia’s future vision identifies community pharmacy as health hubs facilitating the provision of cost-effective and integrated health care services to patients. In 2019, the Australian Government announced the development of a Primary Health Care 10-Year Plan which will guide resource allocation for primary health care in Australia. At the same time, the Government has committed to conclude negotiations on the 7th Community Pharmacy Agreement (7CPA) with a focus on allowing pharmacists to practice to full scope and pledges to strengthen the role of primary care by better supporting pharmacists as primary health care providers. The 7CPA and the Government’s 10-year plan will largely shape the practice and viability of community pharmacy. It is essential that both provide a philosophical direction and prioritize integration, remuneration and resources which recognize the professional contribution and competencies of community pharmacy and community pharmacists, the financial implications of service roles and the retention of medicines-supply roles

Cohort profile : demographic and clinical characteristics of the MILESTONE longitudinal cohort of young people approaching the upper age limit of their child mental health care service in Europe

Purpose: The presence of distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) impacts continuity of mental health treatment for young people. However, we do not know the extent of discontinuity of care in Europe nor the effects of discontinuity on the mental health of young people. Current research is limited, as the majority of existing studies are retrospective, based on small samples or used non-standardised information from medical records. The MILESTONE prospective cohort study aims to examine associations between service use, mental health and other outcomes over 24 months, using information from self, parent and clinician reports. Participants: Seven hundred sixty-three young people from 39 CAMHS in 8 European countries, their parents and CAMHS clinicians who completed interviews and online questionnaires and were followed up for 2 years after reaching the upper age limit of the CAMHS they receive treatment at. Findings to date: This cohort profile describes the baseline characteristics of the MILESTONE cohort. The mental health of young people reaching the upper age limit of their CAMHS varied greatly in type and severity: 32.8% of young people reported clinical levels of self-reported problems and 18.6% were rated to be ‘markedly ill’, ‘severely ill’ or ‘among the most extremely ill’ by their clinician. Fifty-seven per cent of young people reported psychotropic medication use in the previous half year. Future plans: Analysis of longitudinal data from the MILESTONE cohort will be used to assess relationships between the demographic and clinical characteristics of young people reaching the upper age limit of their CAMHS and the type of care the young person uses over the next 2 years, such as whether the young person transitions to AMHS. At 2 years follow-up, the mental health outcomes of young people following different care pathways will be compared. Trial registration number: NCT03013595

Primary health care policy and vision for community pharmacy and pharmacists in Australia

There is evidence that the Australian Government is embracing a more integrated approach to health, with implementation of initiatives like primary health networks (PHNs) and the Government’s Health Care Homes program. However, integration of community pharmacy into primary health care faces challenges, including the lack of realistic integration in PHNs, and in service and remuneration models from government. Ideally, coordinated multidisciplinary teams working collaboratively in the community setting are needed, where expanding skills are embraced rather than resisted. It appears that community pharmacy is not sufficiently represented at a local level. Current service remuneration models encourage a volume approach. While more complex services and clinical roles, with associated remuneration structures (such as, accredited pharmacists, pharmacists embedded in general practice and residential aged care facilities) promote follow up, collaboration and integration into primary health care, they potentially marginalize community pharmacies. Community pharmacists’ roles have evolved and are being recognized as the medication management experts of the health care team at a less complex level with the delivery of MedChecks, clinical interventions and medication adherence services. More recently, vaccination services have greatly expanded through community pharmacy. Policy documents from professional bodies highlight the need to extend pharmacy services and enhance integration within primary care. The Pharmaceutical Society of Australia’s Pharmacists in 2023 report envisages pharmacists practising to full scope, driving greater efficiencies in the health system. The Pharmacy Guild of Australia’s future vision identifies community pharmacy as health hubs facilitating the provision of cost-effective and integrated health care services to patients. In 2019, the Australian Government announced the development of a Primary Health Care 10-Year Plan which will guide resource allocation for primary health care in Australia. At the same time, the Government has committed to conclude negotiations on the 7th Community Pharmacy Agreement (7CPA) with a focus on allowing pharmacists to practice to full scope and pledges to strengthen the role of primary care by better supporting pharmacists as primary health care providers. The 7CPA and the Government’s 10-year plan will largely shape the practice and viability of community pharmacy. It is essential that both provide a philosophical direction and prioritize integration, remuneration and resources which recognize the professional contribution and competencies of community pharmacy and community pharmacists, the financial implications of service roles and the retention of medicines-supply roles

Theories, models and frameworks for health systems integration. A scoping review

University of Granada, Spain (UGR