A little over a week ago I posted the first on what I hope is a series on Home Medicines Reviews out bush. This post is written by pharmacist Lisa Crisp who has been doing the Bush HMRs for the Kimberley Division of General Practice.
The Kimberley presents some unique challenges for pharmacy practice, but as I have found, the greater the challenge, the greater the reward. The distances are vast and the patients often unsure and mistrusting of this new service. But providing a valuable service to people in remote locations has been one of the best jobs I have ever done.
For the past two years I have been fortunate enough to work across the Kimberley region of Western Australia. It is one of the most beautiful offices in the world and this is the story of how I established a career in this wonderful workplace.
Before moving to the Northern Territory in 2007 I contacted as many different pharmacists and others with an interest in pharmacy practice as I could find in the area. Initially the response to my call for employment was slow, but once word spread that there was a pharmacist willing to travel to rural and remote NT and WA, the work flowed. One of the first (and best) positions I took up was working with the Kimberley Division of General Practice (KDGP) to provide a HMR service to the Kimberley region of WA.
With the support of KDGP I am able to travel to the Kimberley and the towns within it at no cost to me. Without this support it would not be economically feasible to make the trip. With KDGP funding my travel, I am also able to venture out to aboriginal communities to provide some patients with the first pharmacy service of their lives. Because many indigenous Australians collect (or have delivered) their medications directly from the aboriginal health service (AHS), they may never enter a pharmacy or come into contact with a pharmacist. While AHS staff are competently trained, it is rare that an AHS staff member would have the time to provide the type and quantity of medicines education that can be passed on during a home medicine review. Over and over again I find myself spending much time providing medication counselling and education to remote patients, but it is this basic medicine information that allows people to better self-manage their medications and avoid adverse outcomes and medication misadventure. For these patients, the education provided at the HMR interview is easily the most valuable part of the process and is always wonderfully rewarding for me.
Each time I visit an aboriginal community I am accompanied by an aboriginal health worker who introduces me to the patient to rapidly establish a level of trust that would otherwise be unachievable in a single visit. I vividly remember my first visit to a remote aboriginal community in the Kimberley. We were so far out of town that we were almost back in the NT and we were completely isolated. Although there were several houses in the community, it felt completely deserted. In the middle of nowhere, with no mobile phone coverage, in a community where I was not known or trusted, I was especially grateful to have a health worker with me that day. It’s a very different place to do a HMR as compared to my home town of Launceston that’s for sure!
I have also found that I have been able to establish much closer working relationships with the GPs that I report to. At some AHSs I spend time discussing the patients face-to-face with the GP both before and after the interview; a luxury very rarely found elsewhere. Remotely located GPs (AHS or other) also seem even more grateful for the service than urban doctors – I figure that they are so used to facing barriers to service provision that to have a willing pharmacist provided through KDGP at no extra work or cost for the GP, is an absolute dream!
The community pharmacies should also receive a mention here. Without their cooperation and support the process would cease. Across the Kimberley community pharmacists have been nothing but helpful and supportive, which makes the process that much easier for me.
It takes a lot more planning to conduct HMRs in the Kimberley. It’s many phone calls and time for KDGP to arrange the logistics of getting me to the Kimberley, and accommodating me there (they provide a hire car, flights, hotel room etc). There’s more preparation to be done at my end for a week on the road, and of course it’s a day’s travel each way to get there, but at the end of a busy week I am always happy to reflect on how much has been achieved and how great it has been to provide home medicine reviews for remotely located patients that otherwise would have missed out on such a service.
For any accredited pharmacist willing and able to travel, there is unmatched reward waiting in rural and remote Australia. With the support of local divisions of general practice, a two week working “holiday” to remote Australia may just be the best thing you ever did! And once you’ve been once, I’m sure you’ll be back because it’s very hard to give up once you get the taste for it!
Lisa Crisp is an accredited pharmacist based in Katherine, NT. She graduated from the University of Tasmania in 2004 and achieved DMMR accreditation with AACP in 2006. Despite living in the Top End, Lisa continues to work in Tasmania, across the Kimberley and the Top End in many roles; accredited pharmacist, locum pharmacist in both community and hospital pharmacies as well as consulting for divisions of general practice and other pharmacy-linked groups.
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