Two Meetings Highlight Disparity in eHealth in Remote Australia

Meeting 1. E-Health Conference, Revolutionising Australia’s Health Care

An invitation only two day seminar on e-Health was held in Melbourne on November 30 and December 1st. Apparently a “draft concept” of the shared e-health record concept was shown. It seems like there is $55 million splashing about for projects based on the personally controlled e-health record (more about money later on).

The Minister for Health and Ageing, Nicola Roxon gave the opening address. Here is part of what she had to say.

Part of our job in embracing this change and exploring further opportunities is to explain to the wider public the benefits of this big step into the future.
Let’s consider some of the situations that face clinicians and patients today.

Take the case of a young mother whose two children suffer from asthma.

The children might have tried many asthma drugs on and off, and keeping track of what each child has tried is challenging – for parents, for doctors, for hospitals.
Or consider the case of a Melbournian retiree escaping to Darwin for a holiday, becoming sick and being raced to hospital by ambulance.

He arrives without his current tablets and is not in a condition to talk about his medical history. What does the ED team need to know to make the treatment effective?

Or let’s think about a carer’s perspective for a moment. Hundreds of thousands of Australians care for a loved one, many of whom can’t participate in their own care which might involve a GP, then local pharmacist, the district nurse, specialists and the local hospital.

There’s a constant worry that the wrong medication might be taken at the wrong time. These fears are well grounded – medication errors currently account for 190,000 admissions to hospitals each year (my italics).

And take the case of the hundreds of thousands of Australians with chronic disease. Many of whom want to better manage their diseases, but lack the connection over their information that can make this happen.

These scenarios reflect the kinds of real-life situations that occur all around Australia every day.

national electgronic health transition authority

Let me digress a bit here. It does have something to do with the second meeting.

Pharmacists reviewing medication histories and more pharmacists in wards in hospitals reduce error rates. And an electronic patient record should reduce them even further.

Aboriginal Community Controlled Health Organisations (ACCHO) are where Aboriginal Australians wish to receive their healthcare. There are five pharmacists I know of that work full time for an ACCHO.

Meeting 2. 28th June 2010 No title, attended by stake holders in remote Indigenous Health

This meeting was called after a presentation and some networking at the National Medicines Symposium. It was to discuss the lack of dispensing software, tools and training for remote area S100 ACCHOs and other Aboriginal Health Services.

  • Dispensing is usually done by Aboriginal Health Workers, Doctors and Remote Area Nurses who in the main have have no specific training for this task and may under-appreciate its importance in Quality Use of Medicines. In some states this may be illegal
  • Dispensing systems either stand alone or incorporated into electronic patient management systems for tasks such as labelling, recording of supplied medication and stock control are for the most part primitive or non-existent. Indeed in many cases medicines are dispensed with handwritten, incomplete, or no labels at all.
  • Yes, that’s right. We are spending millions on eHealth but in remote Australia we still can’t print a legible label for a patient’s medication. Does it surprise anyone that there seems to be no money to rectify this lack of not only dispensing, but no pharmacist involvement?

    Is it too far a stretch to think we are building a whizz bang house, but out bush it is on very poor foundations?

    Telegrams and Dispensing Schedule 4 Drugs in Emergency Cases

    In most Poison’s and Pharmacy Acts and Regulations in Australia there is the ability to give an emergency supply of medication. Within pharmacy it is usually a three day emergency supply. However should the prescriber contact you you can supply and the prescriber must supply a prescription shortly after.

    telegram boys

    Here is the relevant regulation within the Western Australia’s Poisons Regulations

    POISONS REGULATIONS 1965 – REG 38
    38 . Dispensing poisons included in Schedule 4 in emergency cases

    Where a medical practitioner, nurse practitioner, dentist or veterinary surgeon in a case of emergency orally or by telephone or telegram directs the dispensing of a poison included in Schedule 4, he shall forthwith write a prescription complying with the conditions prescribed in regulation 37, mark such prescription to show that it has been given as a confirmation of instructions given by him orally or by telephone or telegram, and despatch such prescription within 24 hours to the person to whom the instructions were given.

    [Regulation 38 amended in Gazette 19 Mar 1996 p. 1222; amended by Act No. 9 of 2003 s. 46.]

    Now I was going to make a smart alec remark about receiving an old fashioned telegram to urgently dispense a medication. A telegram in the 21st Century? Yeah Right. But it seems they have a niche market. Australia Post still provides a telegram service. I like how you can organise the telegram by phone or over the internet.

    When it’s special, send a TELeGRAM. Some messages are too important for a phone call and too special for email.

    That’s how Australia Post markets it. But it goes on.

    The TELeGRAM combines new age demands with old world charm to offer you a quick, convenient way to send a message that matters.

    Create your messages on-line, select from a range of images, and we print and post a hard copy of your special message to any delivery point within Australia.

    I love it. I want a doctor to send their local pharmacist a drug order by telegram. And I want a camera there to see the response. I wonder if singing telegrams or gorilla-grams are also legitimate ways for ordering medications in an emergency.

    A Future of Pharmacy?

    This is the unedited article placed in Auspharm on 6th April 2009

    Well I’m off to the pharmacy to get my weekly supply of medicines. I said “pharmacy”, but perhaps “nursery” is more appropriate. The pharmacies these days are staffed and run by nurses. Funny, although being in short supply, nurses have spread into new areas of health whilst pharmacy seems to have lost the right to work in even the basic area in which they have been trained as well as other areas in which they still work around the world.

    These nurses are busy. As well as dispensing all medicines they treat a range of acute conditions, manage chronic disease, and give vaccinations as well as provide a range of other services. They are so busy they often don’t have time to talk to me about my medicines. Luckily they are all packaged together by dose so I guess I don’t really have to be told much about them.

    Nurses started doing all this work as they could offer more services and be reimbursed with a provider number for Medicare. The Pharmacy Guild fought against individual pharmacists being able to obtain provider numbers. With the decrease in remuneration for a script now down to a $1.14, the ability to bring this extra revenue was essential for a pharmacy to survive.

    You see a pharmacist sometimes. They supervise a large number of pharmacies and supply the medicines in packets and in packed doses to them all. Every now and then a pharmacist visits the nurses to check to make sure they have the required books and perhaps give a bit of training. One even came to see me once. She seemed nice. But I didn’t really know her so didn’t ask all the questions about my medicines that I wanted to.

    The change in pharmacy happened pretty quickly after the government looked at the involvement of pharmacy in looking after one of the sickest and most disadvantaged groups in Australia – our remote indigenous population.

    They noticed that large service providers like Territory Health tendered out the S100 medication supply – but it all had to be labelled for an individual patient. Pharmacies even from the coast were looking at supplying the “dispensed” medicines for a $1.14 each thinking they could make a profit on volume.

    Pharmacy Boards in various jurisdictions didn’t enforce counselling that should be provided with this dispensing. Indeed, even within the organisations there were differing opinions on whether these were actually dispensed or supplied. Was filling a Webster-pak for a patient from S100 medications supplied for use by a remote community a supply of medication or was it dispensing? A lack of consistency and action by bodies set up for the protection of the public reinforced in the bureaucrats’ minds that counselling was superfluous. Anyway, there is always the internet to look things up on.

    The government knew it would not get any serious opposition from the Guild in response to these changes. After all, they seemed perfectly happy to only have pharmacists visit these remote areas and leave “pharmacy” work to nurses and others. I think they found it hard to believe that pharmacy bodies weren’t pushing to have pharmacists doing pharmacy.

    This was reinforced with the new Business rules for pharmacists visiting remote areas not allowing funding to cover the entire population that the health service treats.

    The submissions to the National Health and Hospital Reform Commission did pharmacy no favours. In the area of indigenous health the Guild and SHPA documents argued that each was the better group to send out visiting pharmacists. None put forward an argument that it was criminal that indigenous communities, some of over 2000 indigenous people, a population group with a much higher disease burden than the rest of Australia did not have full time access to a pharmacist.

    The body representing all pharmacists, PSA, became a laughing stock. Their submission did not even mention what pharmacists could offer in indigenous or remote health

    “If they can provide no benefit to one of the sickest groups in society are pharmacists required at all?” So went the thinking. And now it has come to pass.

    We have only ourselves to blame.

    Various commentators from the AMA to Oxfam have stated over the years that indigenous health requires another $400million each year to provide adequate health care to our indigenous population. Yet all pharmacy can offer in reports to the National Health and Hospital Reform Commission with regard to indigenous health is squabbling over who performs visits to remote clinics while our major professional body ignores it all together.

    If pharmacy is unable to articulate a role that it can play in remote health with the sickest and most disadvantaged in our community that at least equates with if not exceeds our “usual” role performed in the rest of Australia (retail and hospital), and is not arguing with the rights of other health professionals to perform our role why should we keep the role we currently have in mainstream?

    Some comments on what led me to this article will appear tomorrow

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