Viability and sustainability of pharmacist input in chronic disease management in rural Australia

Abstract

Introduction: Management of chronic disease patients is a complex continuum, led by doctors, but delivered by a range of health professionals at different levels of care, including primary care. Success is dependent upon adherence to the holistic therapy and on the accessibility and affordability of services. Aim: The aim of this study is to investigate the sustainability of a proposed chronic disease management intervention in community pharmacy and the difficulties faced by pharmacists in implementation. Design: This was a pilot study, designed to support future research. Community pharmacists provided feedback on the protocol, their communication with doctors and the cost of providing point-of-care (PoC) testing through two surveys. The data from both were thematically analysed. Results: Completed questionnaires were returned by eight of nine sites. Sixty percent of pharmacists did not see the PoC component as sustainable without better levels of collaboration with doctors. All sites indicated that the cost of testing cannot be absorbed, and patients or government will have to pay for the service. All sites found that their current staff levels did not allow them to spend sufficient time with large numbers of patients (n = 84). Pharmacist intervention was well accepted by patients. It provided the pharmacists with job satisfaction, but the staffing level, cost and inadequate collaboration from doctors made the sustainability of the intervention doubtful. Conclusion: Pharmacists found that unpaid services were afforded lower priority than those that generated income. All pharmacists agreed that PoC testing can be performed in the community setting at the same standards provided in doctors’ clinics.