The Pharmaceutical Society of Australia’s (PSA) two recently released reports, Pharmacists in 2023 and Medicine Safety: Take Care, both identify the need for medicine safety to be a National Health Priority Area (NHPA). But what action needs to be taken to ensure this happens?
NHPAs are diseases and conditions that are focused on due to their contribution to the burden of illness, injury and death throughout the nation. Current NHPAs include arthritis and musculoskeletal conditions, asthma, cancer control, cardiovascular health, diabetes mellitus, injury prevention and control, mental health and obesity. In 2007, NHPAs were either associated with or were the underlying cause of 90% of mortalities in Australia.
Medicine safety may not yet have the same level of investment or awareness as other critical areas of healthcare, but it should be decreed to be a NHPA, according to PSA President Dr Chris Freeman.
Such a move could be justified on the cost to the community alone, said Dr Freeman.
‘Take road safety, for example,’ Dr Freeman said. ‘Injuries are rightly declared a NHPA, yet you’re nearly four times more likely to be admitted to hospital due to a problem with your medicine compared to being in a motor vehicle accident. But we don’t have the same level of investment for medicine safety.’
Awareness and investment in medicine safety will be the key outcomes of the issue becoming a NHPA, along with further research and evaluation, as identified in the Pharmacists in 2023 report.
‘We have significant funds being attributed to medical and health research – we have the National Health and Medical Research (NHMRC) scheme and the Medical Research Future Fund (MRFF), the latter of which has targeted specifically narrow fields of work,’ Dr Freeman said.
‘It’s our view that medicine safety should be a funded research program out of the MRFF so that we can gain better insights into the causes of medicine-related problems and also what innovations we can implement to reduce the burden of medicine-related harm.’
The first steps
Achieving medicine safety means empowering pharmacists to be more accountable for the quality use of medicines, a core component of any pharmacist’s role – whether in community pharmacy, hospital pharmacy or within a government organisation such as the Therapeutic Goods Administration (TGA). But, Dr Freeman said, pharmacists have not been granted the responsibility to lead medicine safety, which is a necessary step forward.
Transitions of care is also a key risk area for medicine misadventure. PSA suggests more effort should be invested to allow pharmacists to engage with patients when they are going in and out of hospital, so that medicine errors are less likely to occur with an improved clinical handover process.
Workplace reform would help ensure medicine safety is at the forefront of pharmacists’ roles, Dr Freeman said. This includes the implementation of a national reporting system for clinical intervention.
The establishment of a coordinated pharmacovigilance program, which would entail the development of national measures around medicine safety, would help to determine if medicine misadventure was improving or getting worse.
‘We believe pharmacovigilance programs should be run in and from community pharmacy. Pharmacists could report medicine events, which can be done now through reporting to the Adverse Drug Reactions Advisory Committee (ADRAC), but a pharmacovigilance program would allow for a more simplified process. Having that data available will give us some understanding of whether the problem is getting better or worse,’ Dr Freeman said.
In order to make medicine safety a NHPA, action needs to be taken by key stakeholders. These include policy makers from government organisations to set the directive from a top-down approach, but also professional organisations, such as PSA, that are driving forward on behalf of the profession. Individual practitioners and pharmacists, those on the ground, are also vital. This workforce is required to take up the challenge of medicine safety and start running with these programs.
‘I always say that medicine safety is everyone’s responsibility. That includes consumers themselves, and we need to empower consumers to be able to connect with pharmacists who are experts in medicine safety, to have appropriate and in-depth conversations around their medicines. They are then more likely to get the most out of their medicines and to do so in a safe manner,’ Dr Freeman said.
The outcome for pharmacists
If medicine safety was a National Health Priority, pharmacy practice and interactions would change and improve. ‘We would see a refocusing of our efforts into activities which are centred on medicine safety. Many pharmacists in current practice already have some role in medicine safety, but we really want to bring this to the forefront,’ Dr Freeman said.
‘Pharmacists would be able to make decisions with patients around making their medicines safer. If a pharmacist thinks that a patient is at risk of medicine-related harm, they would be empowered to prevent that from happening,’ he said.
‘The ideal system would be that when a person walks into a community pharmacy, the pharmacist can engage with them about medicine safety and be paid based on the time and complexity of the consultation, rather than just on the provision of the product,’ Dr Freeman said.
Other national health priorities
A number of things occur when conditions achieve NHPA status, Dr Freeman said.
Firstly, there is greater awareness of the disease or problem, which empowers people to consider their own personal circumstances and seek the assistance of a trained healthcare professional to help them. More people will seek help when the awareness is there, he said.
For many conditions that are listed as NHPAs, there have been favourable incidence and death rate trends. In cardiovascular health, for example, there has been a decrease in smoking rates, blood pressure levels, contributions of saturated fat to total energy intake, coronary heart disease death rates and stroke death rates.
There are also increased identification rates, Dr Freeman said. ‘We know that there are people who might be having these problems, who are not identified, but by bringing these people to the surface, we can actually intervene and help them with that condition.’
When other conditions have been made NHPAs, there are improvements in how those conditions are managed, because there is a focus on them and increased investment for healthcare professionals to intervene, he said.
‘If we are serious about medicine safety, then we need the level of investment commensurate with it being a National Health Priority,’ Dr Freeman said.