Academic journal article Australian Health Review

Funding Issues and Options for Pharmacists Providing Sessional Services to Rural Hospitals in Australia

Academic journal article Australian Health Review

Funding Issues and Options for Pharmacists Providing Sessional Services to Rural Hospitals in Australia

Article excerpt

Introduction

Many hospitals in rural Australia do not have an on-site pharmacist,1,2 either due to recruitment and retention issues, or because the hospitals lack the capacity to sustain a full-time pharmacist position.3,4 This lack of pharmacists' involvement in rural hospitals is associated with lower rates of medication management activities, such as inpatient medication reviews, reconciliation and advisory services.5-7 The deficit of clinical pharmacy services in rural hospitals is not aligned with the progression of pharmacists' roles in specialist medication management reviews8,9 and the recommendations by the Standards of Practice for Clinical Pharmacy Services.10 The Standards recommended pharmacists' involvement in medication reconciliation, clinical review, therapeutic drug monitoring, adverse drug reaction management, providing medicine information, facilitating continuity of medication management on transfer and quality improvement activities relevant to medication management.10

A multicentre study in 1998 involving eight major acute care public hospitals in Australia demonstrated the value of pharmacists' interventions (n = 1399) over a period of 21 days on average for each site.11 One-quarter of the documented interventions were considered of major significance in preventing or addressing serious medication-related problems; 40% of the interventions were of moderate significance in improving effectiveness of therapy and reductions in patient morbidity.11 The resulting documented outcomes were reductions in length of stay, re-admission probability and expenditure resulting from hospitalisations (annualised cost savings exceeding AUD$4 million for the eight study hospitals).11 Other studies demonstrated pharmacist-mediated activities as valuable in optimising therapy and reducing medication misadventure.12,13

There is a need for increased pharmacist involvement in rural non-pharmacist hospitals.2,5-7 One solution involves sessional employment of an external pharmacist, such as a community or consultant pharmacist, to provide services to the hospital.5,14 This is similar to rural doctors providing primary care services in private practice as a general practitioner and hospital services as a visiting medical officer.3,4 Review of published literature identified a lack of exploration and evaluation of similar arrangements for pharmacists.

To address this gap, a study was conducted in 2012-2013 to identify sessional employment models involving pharmacists providing contracted sessional services to rural public hospitals. As is the case with many health services,3,4,15 funding was identified as a crucial component to the establishment and sustainability of the study sessional employment models. This paper aims to discuss funding arrangements supporting such models in Australia. In doing so, this paper aims to increase awareness of existing and potential funding options to inform future development of sessional models involving pharmacists in rural Australia.

Methods

Ethical approval for data collection was obtained from The University of Queensland's School of Pharmacy Human Research Ethics Committee (2012/9). This qualitative study16 involved purposive sampling17 to recruit pharmacists with experience of providing medication management services on a sessional basis to non-pharmacist hospitals in Australia. Sessional pharmacists were identified through advertising in professional newsletters and online forums, pharmacy contacts and referrals. Data were gathered through individual semistructured interviews exploring perceived outcomes, contractual or service arrangements, funding pathways (the focus of this paper) and factors impacting on their sessional service. Interviews were conducted either by telephone or Skype between August 2012 and January 2013.

Participants provided verbal consent at the start of the interview and all interviews were recorded. They received a gift card (AUD$50) for their participation. …

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