Research reveals impact of Australian Minor Ailments Scheme
UTS research has demonstrated the significant clinical and economic impact with national implementation of a collaborative Australian Minor Ailments Scheme.
Sarah Dineen-Griffin, Dr Victoria Garcia Cardenas, Prof Kylie Williams, and Emeritus Prof Charlie Benrimoj, have evaluated a consultation service for community pharmacists to triage, manage and appropriately refer patients to general practitioners (GPs) for minor ailments through agreed referral pathways for the first time in Australia.
The service supports a structured and integrated approach to consultation, seeks to standardise practice, focuses on increasing the quality and safe use of medicines and encourages patients to seek care at the appropriate level with greater accessibility. The evaluation of the service demonstrated extremely positive results at both the patient and economic level, and the potential impact if the consultation service is implemented on a larger national scale.
The service was co-designed to complement general practice and promotes collaboration between professions. Stakeholders involved in co-design included GPs involved in Western Sydney Primary Health Network (WSPHN) clinical governance, community pharmacists, management leaders from WSPHN, patients and representatives from the Pharmaceutical Society of Australia.
The key elements of the service, include:
1. Standardised triage consultation pre-agreed with GPs
Standardised consultation and documentation processes using IT systems at the point of care.
2. Integrated IT platforms pre-agreed with GPs
HealthPathways: Protocolised clinical care pathways for minor ailments, including evidence-based management and a robust referral framework.
- HealthLink: Direct messaging system allowing for bidirectional communication between the pharmacist and the GP to share patient information including use of nonprescription medicines and referral data for patient follow up.
3. Upskilling community pharmacists
Initial and ongoing training to ensure competency in clinical consultation skills, recognising red flag symptoms, referral escalation processes, and use of IT systems.
4. Change facilitation support
Community pharmacies provided support and ongoing training by a practice change facilitator to drive service implementation.
The consultation service was evaluated in a cluster randomised controlled trial conducted over eight months in WSPHN, compared with usual pharmacist care. Fifty-five community pharmacists from 30 community pharmacies, 150 GPs from 27 general practices and 894 patients were recruited into the study.
The clinical evaluation demonstrated the effectiveness of the service, compared with usual pharmacist care. As follows:
Pharmacists were 2.6 times more likely to perform a clinical intervention and recommended a more appropriate medicine for the patient. This occurred in 21% of all direct product requests.
91% of nonprescription medicine recommendations met pre-agreed protocols, compared to 79% in usual pharmacist care.
- Patients were 1.5 times more likely to receive an appropriate referral by their pharmacist, and were 5 times more likely to adhere to that referral advice and seek medical practitioner care within an appropriate timeframe (20% of all patients were referred).
- Pharmacists identified 2% of patients with ‘red flag’ clinical features. No patients with red flag symptoms were identified in the usual care arm.
- Pharmacists provided self-care advice in almost all consultations (98%), compared to 62% of patients receiving usual pharmacist care.
- 94% of patients achieved symptom resolution or improvement within two weeks, while this was 88% in the usual care arm.
The economic evaluation demonstrated the service to be highly cost effective and provides evidence of significant savings for the Australian health system if implemented nationally. As follows:
The cost-utility analysis revealed the service as highly cost-effective, compared with usual pharmacist care.
Nationally, 2.9 to 11.5% of ED services and 7.0 to 21.2% of GP services are estimated to be for minor ailments.
- These services (9 million to 27.5 million ED and GP services) currently represent a cost to the Australian health system from $511 million to $1.67 billion per annum.
- The transfer of these services to pharmacy would save the Australian government between $380 million and $1.3 billion per annum, based on remuneration of $14.50 per pharmacist consultation as determined by the average duration of the service.
This study demonstrates that a collaborative, structured service provides better clinical outcomes for patients, and large economic benefits for the healthcare system. National implementation of this service, underpinned with national and state self-care policy, would contribute to greater efficiency of health care resources by directing patients to the most appropriate healthcare destination.
The service model provides a solid framework for national roll out. IT infrastructure, change facilitation processes and agreed protocols have already been established. A number of recommendations are presented in the evaluation report for consideration by federal and state policy makers, primary health networks, professional organisations, the pharmaceutical industry and practitioners.
These recommendations demonstrate the significant opportunity for pharmacists, GPs and other health professionals to operate in a collaborative professional capacity to best meet the healthcare needs of their patients, while delivering care at the appropriate level.
Click here to read the full evaluation report.