New roles for health professionals in patient-centred health care services in rural and remote Australia
: community pharmacists sharing the responsibility for chronic disease management

  • Hana Morrissey

    Student thesis: Doctor of Philosophy (PhD) - CDU


    Introduction: Most Australians take at least one prescription medication during their final 30 years and multiple medications during their final 10 years for one or more chronic condition. Chronic disease is increasingly affecting Australians’ quality of life and health expenditure. Medication and healthy lifestyle change are major health interventions, but patient adherence to prescribed therapy is reported to be less than 33%. Patients with chronic disease must collect prescription repeats regularly every month, creating an opportunity for intervention by community pharmacists.

    Aim: To investigate if a collaborative community pharmacist and GP model of care in chronic disease management in rural Australia could improve patients’ outcomes through better monitoring of disease markers, increased self-management skills and greater medication adherence.

    Design and Methods: This project was a pilot, pre- and post-intervention study designed to support future definitive studies. The clinical intervention phase was designed to support the existing advice patients had been given, was minimally invasive (lancet finger pricks for point of care testing) and did not involve any active medication administration. The study used three tools: a modified Health Education Impact Questionnaire (heiQ™) for patients pre- and post-intervention, mid-study survey for pharmacists and end of study feedback statements from pharmacists and patients. The study was conducted in community pharmacies located in rural and remote Australia in areas with a Pharmacy Access/Remoteness Index of Australia of code 2 to 6. The intervention took place over 12 months, of which three months were promotion, three months enrolment and baseline data collection, and six months patient monthly monitoring. Data were analysed in ASReml-R™ using linear mixed models and generalised linear mixed models.

    Results: The patients’ mean modified-heiQ™ score after the intervention was 29.65% higher than at baseline, a statistically significant improvement. The number of medications they took also significantly changed by using alternative medication with fewer side effects, removing duplications and adding medications for previously untreated conditions. During the period of the intervention, all parameters monitored became and remained stable within the patient best target level. Improvement in
    patients’ body mass index and blood cholesterol were difficult to determine due to the short period of the intervention.

    Conclusion: Early detection and early intervention improve quality of life and reduce disease burden and medication-related problems. Blood pressure, total cholesterol, blood glucose level and international normalised ratio parameters are possible to monitor in the community pharmacy setting in Australia, but the cost needs to be covered by either Medicare or the community pharmacy and government agreement. Sub-optimal communication between pharmacists and doctors leads to fragmentation in the provision of health services. A national two-way, balanced, collaborative primary care model for chronic disease between general practitioners and other health professionals that includes pharmacists would address disconnections in the continuity of care and improve patients’ outcomes.

    Note: Please note that appendices are available in CD ROM only.
    Date of Award2014
    Original languageEnglish
    SupervisorPatrick Ball (Supervisor)

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