Aged care onsite pharmacists: Implementing the model in rural and remote areas

Background
Funding is available under a Commonwealth Government initiative for residential aged care homes (RACH) to employ an aged care onsite pharmacist (ACOP). The program was developed and trialed in urban settings through a pilot study and a randomised control trial conducted in the Australian Capital Territory. These studies demonstrated that the ACOP model has the potential to reduce inappropriate mediation use, including use of psychotropics. Further, the ACOP role was able to streamline medication rounds, providing a cost-benefit to the RACH alongside improving clinical governance through the contribution to policy and clinical committees.
Prior to the national rollout, however, the model had not been trialed in regional, rural and remote areas and there is little evidence about the feasibility of the model in these settings. The OPTIMISER3 study is examining the ACOP model in urban, regional, rural and remote settings across Australia. This study aims to provide a comprehensive assessment of the implementation challenges when introducing the ACOP role in rural, regional, and remote RACHs
Method
The study uses a multi-method approach of pre-implementation co-design workshops, activity-based data collection through an online diary and RACH data extractions, along with group forums and individual interviews. Analysis was completed using the Normalisation Process Theory deductive coding framework, a thematic analysis and the quantitative review of quality indicator and activity data. The components were drawn together through the prism of the Consolidated Framework for Implementation Research Framework to examine the barriers and facilitators for ACOP implementation
Results
Our early findings show that the key driver of successful implementation is early collaborative engagement of aged care staff, ACOPs, general practitioners and community pharmacies. This facilitated a shared understanding and strong communication channels. Further, successful integration of the ACOP role in RACHs can be achieved through inclusion in management and clinical governance structures and upfront prioritisation of target areas for medication management improvements.
Geographical areas where existing pharmacists were available could draw on strong existing community relationships. However, areas with little or no access to pharmacists required adaptations not currently funded under the Commonwealth scheme, such as role sharing, online service delivery, and the ability to be onsite into condensed blocks rather than set hours per week. Further barriers facing rural and remote RACHs were the gaps in funding which did not provide for travel, high cost of accommodation and salaries needed to attract the pharmacy workforce.
Conclusions
The ACOP program has shown that successful implementation can be achieved through drawing on local community strengths and upfront collaboration to determine communication pathways and a shared vision of priorities. There are, however, barriers for rural, regional and remote RACHs in accessibility and attraction of the pharmacy workforce. To alleviate these barriers and provide an ACOP program that benefits rural and remote aged care homes; the model requires greater flexibility to accommodate a broader range of service delivery options.