Evaluation of healthcare services provided by pharmacists in Australia

Abstract

Background
Australian pharmacists deliver a range of health services which are funded by the government
under the Community Pharmacy Agreement. The aim of this thesis is to evaluate the
effectiveness of selected clinical pharmacy services and, subsequently, to derive implications
for improving the outcomes of these programmes.
Methods
First, in a narrative literature review the current evidence for the services provided by
community pharmacists was evaluated, after which a proposal for further enhancement of the
programmes was developed. For this purpose, the previous and current Community
Pharmacy Agreements were examined to develop a search strategy. In the second part of the
thesis, medication review reports written by pharmacists were retrospectively analysed to
assess the pharmacists’ use of the pathology data provided to them by general practitioners
with the referral letter. The pathology data from 580 medication review reports were extracted
and the reports were analysed regarding recommendations on laboratory testing. The third
part of the thesis consists of a systematic literature review investigating community
pharmacists’ involvement in point-of-care testing. A comprehensive literature search was
conducted in six databases applying a predefined search strategy. Subsequently, the
methodological quality of the included studies was assessed. Furthermore, the results of the
individual studies on the analytical quality and the effectiveness of point-of-care testing were
synthesised.
Results
The findings of the narrative review showed that there is sufficient evidence for the
effectiveness of the healthcare services provided by community pharmacies. Well-studied
examples are the Home Medicines Review programme and interventions for diabetes and
cardiovascular disease. Based on a theoretical concept for integrated primary care, the
hypothesis was developed that the outcomes of the programmes could be further enhanced
by interlinking the services to ensure a coordinated care for the patient. This was further
explored by, first, retrospectively evaluating the use of pathology data by pharmacists in
medication review reports. The pharmacists provided general practitioners with guideline conforming
recommendations on screening and drug therapy. The recommendations,
however, were not always supported by a rationale. Furthermore, for 31% of patients the
pharmacists did not have pathology data, and, in 14% of the reports, the pathology results
were over a year old which limits their relevance. Second, the current evidence for point-of care testing in community pharmacies was investigated. The results of the systematic review
indicated that community pharmacies are well positioned to deliver point-of-care tests and that
these have a high analytical quality.
Conclusions and recommendations
According to the narrative review, the services that are currently offered by pharmacists in
Australia are effective; nevertheless, they could be further improved by better coordinating the
individual interventions. A concrete example of this is the Home Medicines Review programme
and point-of-care testing. In the medication review reports, pharmacists provided general
practitioners with guideline-conforming recommendations on laboratory testing. A limitation of
this process was that pharmacists did not have access to current laboratory reports for 45%
of patients. This could be improved if pharmacists had independent access to pathology data
and the authority to perform point-of-care tests in the patient’s residence during the medication
review. The systematic literature review lays the foundation for this proposal by demonstrating
that pharmacists performed these tests accurately. To achieve integrated care, pharmacy
services should be better interlinked and coordinated with the care provided by other health
professions.

Date of Award	2018
Original language	English
Supervisor	Alison SHIELD (Supervisor) & Sam KOSARI (Supervisor)