Integrating Pharmacists within Aboriginal Community Controlled Health Services to improve Chronic Disease Management Project

ACCHSs will be offered a pharmacist (aggregated 0.57 FTE across 24 sites, for 15 months duration) under a service agreement. Non-dispensing pharmacists will be integrated within existing primary health care teams, and introduce new services not currently delivered within ACCHS settings. The intervention is for 15 months duration. Eligibility criteria for pharmacists will include current registration with the Australian Health Practitioners Regulation Agency (AHPRA) as a pharmacist; more than 2 years post-registration experience; and post-graduate clinical qualifications or demonstrated clinical experience (e.g. hospital or HMRs). Accreditation for medication reviews will be desirable but not essential. The pharmacist will undertake 10 core roles and additional roles as specified by services and the service agreement which will reflect the pragmatic approach to the intervention. The 10 core roles are: 1. Medication Management Reviews - undertakes Home Medicines Reviews (HMR) and non-HMRs (review not conducted in the patient's home) 2. Team-based collaboration - participate in clinic activities that support team-based chronic disease care plans, and cardiovascular risk assessment 3. Medication adherence assessment & support - assess adherence and identify strategies for improvement (self-care) 4. Medication appropriateness audit, and Assessment of Underutilisation - a sample of patients will be assessed for underutilisation of medicines 5. Preventative health care - promote preventive interventions with patients 6. Drug Utilisation Reviews - identify and improve a priority issue at the service 7. Education and training - conduct sessions for staff and patients 8. Medicines information service - provide medicine related advice to staff and respond to queries 9. Medicines stakeholder liaison - develop a stakeholder plan supporting engagement with community pharmacies 10. Transitional care - facilitate care coordination with other relevant health care facilities The project will adhere to community-based participatory research (CBPR) principles, to ensure clear benefits to project sites, and ensure acceptability and sustainability of the intervention within ACCHSs. Prior to the pharmacist starting a needs assessment will be undertaken with each participating ACCHS and their local priorities used to inform a workplan. Patients will be able to see the IPAC pharmacist similar to any other health professional within the primary health care team. They will benefit from having immediate access to the on-site pharmacist and receive tailored and appropriate medication reviews and support to optimise their use of medicines. Patients who consent to be part of the project will have their health data extracted from the ACCHS clinical information system, and medication reviews in which they participate, and interactions with the pharmacist, recorded in the pharmacists’ logbook. All data is de-identified and able to be linked using the patient ID number. The information that is collected will only be used for this project. On site and external training will be delivered to pharmacists to ensure skills in cultural safety, an introduction to the project and the core roles, an overview of clinical information systems and other software used, obtaining patient consent, recording data, and use of evaluation tools. Facilitated training to maintain confidentiality in the clinic setting, teamwork processes, delivering disease-specific services, understanding roles, and how to explain the pharmacists’ role to patients will also be provided. Resources around the 10 core roles will be developed and available to support the pharmacists' work. Online training will be facilitated for the pharmacists. Modules are Collaboration (PSA); Motivational Interviewing (PSA); and Chronic Disease Management (Aust Govt Dept Human Services Medicare Benefits Schedule). Peer support for all participating pharmacists will be provided through a Mentoring Program facilitated by the PSA in collaboration with NACCHO. The program will source mentor pharmacists from the joint NACCHO-PSA ACCHO Pharmacist Leadership Group and other pharmacists with relevant experience in the ACCHS sector. Mentees will be matched with appropriate mentors by NACCHO and PSA. A minimum of four meetings will be held via teleconference over the project. Peer interaction is also enabled through an online discussion board and other appropriate technological applications. Mentors and mentees can confer, provide support and share resources, as a group or one-on-one.