Home' Australian Pharmacist : November 2011 Contents Vol. 30 -- November #11, 2011
Finding your patients
Indigenous people are classically
a mobile population. People may
change location, be staying with
family or change where they live
based on what the weather is doing.
Indigenous people may not have a
fixed street number address.
For example, a recent HMR had the
'Drive down the road, turn right,
then look for the dip, the rise and
the swerve and then take that
So, needless to say, finding your
patients can be both difficult and
time consuming. You will likely not
complete all of the HMR visits you
set out to do at the start of the
day, and for which you may have
referrals. It is also important to be
aware of events occurring in the
community, and be respectful of
funerals and sorry business.
Potential challenges to
• no telephone,
• phone number changes,
• location changes,
• address not updated/recorded,
• location hard to find.
The unfamiliar concept of an
An appointment time is an odd
concept to many Indigenous
patients, but it is obviously an
essential part of the working day
of a busy HMR pharmacist. You
therefore cannot guarantee a HMR
visit will take place. You may have
quite a lot invested in this occurring
if you have travelled a long distance.
Thus, you need to consider the way
that this will make you feel, and
not bring any negativity with you
into the HMR consult when you DO
achieve meeting with a patient if
this is after a number of attempts.
Flexibility is essential here.
Distance and access
These are perhaps two of the more
obvious challenges listed here
and hold true for both Indigenous
and non-Indigenous patients
living in rural and remote areas of
Australia. In rural and remote areas
options for travel may not always be
reliable; roads and airstrips may be
cut off during the wet season. The
importance of considering distance
and access issues should not be
Reduced availability of GPs in
As mentioned previously, there may
not be a full-time doctor present at
the remote community health clinic.
This position is often on a fly-in-fly-out
basis for a limited number of days per
week, fortnight or month. Therefore,
emergency cases will become priority
for the GP when they are present on
the ground. GPs are less available to
make HMR referrals, and indeed to
follow-up on the HMR reports and
lodge Medicare claims. In addition,
there is often a reduced continuity of
GPs in this setting, thus the doctors
are then less familiar with the patients
in need of a HMR.
Question for self reflection -- Should
members of the health team be able
to refer for HMRs in such situations?
Reduced availability of
This point is constantly in a state of
flux. Different areas of the country
may or may not have problems
attracting accredited pharmacists, and
this is sure to vary from year to year.
It is also worth considering whether
there is true value in a single one-off
visit to a remote community. In this
case the accredited pharmacist has
no chance to build relationships with
the clinic staff or patients. In times
of reduced pharmacist availability,
there is always the risk that GPs may
stop referring secondary to HMRs not
being completed in a timely manner.
Question for self reflection -- How can
we achieve a sustained relationship
and how do we attract more
pharmacists to remote practice?
Cultural barriers have been mentioned
already, but of course there are
language barriers to consider here
also. The involvement of an interpreter
is obviously highly desirable but not
always achievable. Most pharmacists
working in the southern states will
likely be using trained interpreters.
In remote practice, we do not usually
have access to people who are trained
as interpreters and familiar with
medical terms or otherwise. Rather,
we rely on people who are simply
able to speak multiple languages and
are happy to help. We may use family
members more than would be ideal;
and in fact the interpreters available
may well be family members of the
patient in question (as each language
group can be quite small).
I sometimes use the term 'nod-
and-smile patients' and by this I
mean those patients who nod, smile
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