Home' Australian Pharmacist : Australian Pharmacist March 2013 Contents 8
Australian Pharmacist March 2013 I ©Pharmaceutical Society of Australia Ltd.
Budget submission targets
By Andrew Daniels
Pharmacists would be more involved in
reducing the burden of chronic disease
if the Australian Government accepts
the proposals outlines in PSA's 2013--14
The submission focusses on two key
chronic conditions: type 2 diabetes mellitus
(T2DM) and atrial fibrillation (AF), which are
estimated to cost the Australian economy
$7.25 billion each year.
PSA advocates that $7.94 million be spent
over two years to conduct and evaluate
a Diabetes Education and Medication
Management Service; and for a further
$50.4 million over two years for an
Anticoagulation Management Service
The submission points to recent reports
to the Australian Government that have,
'indicated that scope exists for reform of
current arrangements for people with
non-insulin dependent T2DM and AF.'
It says that, 'With ongoing pressure on
the health budget (and, in particular,
itspharmaceutical benefits component)
effective implementation of services that
support improved self-management of
chronic diseases and long-term conditions,
such as AF and diabetes, is needed'.
PSA National President, Grant Kardachi,
said the proposal would result in improved
consumer understanding of their condition
education and through providing support
material, as well as improved medication
adherence through educating consumers
about their medicines.
'Our submission would also see improved
consumer self-management through
education including individualised
blood glucose testing requirement and
need for regular glycated haemoglobin
testing. Importantly it would also result in
greater collaboration with other primary
care health professionals -- in particular
the consumer's general practitioner
-- and improved health outcomes for
consumers with type 2 diabetes mellitus.'
Mr Kardachi said the submission's other
focus was for a Pharmacist Anticoagulation
Management Service (PAMS) aimed at
enhancing health outcomes for consumers
'This proposal integrates pharmacists into
the care of consumers on warfarin given
the strong primary health care role and
medication management expertise of
pharmacists,' he said.
"The service will ensure safe and
appropriate use of warfarin and optimise
the long term benefits of warfarin therapy
for consumers thereby delivering savings
to the health budget and provide timely
access to health professional intervention to
tailor the consumer's medication needs.
'It will also contribute medication
management expertise in a manner that
supports the GP's "whole-of-person"
care delivery and enhance quality use of
medicines for the individual consumer and
for the wider health care community."
Mr Kardachi said the proposal addressed
priorities and recommendations
identified in recent reports to the
Table 1. Anticoagulation Management Service
Funding: A total of $50.4 million is
requested over two years to conduct and
evaluate a pharmacist anticoagulation
management service (PAMS) to optimise
the appropriate use of warfarin and deliver
better health outcomes to consumers and
savings to Federal Government expenditure
on medicines and other health costs.
Broad description of service:
The PAMS described in this proposal consists
of three component services, each of which
is designed to meet specific clinical needs
of the consumer. The three services will
contribute to overall better management of
Australian consumers on warfarin therapy.
1. Post hospital discharge monitoring
service (PHDMS). Consumers who have
been initiated on warfarin following
an acute hospitalisation event are
particularly vulnerable during the
immediate post discharge period.
Pharmacists will provide this service
in collaboration with the consumer's
GP to stabilise the consumer's warfarin
therapy through intensive monitoring
and appropriate dose adjustment in the
consumer's home. Close clinical attention
is warranted during this period of
transition back into the community and to
minimise any potential adverse outcomes
and prevent rehospitalisation.
2. Community pharmacy monitoring
service (CPMS). This service will assist
consumers on long term warfarin
therapy where maintaining a stable
therapeutic response is important from
a patient safety perspective as well as to
maximise the benefits of preventive care.
Pharmacists will work in collaboration
with the consumer's GP and provide this
service in the community pharmacy.
3. Pharmacist-assisted self-monitoring
service (PASMS). This service will benefit
consumers on long term warfarin therapy
who wish to self-monitor. Pharmacists
will assist consumers who have a good
knowledge base of the use and effects
of warfarin, and health literacy and self-
Expected core outcomes: The following
outcomes are expected through the
implementation of a PAMS:
• Optimisation of the quality use of warfarin
to benefit individuals and the Australian
health care system. Warfarin is currently
subsidised through the PBS at an annual
cost to government of $23.4 million
(2.6 million prescriptions in 2011--12, the
17th highest PBS medicine by volume).
• A flow-on reduction in the potential use
of new and significantly more expensive
oral anticoagulants, with accompanying
savings to the Federal Budget. The benefit
and long term cost effectiveness of these
products are currently uncertain.
• Reduction in the rate of occurrence
of warfarin-related adverse outcomes
(thromboembolic event or bleeding
event) and consequential savings to
costs associated with hospitalisation
• Reduction in the risk of stroke associated
with atrial fibrillation, a condition which
has an annual cost to the Australian
economy of at least $1.25 billion or direct
health system costs of $900 million.
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