Pharmacists will have the power to alter prescriptions for patients with chronic conditions like asthma in a controversial Victorian trial that shifts some patient care away from doctors.
The Australian Medical Association has been highly critical of the proposal, which the state government this week opened up to expressions of interest. Believed to be an Australian first, the 18-month pilot is expected to launch at two sites in regional Victoria and a third in Melbourne..
Applications are open to pharmacies and general practices that can work together and are in areas where there is a lot of chronic disease.
Up to 90 patients who meet certain requirements and have either asthma, hypertension or high cholesterol or are taking anticoagulants would be managed by a doctor and pharmacist team under the pilot. A care plan would be established by the doctor and monitored by the pharmacist, who can alter medication doses.
The move comes after the Andrews government allowed pharmacists last May to administer flu and whooping cough vaccines.
The expansion of pharmacists' roles has been criticised by AMA vice-president Dr Tony Bartone, who is sceptical shared management would lead to lower costs or improve access to quality care.
"You cannot offer a lesser standard of care without putting the patient at risk. You cannot trade off the health of Victorians against a false perception of cost-reduction," he said when the proposal was first floated in 2015.
On Wednesday he said: "We need co-ordination of complex disease management to not be fragmented through multiple providers; it needs to be co-ordinated by one person."
The president of the Royal Australian College of General Practitioners, Dr Bastian Seidel, said: "There are plenty of highly qualified GPs out there who are more than capable and willing to do chronic disease management for patients.
"It's very easy for patients to get in to see their GP; access does not seem to be much of a problem. The concern really is that sometimes patients are not able to afford to see their GP on a regular basis and that's a direct consequence of the extension of the Medicare rebate freeze.
"Pharmacies are not going to offer services for free either."
Retired psychologist Sam Ginsberg, 73, has had asthma since he was a child and said being able to have his medication managed by his pharmacist would make life easier.
Dr Ginsberg said he trusted his pharmacist to make clinical decisions about his medication, which would save him some visits to the doctor.
"I have a management plan with my specialist but if I needed to modify that quickly it would be so much quicker and easier to go to the chemist," he said.
"Particularly with the asthma storm we had, something can strike quickly. My management is stable but something like that throws it out and sometimes even the GP has a day or two waiting when they're busy."
Acting Health Minister Jenny Mikakos said engaging pharmacists in primary care would take pressure off hospitals in the long run.
"We know that currently more than half of visits to GPs involve managing a chronic condition, rather than diagnosing new conditions," she said.
"Through this pilot, patients will be able to conveniently manage their chronic condition, in accordance with a GP's care plan, at their local pharmacy, closer to home.
"In the long-term, better management of chronic disease within our primary healthcare system will lead to fewer avoidable hospital admissions."
Michelle Goldman, the chief executive of Asthma Australia, said the move would also mean people not managing their condition could be identified and offered help.
Pharmacy Guild of Australia Victorian branch president Anthony Tassone said:
"A pharmacist under a GP management plan can help continue the therapy for a patient who has run out of a prescription but can't access a doctors appointment."
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