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COVER
Karalyn told Australian Pharmacist there needed to be an allowance for accommodation.
‘I can spend five or six days out there. At times, I barter with health and hospitals services because I am doing their aged care beds at the same time and if able they will kindly give me accommodation at hospitals.’
In her view HMRs are a perfect example of a program that needs a flexible funding agreement. She sees the present HMR program as a very urban model that does not allow for long distances travelled.
Sitting in a silo
According to Karalyn, because the community pharmacy agreements (CPAs) sit in their own little niche and because HMRs are in that niche they have become contained in a little bubble.
‘It is one of my arguments for why HMRs should be in the MBS system. It would be far easier to work in a collaborative partnership with GPs and nurses in these locations if we were not in the CPA. Doctors have these perceptions that because we are being funded out of the CPA bubble we are adequately funded and it all happens.
‘They don’t understand that the only money we get out of the MMR program is for actually performing the HMR. The money I get paid, the $125 for travel, comes out of a separate bundle of money under the Rural and Remote Loading Program.
‘There is this misconception that the CPA agreement completely funds what I do.
‘I really enjoy the medication management programs – HMRs, QUM, RMMRs. It is the form of pharmacy that I love.
‘I was one of the first people accredited in Australia because it was exactly how I wanted to practice. I became a better community pharmacist because of the advanced practice learning that enabled me to be an accredited pharmacist.
‘I really enjoy the fact that when I go to a home and sit down with the patient, their carer and family, and go through everything, the light bulbs come on inside people’s eyes.
‘When you explain things and go through techniques they are so appreciative that someone has come and spent the time with them to make improvements.
‘To change how people do things you have to keep going back and revisiting it to get them to implement change. When talking to them at an HMR interview you lay the first seeds and then you ask a few more questions and then you go back and lay the second seeds, you talk a bit more and at the end in summing up I write them a list and I leave it with them.
‘I say well this is what I think you can do to manage better but all the way through I have been laying down that scenario. At the end I say I want you to do this, this and this and they say – “ah that all makes sense” – because I have given them time in the 30–40 minutes that I am there to think it through.
‘A very busy GP has 7–9 minutes to get things into someone’s head and get them thinking. They can’t possibly get that whole change thing happening.
‘When we did the evaluation of the HMR project we ran focus groups and I brought in some of my patients. They all said how much they appreciated the fact that a pharmacist came to them, sat down and talked their language and explained things. Also, the pharmacist was contactable after the interview. I always leave my business card.’
Karalyn believes western Queensland has many patients who need help and who are getting bits of healthcare from everywhere but do not have continuity in their care apart from the community nurse. Doctors drive or fly in and out and change often.
‘Those poor community nurses are really worn out. They are running around doing the best they can for these patients. I love being able to support the community nursing services. I also support the community pharmacies in that region.
‘All this travelling and juggling roles is not making me rich. [According to her accountant she received payments from 28 different entities last financial year] I am just making a living.
‘My work in community pharmacy underpins it all. If I
can bring some of my costs down – accommodation for example – it will be more viable. There needs to be more money in the medication management program for more people to take it on.
‘You couldn’t do it if you had kids and a mortgage!’
References
1. Huxhagen K. Review of Pharmacy Remuneration and Regulation Submission #81; 17-Sep 2016. At: http://www.health.gov.au/internet/main/publishing.nsf/Content/review- pharmacy-remuneration-regulation-submissions-cnt-2/$file/81-2016-09-17-karalyn- huxhagen-submission.pdf
26 Australian Pharmacist January 2017 I ©Pharmaceutical Society of Australia Ltd.