Pharmacy role in managing disease
You pop into your local pharmacy for a check of your blood pressure, cholesterol, medication, diet and exercise regime. Your condition is monitored and recorded. Information provided is expert and up to date. If need be, you are referred without delay to a GP.
That was the vision Daniel Sabater-Hernández developed as a young student in his native Spain. Growing up in the Canary Islands, he witnessed from a young age the trust his community placed in his family's pharmacy.
Once he had qualified, Dr Sabater-Hernández made it his mission to enhance the pharmacist's contribution to society. He imagined a community pharmacy service to reduce the burden of cardiovascular disease (CVD) for patients and the health system.
"Pharmacies are under-utilised and can do much more to reduce cardiovascular disease," says Dr Sabater-Hernández, now a researcher in the Graduate School of Health at the University of Technology Sydney (UTS).
"They have wide knowledge and expertise and are in a unique position to educate people about potential risk factors and to closely monitor medications."
Dr Sabater-Hernández says the 5000 or so community pharmacies in Australia are well placed, with other healthcare professionals, to screen and manage the main cardiovascular risk factors before they lead to heart attack or stroke.
The four leading risk factors for CVD are high blood pressure, high cholesterol, diabetes and smoking. Cardiovascular disease is the leading cause of death in Australia, accounting for 30 per cent of the total. Figures from the Australian Institute of Health and Welfare put the number of people with some form of CVD – coronary heart disease, stroke, heart failure, irregular heartbeat, high blood pressure – at more than 3.5 million. Medicines to treat CVD cost the Pharmaceutical Benefits Scheme about $1.8 billion in 2012-13.
Dr Sabater-Hernández is working with UTS researcher Dr Dena Fam, of the Institute for Sustainable Futures (ISF), and says the goal of their project is to make the system more sustainable: "It's about collaboration and always respecting other health professionals, knowing when to refer patients and how to collaborate with GPs and specialists."
The skills of Dr Fam and ISF in engaging key players and planning for the future will be important to the project's success.
"We develop processes, set up workshops and analyse qualitative data with the aim of getting people thinking about how to create change and visualise what needs to happen for a community pharmacy service to become a reality," says Dr Fam.
The first community pharmacy workshop was held in July, with Dr Sabater-Hernández and Dr Fam gathering health professionals from across the sector. A follow-up workshop is planned for November, with a pilot study on the horizon.
"The first workshop was very productive," says Dr Fam. "There was a lot of interest in how we can work together in cardiovascular health and how we can move to a more sustainable system. Right now, it's all about triggering people's imagination."
For Dr Sabater-Hernández, who has spent years working on the project, the collaborative aspect is exciting. "To change the system, to change policy, to improve health, we need to bring people together. You cannot do it alone."
Pharmacist Catherine Bronger, managing partner of Chemistworks, attended the July workshop and believes pharmacists are in a perfect position to deliver a cardiovascular service.
"Patients come in regularly to pick up medicines or inquire about minor ailments so we are usually their first point of contact for advice. We can build on that relationship and use that trust for better patient outcomes," says Bronger.
Ron Garner, 61, from Ashfield, was diagnosed with higher than normal levels of cholesterol 15 years ago. He attends his pharmacy's sleep apnoea clinic and would welcome a similar service in cardiovascular care.
"I go regularly for check-ups. It's convenient. I don't have to wait six weeks for an appointment with a specialist and it's cheaper," says Garner.
"The pharmacists communicate in a friendly, easy manner and I get to monitor my own progress. My pharmacist and I have built up a good trust."
Stories written and produced by the University of Technology, Sydney, for Brink, a publication distributed monthly in The Sydney Morning Herald.
