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The problems - lack of locums, difficulty with gaining useful
Continuing Education, lack of peer support, inability to leave
the premises during business hours, distance from all the friends
and activities enjoyed during university years and so on ad nauseum.
My
previous attempts to improve the situation through existing hospital
and community pharmacy channels were not successful. There is
a real barrier to communicating when the parties cannot grasp
the back-ground to the problems. City-based pharmacists and trainees
have to experience rural practice to understand the broader concepts.
The
next step was to look for local solutions. Not pharmacy solutions,
because there was no avenue at that time for addressing these
issues. However, there was real concern in government circles
about health services in rural areas. And, if pharmacists could
have interacted more easily with the other health professions,
they would have discovered that our problems were common to all.
The
local Division of General Practice already had in place procedures
for recruitment and retention of rural doctors. This included
support for locum practitioners, information kits on the various
practices in the rural towns and a positive approach to the problem.
It also wanted to increase its activities through government funded
projects.
So,
the purchase of the pharmacy at Rainbow and my determination to
restructure the pharmacy activities in the town (and also the
neighbouring town of Jeparit) provided the basis for a RHSET project
over two years. The project also included some preliminary investigations
into using video conferencing to help patient counselling in pharmacy
depots.
The
initial project paid for a project manager at the Division for
two days each week. This was a really innovative project for the
Division of General Practice. A pharmacy project in a medical
organization.
The
project manager, Mrs Jane Measday was not a pharmacist. This was
an advantage - she questioned every aspect of our activities in
the community pharmacy. And, because of this it became increasingly
clear that we had to look at our priorities, move outside the
"four walls" of pharmacy and focus on positive outcomes.
We knew what a pharmacist was, but that didn't necessarily correspond
with what she or the GPs understood!
The
Division provided the secretarial assistance, and funded monthly
teleconference sessions for all the pharmacists in the region.
It also funded a fortnightly Pharmfax, an A4 newsheet faxed to
all interested pharmacists.
Examples of the Pharmfax can be viewed at www.westvicdiv.asn.au
- click on the rural pharmacy icon.
These
initiatives have continued after the project was concluded.
The Division continues to provide funds and secretarial assistance.
Towards the end of the project there was another rural pharmacy
in danger of being closed.
The Division of General Practice provided the support for that
community to retain their pharmacy - in a similar way to the Rainbow
story.
The
Division then successfully obtained funding for another two year
project looking at GP/Pharmacy Liaison. For this project it employed
a pharmacist part-time. This project was also extremely successful
- with a focus on the common interest areas shared between doctors
and pharmacists.
These
included medication use and poly-pharmacy, drug seeking behaviour,
primary health care, specific disease counselling and health promotion.
Group discussions and problem solving case studies began the process
of breaking down the barriers between GPs and pharmacists.
This
project concluded at the end of 2001.
In February this year the West Vic Division of General Practice
produced a "How To Kit" which was sent to every Division
of General Practice in Australia.
The
kit contains a series of fact sheets.
These
two projects helped form the basis for the National DMMR facilitators
within the Divisions of General Practice, and in our Division
a further increase in pharmacists employed. We have an advantage
in the West Vic Division in that the facilitator has been involved
in all the ground-work and relationship building between GPs and
pharmacists. The pharmacists are already meeting as a pharmacy
group - sharing concerns, and discussing case studies. The group
includes all pharmacists - locum, community, hospital and consultant.
Some join in by teleconference, with the others at the Horsham
or the Ararat Division offices.
The
next project, just commenced is the provision of a locum pharmacy
service for the region.
The Division is coordinating the service, with the Pharmacy Group
providing input into the project.
The project pays for travel and weekend accommodation expenses.
The pharmacist pays the locum's wages.
As
an aside, I am really sad that so many of our "four wall
syndrome" sufferers have not even grasped the fact that employing
a locum for a week - just to be free to leave the premises and
be seen in the street, is very therapeutic.
In
conclusion, I never cease to be amazed at the results of saying
"OK. but......" when I was asked to purchase the pharmacy
at Rainbow.
Also, I never cease to be amazed at the generosity and support
extended to pharmacists by the West Vic Division of General Practice.
Our
pharmacists used to whinge about locums, CE, cost of becoming
accredited to do medication reviews - a bit like farmers and the
weather!
But not any more.
Amazing!!!!
And,
that's your lot for this month.
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