The evolving profile of cognitive pharmaceutical services in Australia

Pharmacist-only supply of nicotine vaping products: proposing an alternative regulatory model for Australia

Regulation of nicotine vaping products (NVPs) is an ongoing challenge across the world. Australia currently has a globally unique NVP regulatory model that requires a medical prescription to purchase and use NVPs, with further restrictions in progress in response to evidence of widespread illicit NVP sales. Against this background, we examine the new measures and consider a modification of the model to pharmacist-only supply as an option for increasing access to NVPs for smoking cessation, while retaining health practitioner oversight of supply. We describe the strengths and challenges of implementing a pharmacist-only NVP supply option in Australia. Compared with the current prescription-only model, pharmacist-only supply could increase access to a lower exposure nicotine product in a highly regulated therapeutic context while addressing youth access and purchasing for non-therapeutic use, reduce demand for illicit products for smoking cessation purposes and avoid overburdening medical services with consultations to obtain NVP prescriptions. This approach can also accommodate current government goals such as eliminating NVP advertising, youth-focused branding and supply from grocery and convenience stores.

Global landscape of community pharmacy services remuneration: a narrative synthesis of the literature

Community pharmacists form a vital part of the health system all around the globe. Pharmacy remuneration models are aimed to ensure that pharmacies are sustained, and pharmacists could provide cost-effective services to the patients. This review summarizes the pharmacy services remuneration systems from different parts of the globe. Some countries have well-established reimbursement systems that recognize and compensate community pharmacies for their services, others are in the process of expanding the scope of reimbursable services. It further concludes by highlighting the ongoing efforts to incorporate pharmacist-provided services into reimbursement schemes and the need for standardized and consistent approaches to pharmacy remuneration globally.

An in-depth examination of funded and unfunded cognitive pharmaceutical services

Background

A substantial expansion in the scope of practice of community pharmacists has become evident over the years, with increased government remuneration pledged to support cognitive pharmaceutical services (CPS) delivery as part of the Australian Community Pharmacy Agreements. Exploring experiences in providing funded and unfunded CPS within the existing work environment will enable better understanding of community pharmacists' roles and responsibilities in delivering CPS.

Objective

To explore pharmacists' roles, responsibilities, experiences, and perceived impact associated with delivering CPS.

Methods

Qualitative semi-structured interviews (n = 25) were conducted with practising community pharmacists in Australia who were engaged in delivering CPS during the time when the Sixth Community Pharmacy Agreement (6CPA) was in effect. Verbatim transcripts were thematically analysed (inductive analysis).

Results

All participants reported an expansion of services being provided in community pharmacies. Pharmacists offered a broad range of CPS within the community pharmacy setting, via 6CPA-funded and non-6CPA or unfunded initiatives. Almost all participants reported that their pharmacy provided 6CPA-funded initiatives such as dose administration aids, clinical interventions, MedsChecks/Diabetes MedsChecks, and Home Medicines Reviews. User-pay services being offered included pharmacist-led flu vaccinations, opioid substitution therapy, sleep apnoea services, and absence from work certificates, among other services. However, profit margins on user-pay services were minimal. CPS provision was seen to have positive impacts at patient and health care system levels. Pharmacists felt they enabled timely and convenient access to health care for patients in the community pharmacy setting, and facilitated quality use of medicines, which in turn had positive impact on the community pharmacy business.

Conclusions

A prominent shift in the provision of CPS was evident. Professional services provision has become the status quo for the practice of the profession, indicative of a likely shift in the work value of community pharmacists. Pharmacists should be further recognised professionally and financially for their contributions as health care professionals within the broader health care system.