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Pharmacy in the future: A consumer perspective

Pharmacists and patients have seen many changes in the medicines environment, while projects such as Pharmacy Forecast Australia try to anticipate the coming, inevitable major changes. With this issue of the Journal presenting key findings of the inaugural Pharmacy Forecast Australia, we here reflect on the future of pharmacy from the perspective of consumers. Already, increasingly targeted health delivery in homes and in other community settings has imparted more complexity to the quality use of medicines (QUM). For consumers to optimise their health, they need greater health literacy, numeracy, and greater activation. Pharmacists then need the skills to meet patients’ needs. While there is a set of national indicators for QUM in Australian hospitals, there is no set of indicators for QUM delivery outside the hospital environment. Indicators for QUM in outpatient and community care must be developed and implemented for systemic inclusion in the development of a more personalised healthcare environment. This is needed to keep pace with the direction of future healthcare delivery which will be more personalised, and more home or community-based. The future will also see a more systemic role for digital and virtual health care in embracing personalised medications. We have already seen the advent of e-prescribing, which is one valuable addition to the telehealth toolbox. We need connected information systems to capture and analyse real-world data, which can then be used to inform the future of medicines and pharmacy. A multipronged approach, and suggestions by consumers and clinicians, include the creation of a national health literacy framework, in line with the recommendation in the draft National Preventive Health Strategy, to include dedicated funding for primary health networks to support the development and delivery of more tools and training for the further development of QUM literacy. There are things we can learn from approaches used in other countries. The UK and the Netherlands, for example, limit duplication and increase QUM by having patient registration with one GP and one pharmacy which also allows for an integrated systems approach. This could end the possibility for any prescription duplication across multiple doctors and pharmacies, while increasing the longevity of the doctor/pharmacist and patient relationships. Recent consumer and clinician feedback to the Consumers Health Forum (CHF) on QUM in a number of research projects have raised other interesting possibilities and challenges for primary health care as it stands. Conversations encouraging self-care and improving health literacy start with primary health clinicians. We know that significant numbers of Australians appear to lack the capacity to access, understand, appraise and use crucial information to make health-related decisions. We also know that consumers will sooner turn to the Internet for answers to questions about health and medicines rather than speak to a doctor or pharmacist. And while people will sooner speak to a pharmacist or nurse than a doctor, there is still a lot that can be done to decrease the barriers to having those conversations. Consumers need clarification regarding how to find quality information online. They need the right information from the right sources, as well as short, clear Consumer Medicines Information sheets written in plain English and/or using international symbols that can be understood – no matter the language of the consumer – for basic information sharing. They need better access to interpreters – a free service that all pharmacists can access. The development of clear prompts that can be used by consumers, pharmacists and doctors could be one way to start changing behaviours around QUM. CHF is proposing the adaption of the Institute for Safe Medication Practice Canada’s 5 Questions to Ask your Pharmacist. Those questions cover issues such as the benefits, risks and costs of medicine. We need to help consumers be wise consumers, to know their choices and be equipped to make the right decisions, but we need clinicians to start those conversations. The core essence of being a primary health clinician is having a conversation with your patient. We are moving away from the culture of people doing what a clinician has told them to do in an unquestioning way, and towards people taking more responsibility for their own health care. But they need the encouragement and permission of pharmacists, GPs, nurses and other primary health clinicians to do this. Consumers are demanding integrated care and are aware that much medication misadventure can occur as they transition from hospital into other care settings, such as primary or aged care. We need to accelerate more effective discharge, interprofessional communication between hospital pharmacists and communitybased providers, and models of care such as non-dispensing pharmacists in general practices.