Annabel Young: Drug misuse puts avoidable strain on our health system

Opinion

The cost to our hospitals of admissions due to medicine mismanagement is huge - and an entirely preventable expense which needs to be addressed.

We are seeing increasing admissions of patients who are not taking their medications properly, because they are confused. Medicines are complicated and there are a multitude of questions that come up which patients can't always resolve such as, can I share this medicine with someone who has similar symptoms?

If I miss a dose should I double up next time? Can I stop taking this medicine when I feel better? All these questions become further complicated for a patient taking more than one medicine.

The solution is better management of the medicines of all patients, even patients on simple medicine regimes - which should start at the patient's home, not the Emergency Department of their local hospital.

It is estimated that there are about 40,000 patients in the community each taking 14 or more medicines. Combined they account for 72,000 hospital admissions each year.

On average, they stay 5.4 days per visit. Even a 1 per cent drop in these would save hospitals at least $5000 per admission.

Addressing this problem so that patients and their medicines are better managed in the community is an obvious way to reduce costs in the hospital system.

We already have a huge resource of professional medicine experts working in our communities who are capable of taking on the role of managing patient medication regimes - community pharmacists.

Internationally, there is growing recognition that pharmacists are severely under-utilised and initiatives are under way to make better use of their skills at a time when health resources are stretched to the limit.

A good and recent example is a scheme run in the Isle of Wight where pharmacists regularly review patients' use of respiratory medicines. The results have been impressive - emergency admissions to hospital due to asthma have dropped by more than 50 per cent and there has been a 25.2 per cent fall in the numbers of prescriptions for short-acting, selective beta agonists.

What a difference this makes for each patient and their family.

In New Zealand there is a serious shortfall in health resources. Both here and overseas better use of the skills and availability of community pharmacists is being viewed as part of the solution. This has led to a world-wide movement towards greater government funding of the management of patients and their medicines by each patient's community pharmacist.

The community pharmacy model in New Zealand is a partnership with government whereby pharmacists are paid for dispensing prescribed medicines and providing associated advice.

The downside of this dispensing model is that it only allows for advice to be given at the time when the medicine is dispensed. We all know how difficult it is to remember that advice when we get home.

The New Zealand model largely ignores the benefits from the wider management of medicines which has been proven to have a massive impact on people's quality of life and wellbeing, particularly for those with chronic conditions.

It has been estimated that 50 per cent of patients with chronic conditions do not comply with their medicines regime. The Isle of Wight example is just one that shows the benefits of regularly reviewing how patients are using their medicines.

The good news is that there are a number of local initiatives already happening throughout New Zealand. Some District Health Boards are experimenting with Medicines Use Reviews (known as MURs) where a pharmacist is paid by the DHB to work with the patient to monitor and advise on their total medicines usage. Other DHBs are using community pharmacies to work closely with chronically ill patients to ensure that they maintain their medicines schedule.

In other countries, work on diabetes, obesity, asthma, medicines compliance and population health are all becoming part of the pharmacy role. This use of the pharmacist as the medicines specialist, who is most closely in contact with the patient in the community, is where the opportunity lies for the government to expand the role of pharmacy and relieve the burden on other parts of the health sector.

The mathematics on increasing the investment into medicines management in the community is not complicated. And the health benefits are obvious.

* Annabel Young is chief executive officer of the Pharmacy Guild of New Zealand.