Karen O’Leary
I work to improve the use of medicines by influencing policy and or helping decision makers to make ‘better’ decisions.
My job is not glamorous; it’s not cutting edge or very exciting. It takes months or years to get things achieved but it is important to both improving what we offer and maintaining gains made in the past.
The policy enables, it provides a set of guiding principles to help with decision making at the bedside, in a pharmacy or in the health system as a whole. The policy provides clear statements about our health system, about how we as pharmacists seek to conduct our services. The policy is like engineering if it’s good no one notices; if it is poor things collapse, the failure is obvious.
I was fortunate to spend my first 10 years as a pharmacist in a hospital which, at the time, was probably the largest pharmacy service in Australia and lead by a trailblazer.
I remember the day he handed me a draft paper and asked me for my opinion of the contents. Me, a relatively junior clinical pharmacist, was being asked to read and comment on a national review of medicines and pharmacy services being prepared for the health minister.
He encouraged, and expected, me to think about the patient in front of me, the groups of patients I was responsible for on my wards and the bigger picture; how the hospital funded medicines, why would they fund pharmacists and how to influence the health minister. He made me appreciate that decisions made ‘somewhere’ were influencing how and what service my patients had access to and what I could offer to support them.
So I thought it wise to try and understand the basis for how these decisions are made.
I got involved in the initial work in case-mix in Australia. This helped with understanding the ‘what and where’ of which patients we should be targeting for pharmacist services.
This led me to be involved in one of the early trials of pharmacists visiting patients in their home after their discharge to try and prevent readmissions in the early 1990s. At the same time, we started a pilot project looking at moving our clinical pharmacy service into the emergency department to deliver pharmacist services earlier in the admission. It was exciting to be the pharmacist managing the clinical pharmacy team at this time. We celebrated 21 years of clinical pharmacy in our hospital. Evidence was mounting about what pharmacist could offer patients, the community and our society as a whole.
And then a recession hit…
Clinical pharmacists were seen as an indulgence; decision-makers focused on the most efficient way to supply medicines, nothing else mattered. Savage, indiscriminate funding cuts were made. Many pharmacists moved away from our hospitals, including myself.
As a profession we hadn’t made a strong enough case to decision makers, we hadn’t influenced those that mattered. There were no national policies that enshrined medication safety as a patient right. In the years since I have watched as individual pharmacists, and the profession as a whole, have tried to claw back to providing the level of service offered in our hospitals more than 20 years ago. The decade-long shortage of pharmacists in Australia didn’t help. It has taken a substantial time to rebuild a clinical pharmacy workforce and a long time to rebuild our management workforce, to rediscover our combined corporate knowledge.
The sheer number of patients with multiple underlying chronic diseases, the increasing cost of medicines and a greater awareness of the harm of inappropriate use of medicines (and the associated costs) offers us another chance to show the how, when and why we can make a difference. Policymakers don’t accept flimsy evidence. They require solid, specific and yet ‘generalisable’ evidence and they require that the workforce, not a handful of individuals, is capable of delivering what is required. A younger pharmacist joined our team at SHPA last year and the discussions we have had has reinforced to me just how important it is that we work at knowing and retaining our ‘corporate memory’; that how a policy decision has been made is just as important as the actual final decision.
To influence policy we must build on and learn from the past – what worked well, what didn’t deliver real benefits and why we failed to achieve lasting reform. We can’t rely on flashes of brilliance, although we can be inspired by it. As a profession, we need to identify the most effective and efficient way we can provide the greatest benefit to the patient in front of us, the groups of patients we provide services to as well as the community as a whole. We need to find ways of generalising lessons learnt in one sector or one patient group into the ‘business as usual’ model.
At SHPA’s annual conference last year, the Federal President Professor Michael Dooley challenged all attending to make a difference every day and to reflect each day on how we had made a difference. I challenge you to think about the patient in front of you, the groups of patients you provide services to as well as the bigger picture. Learn from the past, be inspired, explore options, publish your findings to build our collective knowledge and support those who seek to translate your work into policy reality.