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QUMAX - One Year on and Where to From Here

Issue: Issue 81: April 2009
Author: Karalyn Huxhagen

Earlier this month the PGA (Pharmacy Guild of Australia) and NACCHO (National Aboriginal Community Controlled Health Organisation) hosted a meeting in Canberra to discuss how QUMAX (Quality Use of Medicines Maximised for Aboriginal and Torres Strait Islander Peoples) is going and where to from here.
The meeting was attended by state affiliates from NACCHO and the State Quality Use of Medicine facilitators employed by the Pharmacy Guild. Other attendees included the Department of Health and Ageing employees who are involved with this program and people employed in the various community controlled health centres that are using QUMAX

It was disappointing that there were not more of the pharmacists present who are actually using the program in their pharmacies.
There were many presentations by various community controlled health centres and the pharmacists they work with.
These presentations highlighted the variance that is possible within the program parameters. The desire by NACCHO to have pharmacists employed in the health services is not possible in all areas and the best system has to be developed at an individual health service level.

While I agree with the program and support it fully once again it is a program that the reimbursement for the pharmacist providing the service is minimal.
We are paid the co-payment or the DAA fee for providing medication and/or a DAA but that is all.
The program does not have a component for the reimbursement for the time taken to process the claims to the Pharmacy Guild IT program or the time taken to reconcile these payments.
The IT platform is not hard to use but it does have its moments and I have lost all my data at one stage and had to start again. You cannot claim for payment until you have at least $100.00 to claim. Therefore if the clients are intermittent you will not receive reimbursement for some time.

The provision of a DAA does not stop there.
The pharmacist needs to counsel on the correct use of the DAA, follow up when the DAA’s are not picked up.
There is no compensation for the management of this whole process. You have to be a clever pharmacist and build this into your DAA fee.

There are many areas that community pharmacy can be involved in this program.
The business rules state that the pharmacy staff will undertake cultural awareness training provided by the AHS. I sent my staff to this training which was very good.
The pharmacy staff were paid for their time to attend this training but there is no compensation possible from the program to cover these costs incurred by the pharmacy.

The pharmacy staff are required to monitor the PBS and safety net status of the clients.
The pharmacy staff are also to provide training to the AHW’s and AHS staff on calculating the PBS safety net and Medicare rules.
There is no funding provision in the program to cover the cost of this training time.
Many of the pharmacists are providing clinical education for the AHW’s and other education as needed.
At this stage the AHS dose not have the ability to use QUMAX funding to cover the pharmacists time and expertise in providing this service. The next version may address this issue.

The staff at the health centres are keen to use other programs such as HMR’s and many have developed good working relationships with their pharmacists to provide the HMR’s and support.
An Aboriginal health worker (AHW) accompanies the pharmacist when the pharmacist visits a client to perform the HMR. There is also no funding available to cover costs for travel of the pharmacist to remote locations.

Many of the AHS’s have used other funding models and resources to compensate the pharmacists for their time. It would be advantageous to the success of this program if a more equitable model of funding and reimbursement was negotiated for the pharmacists.
There are changes to the program to come in 2010 but the community pharmacists currently involved in the program need to be very vocal when approached by the program evaluators to ensure that those involved in the program management are aware of the program’s limitations and problems.

While both Community pharmacy and the Aboriginal health services are keen to see this program continue.
To be of great benefit to these people, community pharmacy needs to be able to be compensated for the time, resources and skills that they bring to this program.
At this point I feel we are being marginalized by the program itself and we are relying on the AHS to bear costs that should have come from the program funding pool for the community pharmacists.

I encourage all of the community pharmacists who are involved in this program to have a discussion with the evaluation team about the strengths and weaknesses encountered with the program.
I also encourage you to inform the Program coordinators, the Pharmacy Guild of Australia, the problems and issues encountered in delivering the program.


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