Bring Clinical Pharmacy to the Community – Expand Hospital Outpatient Clinics!

Abstract

Bring Clinical Pharmacy to the Community -Expand Hospital Outpatient Clinics! When I was a hospital pharmacist in the 'good old days', outpatient clinics appeared to be a larger contributor to the pharmacy department and overall hospital activity than they are today. The past 20 years have seen cutbacks and rationing of hospital outpatient services to varying degrees between the states. This has been in large part a cost-shifting exercise designed to transfer the costs of outpatient care to the federal government via Medicare and the Pharmaceutical Benefits Scheme. 1 It is well recognised that there is now poor access to public hospital outpatient services in this country. 2 The privatisation of hospital clinics and/or other health services and outsourcing to private providers have been contributors to the decline in the role of the academic teaching hospital and academic medicine in Australia. 3 The National Health and Hospitals Reform Commission was formed to develop a long-term health care plan for Australia. The Commission released their interim report on healthcare system reform entitled, 'A healthier future for all Australians' in December 2008. 4 One of their recommendations relating to timely access and safe care in hospitals was that 'all hospitals review provision of ambulatory services (outpatients) to ensure they are designed around patients' needs and, where possible, located in community settings'. Although this sounds somewhat similar to the federal government's GP Super Clinics initiative it is driven by hospitals. 5 I shall return to this theme later.This approach is consistent with Walsh's vision of Australian hospitals and healthcare delivery in 2100. 6 'Ambulatory centres, highly automated, highly accessible, will be customer friendly one-stop health shops of tomorrow. Hospitals will remain cherished icons and centres of health knowledge, but will be a lesser component of the health care system than they are today, there will be less of them, and they will lose their dominance as the focus of healthcare training, policy and activity.' 6 According to Walsh's description, hospitals rose in prominence during the twentieth century and reached their peak in Australia during the 1970s, consuming almost 40% of the healthcare budget. 6 Over recent decades the emergence of community-based ambulatory care has shifted medical and surgical work away from the hospital inpatient (and outpatient) settings.It is clear and has been noted by Brand and others that the current hospital service models that focus on acute episodic illness are unlikely to meet the needs of patients with chronic exacerbating and remitting conditions. [7][8][9][10][11][12][13] Hence, the shift towards the design of new chronic care models that are knowledge-based, patientcentred, collaborative and continuous. 11,13 It is virtually impossible to have a major impact on chronic disease management within the abbreviated timeframes that patients now spend in hospitals. The proportion of same-day hospital separations is increasing and the...