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Solving one of Australia’s most overlooked healthcare risks

It’s a problem that causes an estimated two million visits to GPs every year, but thanks to a new system built by researchers in Tasmania, Australians are better protected than ever before.

As you wander through the aisles of your local pharmacy, killing time as your prescription is being filled, do you ever wonder what’s going on behind the counter?

For the uninitiated, it might seem as though a pharmacist’s job isn’t all that complex, but in reality, they’re a vital fail-safe for many of us at risk of side effects and complications from our medications.

To appreciate the value of this work, says Professor Luke Bereznicki from the University of Tasmania’s School of Medicine, you need to understand that the role of the community pharmacist goes much further than filling out a prescription.

“A lot of the good clinical work that pharmacists do is around the early identification of potential problems and taking action to stop them,” he explains.

“Often a pharmacist will notice something about the patient's medication profile. They'll contact the GP or the prescriber, and make a recommendation that might prevent that problem from occurring.”

These sorts of pick-ups, and all the steps pharmacists take to keep their patients safe and well, are known as clinical interventions.

Shifting the status quo

There’s a lot that can go wrong when patients start taking new or multiple medications.

In Australia, more than 200,000 unplanned hospital admissions per year are medication-related. That figure encompasses problems caused by not taking enough or taking too much medication, as well as side effects from taking the recommended dose, and drug interactions.

Combined with the number of visits to GPs and other medical practitioners, this represents a weighty burden on the Australian healthcare system.

While community pharmacists have long played a pivotal role in identifying and resolving potential medication-related problems, prior to 2010, they received payment from the government based solely on the number of prescriptions dispensed.

“The professional bodies were going to the government and saying, ‘There's a lot of additional value in what pharmacists are providing here. We need this to be recognised in some way,” says Professor Bereznicki.

In 2003, a research team at the University of Tasmania, led by Professor Gregory Peterson, was formed, with the aim of developing a system that would encourage, rather than hinder, pharmacists in reducing the impact of medication-related problems.

Over the next seven years, the researchers applied their expertise in clinical pharmacy, information technology, and economics to develop and trial an electronic documentation system for clinical interventions that merged with existing pharmacy software.

The resulting system, known as Pharmacy Recording of Medication Incidents and Services electronically (PROMISe), was put to the test by community pharmacists in Tasmania, Victoria, and NSW.

The hidden value of interventions

During the study, pharmacies using the new system recorded twice the rate of interventions compared with standard practice.

In the next stage of the research, an expert panel of pharmacists and medical practitioners closely examined a number of interventions that had been recorded during the study.

“A clinical panel was assigned to think about, did the pharmacist actually prevent something that was likely to occur? And how severe was the event that could have occurred," says Professor Bereznicki.

“Then they could put likelihood ratings and severity ratings around those recommendations, and from there we could assess what might have been prevented by making that intervention, and estimate the cost savings.”

Economic analysis

Key facts

  • More than 200,000 hospital admissions in Australia each year are medication-related, and most are preventable.
  • Between 2010 and 2014, clinical interventions delivered through the PROMISe program resulted in 1 million avoided days in hospital.
  • Based on the PROMISe trial, each medication-related clinical intervention by a pharmacist saves around $220 in healthcare costs. Over 1 year, that equates to a $180 million saving.
  • Researchers have found that 85-90% of side effects experienced by elderly patients are considered preventable.


About the researchers

Professor Luke Bereznicki

Professor Luke Bereznicki is a pharmacist with 12 years experience working in the health care sector, and has been an academic at the University of Tasmania since 2007. His career is dedicated to improving pharmacy practice in Australia through learning and teaching, research and advocacy. He provides leadership within the University of Tasmania as Head of Discipline (Pharmacy) and Deputy Head of School (Medicine), and nationally within the pharmacy profession within a range of professional and industry bodies.


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Professor Gregory Peterson

Greg has held a personal Chair at the University of Tasmania since 2000, awarded on the basis of his research and teaching excellence. Greg has led many state and national projects directed at improving the use of medications and patient outcomes in community, hospital and aged care sectors.


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