Concerns raised over emerging models of care

03 Jun 2024

The emergence of services designed solely to provide customers with access to a predetermined medicine raises concerns that some practitioners may be putting profit ahead of patient welfare.

The Australian Health Practitioner Regulation Agency, the Pharmacy Board of Australia, the Medical Board of Australia and the Nursing and Midwifery Board of Australia remind practitioners of their long-established responsibilities when prescribing and dispensing medicines, and how they continue to apply in the context of evolving business models.

New models of healthcare, including the use of telehealth, are important enablers of greater access to health services. The Boards and Ahpra support the responsible and safe use of telehealth. The development of new medicines also plays an important role in improving the health of many patients. Ahpra and the Boards’ concerns focus only on practitioners seeking to take advantage of them in ways that sidestep their obligations to safe practice. 

Practice models of concern often feature clinics that treat a single issue or prescribe and dispense a single medicine in response to patient demand. Some focus on high-volume telemedicine consultations and or computer algorithm-based prescribing of medicines resulting in prescriptions being supplied directly to pharmacies. This enables the supply of unregistered or compounded medicines directly to patients, removing the consumers’ choice of provider and preventing direct contact between patients and pharmacists.  This may prevent necessary information exchange to support the safe supply and use of medicines. Pharmacies and prescribing clinics collocated and set up as a one-stop-shop to prescribe and dispense a single medicine being sought by consumers are also on regulators’ radar.

The Chair of the Pharmacy Board of Australia, Brett Simmonds raised concerns that it may be difficult for pharmacists to safely dispense these medicines if these models of care continue to grow in popularity. 

‘Prescribers and pharmacists need to work collaboratively to ensure medicines are appropriate and safe for the consumer. The concerning nature of these ‘one-stop-shop’ models makes it extremely difficult for pharmacists to do this.’  

The Board reminds pharmacists that the care of the patient is their primary concern. ‘Good practice’ to ensure the safe supply of medicines includes:

• Effective communication between authorised prescribers and pharmacists dispensing prescribed medicines. It also involves an understanding of the important role of each profession to ensure that the interests of the patient are their primary priority.
• If a pharmacist believes that it is not safe or appropriate to dispense and supply a prescribed medicine, they must communicate their concerns to the prescriber and patient so that alternative options can be considered. This may include not supplying the prescribed medicine and recommending another suitable medicine that if agreed, the authorised prescriber would need to prescribe.
• Recognising and respecting the rights of patients or clients to make their own decisions which includes the right to choose where they wish to access prescribed medicines. Pharmacists must not enter into arrangements for exclusive supply of prescriptions from a health practitioner/prescriber or other third party, although pharmacists may offer to retain prescriptions for subsequent dispensing with the patient’s or client’s consent.
• If patients who require the supply of prescribed medicines are engaging with a pharmacist via a pharmacy which uses an online platform, a pharmacist should communicate with the patient to obtain any required information and to offer counselling to ensure safe use of medicines and patient safety.

In short, the Pharmacy Board of Australia views some of these models of prescribing and dispensing as failing to meet the standards of good practice, with consequent risks to patient safety that have the potential to cause significant harm.  Pharmacists are urged to think carefully before participating in any such arrangement.

More information

• Read the Joint statement on professional responsibilities when prescribing and dispensing.
• Information for practitioners about virtual care.