Contribution of the community pharmacist workforce to primary care through the lens of medicines classification: comparison of Aotearoa New Zealand and Australia
Chloë Campbell
1 * , Caroline Morris 1 , Bruce Sunderland 2 , Lynn McBain 1 , Petra Czarniak 2
1
2
Abstract
Optimal use of the workforce in primary care is critical due to increasing complexity and demand resulting from multi-morbidity in ageing populations. Improving public access to medicines by making them available via a pharmacist without prescription can support self-care while ensuring oversight by a health professional.
The aim of this paper was to identify and explore key differences between New Zealand and Australia in medicines classified nationally for pharmacist-only non-prescription supply.
Medicines legally classified to allow sale by a pharmacist without a prescription were identified and compared between the two countries as of 1 February 2024. Based on consensus among the research team, notable differences were subjected to qualitative consideration about how medicines classification may be used to extend the role of pharmacists in primary care.
Overall, New Zealand has a less restrictive approach to classification than Australia providing New Zealanders increased access to medicines via a pharmacist in two key therapeutic areas: sexual and reproductive health and infection. Oral contraceptives, sildenafil, antibiotics for urinary tract infection and two COVID-19 antivirals were classified for supply without prescription via pharmacists in New Zealand but not nationally in Australia, although some alternative legislative mechanisms are emerging at state level.
Medicines classification has an ongoing role in enabling pharmacist contribution to primary care. Medicines classification needs to be considered alongside commissioning of services and other policy to facilitate integration of community pharmacy-provided care within the wider primary care environment. Digital tools supporting information sharing, collaboration and communication are key.
Keywords: Australia, community pharmacy, medicines access, New Zealand, pharmacist, pharmacy services, primary care, regulation, workforce.
References
1 Bader L, Duggan C. FIP’s Commitment to Action on the WHO Astana Declaration: transforming pharmacy for better health for all. Res Social Adm Pharm 2020; 16(5): 724-6.
| Crossref | Google Scholar | PubMed |
2 Aggarwal P, Woolford SJ, Patel HP. Multi-morbidity and polypharmacy in older people: challenges and opportunities for clinical practice. Geriatrics 2020; 5(4): 85.
| Crossref | Google Scholar | PubMed |
3 Ministry of Health. Pharmacy Action Plan 2016 to 2020. Available at https://www.health.govt.nz/publication/pharmacy-action-plan-2016-2020 [accessed 12 February 2024].
4 Australian Government. Australia’s Long Term National Health Plan. 2019. Available at https://www.health.gov.au/resources/publications/australias-long-term-national-health-plan [accessed 1 February 2024].
5 Isenor JE, Cossette B, Murphy AL, et al. Community pharmacists’ expanding roles in supporting patients before and during COVID-19: an exploratory qualitative study. Int J Clin Pharm 2023; 45(1): 64-78.
| Crossref | Google Scholar | PubMed |
6 Therapeutic Goods Administration. Therapeutic Goods (Poisons Standard - February 2024) Instrument. 2024. Available at https://www.legislation.gov.au/F2024L00095/asmade/text [accessed 11 February 2024].
7 Medicines Regulations 1984. Available at https://www.legislation.govt.nz/regulation/public/1984/0143/latest/DLM95668.html [accessed 12 February 2024].
8 Gauld NJ, Kelly FS, Emmerton LM, et al. Widening consumer access to medicines: a comparison of prescription to non-prescription medicine switch in Australia and New Zealand. PLoS One 2015; 10(3): e0119011.
| Crossref | Google Scholar | PubMed |
9 Medsafe. Medicines Classification Database. Available at https://www.medsafe.govt.nz/profs/class/classintro.asp [accessed 1 February 2024].
10 Medsafe. How to change the legal classification of a medicine in New Zealand: Guidance document. 2019. Available at https://www.medsafe.govt.nz/downloads/how_to_change_medicine_classification.pdf [accessed 12 February 2024].
11 Bessell TL, Hiller JE, Sansom LN. Pharmacist only’ medicines. Aust N Z J Public Health 1999; 23(6): 661-2.
| Crossref | Google Scholar | PubMed |
12 Gauld NJ, Kelly FS, Kurosawa N, et al. Widening consumer access to medicines through switching medicines to non-prescription: a six country comparison. PLoS One 2014; 9(9): e107726.
| Crossref | Google Scholar | PubMed |
13 Hope DL, Woods P, Mey A, et al. Australian pharmacists: ready for increased non-prescription medicines reclassification. Int J Pharm Pract 2020; 28(3): 246-54.
| Crossref | Google Scholar | PubMed |
14 Pae Ora (Healthy Futures) Act 2022. Available at https://www.legislation.govt.nz/act/public/2022/0030/latest/LMS575405.html [accessed 12 February 2024].
15 Therapeutic Products Act 2023. Available at https://www.legislation.govt.nz/act/public/2023/0037/latest/whole.html [accessed 13 February 2024].
16 Pharmac. Pharmaceutical Schedule Rules - Rule 1.3.7. 2024. Available at https://schedule.pharmac.govt.nz/ScheduleOnline.php [accessed 12 February 2024].
17 Pharmacy Council of New Zealand. Standards for the supply by pharmacists of the emergency contraceptive pill. 2019. Available at https://pharmacycouncil.org.nz/pharmacist/medicines-reclassification/ [accessed 13 February 2024].
18 Medicines Classification Committee. Minutes of the 67th Meeting of the Medicines Classification Committee. 2021. Available at https://www.medsafe.govt.nz/profs/class/Minutes/2021-2025/mccMin26Oct2021.htm [accessed 11 February 2024].
19 Medicines Classification Committee. Minutes of the 68th Meeting of the Medicines Classification Committee. 2022. Available at https://www.medsafe.govt.nz/profs/class/Minutes/2021-2025/mccMin26Apr2022.htm [accessed 12 February 2024].
20 Queensland Government. Extended Practice Authority - Pharmacists - Version 4. 2023. Available at https://www.health.qld.gov.au/__data/assets/pdf_file/0027/1108944/epa-pharmacists.pdf [accessed 11 February 2024].
21 Queensland Government. Extended Practice Authority - Pharmacists - Version 1. 2021. Available at https://documents.parliament.qld.gov.au/tableoffice/tabledpapers/2021/5721T1437.pdf [accessed 11 February 2024]
22 Government of Western Australia Department of Health. Treatment of urinary tract infection by pharmacists. 2023. Available at https://www.health.wa.gov.au/Articles/S_T/Treatment-of-urinary-tract-infection-by-pharmacists [accessed 11 February 2024].
23 South Australia Health. South Australia Community Pharmacy Urinary Tract Infection (UTI) Services UTI Management Protocol. 2024. Available at https://www.sahealth.sa.gov.au/wps/wcm/connect/b52bbef1-4fed-4502-96ed-3ebf97ebdee1/Community+Pharmacy+UTI+Service+SA+Management+Protocol+-+Final1.pdf
24 New South Wales Health. NSW Pharmacy Trial. 2024. Available at https://www.health.nsw.gov.au/pharmaceutical/Pages/community-pharmacy-pilot.aspx [accessed 11 February 2024].
25 Victoria State Government Department of Health. Victorian Community Pharmacist Statewide Pilot. 2024. Available at https://www.health.vic.gov.au/primary-care/victorian-community-pharmacist-statewide-pilot [accessed 1 March 2024].
26 Tasmanian Government Department of Health. Protocol for Management of Urinary Tract Infections - Tasmanian Community Pharmacist Pilot Program Version 1.0 - January 2024. 2024. Available at https://www.health.tas.gov.au/sites/default/files/2024-01/protocol_for_management_of_urinary_tract_infections.pdf [accessed 1 February 2024].
27 Medicines Classification Committee. Minutes of the 48th Meeting of the Medicines Classification Committee. 2012. Available at https://www.medsafe.govt.nz/profs/class/Minutes/2011-2015/mccMin30Oct2012.htm [accessed 11 February 2024].
28 Therapeutic Goods Administration. Final decisions and reasons for decisions by delegates of the Secretary to the Department of Health and Ageing - 2.6 Oseltamivir. 2013. Available at https://www.tga.gov.au/sites/default/files/scheduling-decisions-1306-final.pdf [accessed 12 February 2024].
29 New Zealand Government. Classification of Medicines Gazette Notice 2022-go2856. 2022. Available at https://gazette.govt.nz/notice/id/2022-go2856 [accessed 11 February 2024].
30 Medicines Classification Committeee. Minutes of the 58th Meeting of the Medicines Classification Committee. 2017. Available at https://www.medsafe.govt.nz/profs/class/Minutes/2016-2020/mccMin16May2017.htm [accessed 12 February 2024].
31 Medsafe. Product/Application Search. Available at https://www.medsafe.govt.nz/regulatory/dbsearch.asp [accessed 1 February 2024].
32 Braund R, Ratnayake K, Tong K, et al. Pharmacist supply of sildenafil: pharmacists’ experiences and perceptions on training and tools for supply. Int J Clin Pharm 2018; 40(3): 650-8.
| Crossref | Google Scholar | PubMed |
33 Therapeutic Goods Administration. Final decisions amending or not amending the Poisons Schedule - 1.1 Sildenafil. 2018. Available at https://www.tga.gov.au/resources/publication/scheduling-decisions-final/final-decisions-amending-or-not-amending-current-poisons-standard-november-2018/11-sildenafil [accessed 13 February 2024].
34 Therapeutic Goods Administration. Final decisions amending or not amending the Poisons Schedule - 2.4 Oral contraceptive substances. 2021. Available at https://www.tga.gov.au/resources/publication/scheduling-decisions-final/notice-final-decisions-amend-or-not-amend-current-poisons-standard-acms-34-joint-acms-accs-28-accs-31 [accessed 13 February 2024].
35 Victoria State Government Department of Health. Protocol for Resupply of the Oral Contraceptive Pill - Victorian Community Pharmacist Statewide Pilot - October 2023. 2023. Available at https://www.health.vic.gov.au/sites/default/files/2023-10/clinical-protocol-oral-contraceptive-pill.pdf [accessed 1 March 2024].
36 South Australia Health. UTI treatment and contraceptive pill access. 2024. Available at https://www.sahealth.sa.gov.au/wps/wcm/connect/Public+Content/SA+Health+Internet/About+us/Department+for+Health+and+Wellbeing/Office+of+the+Chief+Pharmacist/Community+pharmacy+initiatives/UTI+treatment+and+contraceptive+pill+access+new/UTI+treatment+and+contraceptive+pill+access [accessed 1 March 2024].
37 Gauld N, Bryant L, Emmerton L, et al. Why does increasing public access to medicines differ between countries? Qualitative comparison of nine countries. J Health Serv Res Policy 2015; 20(4): 231-9.
| Crossref | Google Scholar | PubMed |
38 Therapeutic Goods Administration. Submissions received and TGA response: Proposed criteria for Appendix M of the Poisons Standard to support rescheduling of substances from Schedule 4 (Prescription only) to Schedule 3 (Pharmacist only). 2019. Available at https://www.tga.gov.au/resources/publication/publications/submissions-received-and-tga-response-proposed-criteria-appendix-m-poisons-standard-support-rescheduling-substances-schedule-4-prescription-only-schedule-3-pharmacist-only [accessed 12 February 2024].
39 Queensland Government. Extended Practice Authority - Pharmacists - Version 2. 2022. Available at https://documents.parliament.qld.gov.au/tp/2022/5722T1345-36EC.pdf [accessed 12 February 2024].
40 Minister of Health. New measures to tackle COVID-19 and flu. 2022. Available at https://www.beehive.govt.nz/release/new-measures-tackle-covid-19-and-flu [accessed 11 February 2024].
41 Food and Drug Administration. Coronavirus (COVID-19) Update: FDA authorizes pharmacists to prescribe Paxlovid with certain limitations. 2022. Available at https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-pharmacists-prescribe-paxlovid-certain-limitations [accessed 7 October 2023].
42 Traynor K. Québec authorizes pharmacists to prescribe Paxlovid. Am J Health Syst Pharm 2022; 79(14): 1126-7.
| Crossref | Google Scholar | PubMed |
43 New Zealand Government. Classification of Medicines Gazette Notice 2021-go1534. 2021. Available at https://gazette.govt.nz/notice/id/2021-go1534 [accessed 14 February 2024].
44 Bay of Plenty Community Pharmacy Group. Pharmacy programmes and services assisted by Bay of Plenty Community Pharmacy Group. 2024. Available at https://bopcpg.co.nz/services [accessed 12 February 2024].
45 Australian Government. PBS Continued Dispensing Arrangements. 2024. Available at https://www.pbs.gov.au/info/general/continued-dispensing [accessed 11 February 2024].
46 Aly M, García-Cárdenas V, Williams K, et al. A review of international pharmacy-based minor ailment services and proposed service design model. Res Social Adm Pharm 2018; 14(11): 989-98.
| Crossref | Google Scholar | PubMed |
47 NHS England. Community pharmacy advanced service specification: NHS Pharmacy First Service - November 2023. 2023. Available at https://www.england.nhs.uk/publication/community-pharmacy-advanced-service-specification-nhs-pharmacy-first-service/accessed [11 February 2024].
48 Hikaka J, Haua R. Examining equity in a void of evidence - pharmacist minor ailments services and the role of systematic reviews. Explor Res Clin Soc Pharm 2022; 7: 100174.
| Crossref | Google Scholar | PubMed |
49 Hikaka J, Haua R, Parore N, et al. Designing for health equity: a mixed method study exploring community experiences and perceptions of pharmacists’ role in minor ailment care. Res Social Adm Pharm 2023; 19(4): 643-52.
| Crossref | Google Scholar | PubMed |
50 Te Whatu Ora Health New Zealand. Community Pharmacy Minor Ailments Service Frequently Asked Questions - June 2023. 2023. Available at https://www.tewhatuora.govt.nz/assets/For-the-health-sector/Community-pharmacy/Minor-ailments-service/Community-Pharmacy-Minor-Ailments-Service-FAQ.pdf [accessed 11 February 2024].
51 Burling NJ. Pharmacists still funded for minor-ailments in Northland, Hawke’s Bay and Upper Hutt. 2023. Available at https://www.pharmacytoday.co.nz/article/news/pharmacists-still-funded-minor-ailments-northland-hawkes-bay-and-upper-hutt [accessed 12 February 2024].
52 Nakhla N, Taylor J. Self-care and minor ailments: the view from Canada. Explor Res Clin Soc Pharm 2024; 13: 100412.
| Crossref | Google Scholar | PubMed |
53 Gysel SC, Tsuyuki RT. The pharmacist primary care clinic: the evolution of pharmacy practice? Can Pharm J 2024; 157(2): 47-9.
| Crossref | Google Scholar | PubMed |
54 Swart A, Benrimoj SI, Dineen-Griffin S. The clinical and economic evidence of the management of urinary tract infections by community pharmacists in women aged 16 to 65 years: a systematic review. Int J Clin Pharm 2024; 46(3): 574-89.
| Crossref | Google Scholar | PubMed |
55 Pharmaceutical Society of New Zealand. Covid-19 oral antivirals for pharmacist only supply - training programme. 2022. Available at https://www.psnz.org.nz/Product?Action=View&Product_id=810 [accessed 13 September 2023].
56 Thai T, Chen G, Lancsar E, et al. Beyond dispensing: better integration of pharmacists within the Australian primary healthcare system. SSM Qual Res Health 2022; 2: 100109.
| Crossref | Google Scholar |
57 Te Whatu Ora Health New Zealand. Integrated Community Pharmacy Services Agreement. 2023. Available at https://www.tewhatuora.govt.nz/for-the-health-sector/community-pharmacy/community-pharmacy-agreement/ [accessed 13 February 2024].
58 Andrews S, Gasparini J, Henderson G. Evaluation of Gout Stop and Owning My Gout management programmes - A final report for Arthritis New Zealand and its partners. 2020. Available at https://www.arthritis.org.nz/research/reports/ [accessed 13 February 2024].
59 Pollack S, Skillman S, Frogner B. Assessing the size and scope of the pharmacist workforce in the U.S. 2020. Available at https://familymedicine.uw.edu/chws/publications/assessing-the-size-and-scope-of-the-pharmacist-workforce-in-the-us/ [accessed 13 February 2024].
60 National Institute for Health and Care Excellence. Patient Group Directions. 2013. Available at https://www.nice.org.uk/guidance/mpg2/resources/patient-group-directions-pdf-1779401941189 [accessed 12 February 2024].
61 General Pharmaceutical Council. Standards for the initial education and training of pharmacists. 2021. Available at https://www.pharmacyregulation.org/education/education-standards [accessed 13 February 2024].
62 Walpola RL, Issakhany D, Gisev N, et al. The accessibility of pharmacist prescribing and impacts on medicines access: a systematic review. Res Social Adm Pharm 2024; 20(5): 475-86.
| Crossref | Google Scholar | PubMed |
63 Akman M, Ayhan Başer D, Usanma Koban B, et al. Organization of primary care. Prim Health Care Res Dev 2022; 23: e49.
| Crossref | Google Scholar | PubMed |
64 Keller ME, Kelling SE, Cornelius DC, et al. Enhancing practice efficiency and patient care by sharing electronic health records. Perspect Health Inf Manag 2015; 12(Fall): 1b.
| Google Scholar | PubMed |
65 Mercer K, Burns C, Guirguis L, et al. Physician and pharmacist medication decision-making in the time of electronic health records: mixed-methods study. JMIR Hum Factors 2018; 5(3): e24.
| Crossref | Google Scholar | PubMed |
66 Te Whatu Ora Health New Zealand. Hira: Connecting health information. 2024. Available at https://www.tewhatuora.govt.nz/our-health-system/digital-health/hira-connecting-health-information/ [accessed 12 February 2024].
67 Australian Digital Health Agency. My Health Record. 2024. Available at https://www.digitalhealth.gov.au/initiatives-and-programs/my-health-record [accessed 8 February 2024].
68 Queensland Health. Queensland Community Pharmacy Scope of Practice Pilot. 2024. Available at https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/community-pharmacy-scope-of-practice-pilot [accessed 29 February 2024].
