VETERANS: WHY CAN’T PHARMACISTS INITIATE THE SERVICES PROCESS?
Where GP services are limited or lacking, why can’t pharmacists start getting ex-servicemen and women the help they need? wonders Karalyn Huxhagen
It always astounds me, when speaking with patients who are current serving members of the armed forces or have a Veterans Gold Card, that they are unaware of the services and programs available to them.
In rural communities I encounter patients who require programs such as sleep studies, maybe CPAP machines, continence aids, counselling, wound care and of course their medications to name a few. Many of these patients are struggling to afford to pay for their health care.
The lack of a support person who lives in the community who can assist the patient to apply for the services they require; a GP who has no understanding of the veteran affairs program and a lack of ability to use a system that is mainly Internet-based makes accessing these services very difficult.
One of my recent patients’ lives in a quite humble dwelling in a rural community. He is a returned veteran and lives on his veteran’s pension.
There are no floor coverings on his floors, the garden is completely overgrown to the point of a small track to the gate being the only access and the stairs were a nightmare of holes and rickety wobbles.
This gentleman has a huge hernia that requires attention and cardiac issues which are making surgery very risky. Part of his problems is essential tremor.
He has no internet or television as he cannot afford it. To call someone on the telephone is very hard for him as he cannot hold the telephone for long due to his essential tremor.
The GP services in this town disappeared from December to the end of February and when they did return, very few patients will visit the GP. This GP is not well liked or highly regarded by the community.
The chronic disease nurse at the surgery asked me to visit the client for a HMR. The reality is that his medicines are appropriate and his medication issues are well cared for by the community pharmacy. He has access to community nursing services that do their best to provide a wide range of services.
This person’s major problem is that the Department of Veteran Affairs has many services available that he could access—but who can assist him to go through this process?
The DVA is not going to send an investigator 850km into the central Queensland highlands to perform an appraisal.
The community care nurse, chronic disease nurse at the health centre, community pharmacist and HMR pharmacist are all contributors to his care but we are unable to initiate GP-led programs, nor are we allowed to be paid to be the coordinator of these programs.
The GP is paid to develop and administer a coordinated care program for gold card holders with the above conditions. How do we change the format of these programs when there is a lack of GP on site?
The coordinated veterans care (CVC) program and all of its offshoots are available for all veterans who hold a gold card but the client needs a GP in the location to initiate and coordinate the programs.
The CVC program extends to clients with the following conditions:
congestive heart failure;
coronary artery disease;
pneumonia;
chronic obstructive pulmonary disease; and
diabetes.
So if the HMR and community pharmacists are the health professionals who identify that the veteran is at risk and in need of assistance, why can’t we refer to the Department to initiate these programs?
I am absolutely 100% behind the GP being involved in the care of the patient, but there are many areas of Australia that lack a GP and so services cannot be initiated.
There has to be provision for initiation of services to have alternative pathways in areas that lack GP services. There needs to be a system that allows the health worker who is in these communities to be able to start the process that enables access to services.
If there is only a community health service available in these communities and a community pharmacy, is it not feasible to allow pharmacy to be part of the program coordination? There is a need for an alternate model for these circumstances.
You can access the coordinated veteran care program here http://www.dva.gov.au/providers/provider-programs/coordinated-veterans-care
Karalyn Huxhagen is a community pharmacist and was 2010 Pharmaceutical Society of Australia Pharmacist of the Year. She has been named winner of the 2015 PSA Award for Quality Use of Medicines in Pain Management and is group facilitator of the Mackay Pain Support Group.