From nurse prescribing to an Australian experiment: some recent news in primary health care
There is an international trend towards nurses having a greater role in prescribing of medicines,
The evolution of primary health care organisations in Australia.
These issues are explored in the latest articles profiled by the Primary Health Care Research & Information Service.
Expanding role of nurses improves patients’ access to medicines
Melissa Raven writes:
There is widespread and increasing acceptance of the legitimacy and value of nurse prescribing, according to a recent review of research conducted by PHCRIS.
It found there is an increasing trend worldwide for nurses and other non-medical healthcare professionals to be authorised to prescribe drugs.
In recent years, nurse practitioners and eligible midwives have been granted prescribing privileges throughout Australia (except for the Northern Territory, where legislation has been granted but not enacted).
Most, but not all, Australian nurse practitioners prescribe drugs, usually at least once a day, but prescribing does not dominate their clinical practice.
Prescribing is most common in paediatric/neonatal care, emergency care, primary care/general practice, and sexual health/women’s health, and much less common in aged care and palliative care.
The most frequently prescribed types of medications in 2010 were anti-infectives, analgesics, psychotropics, and cardiovascular medicines. Anti-infectives and analgesics dominated in emergency care.
Australian nurse practitioners are highly qualified. Most have a master’s degree (which is now a prerequisite) and have had many years of nursing experience.
Internationally, nurse prescribing extends well beyond nurse practitioners and eligible midwives and is becoming increasingly common.
In 2010, seven Western European and Anglo-Saxon countries had introduced nurse prescribing, beginning with the US in the 1960s, followed by Canada, Sweden and the UK in the 1990s, Australia in 2000, New Zealand in 2001, and Ireland in 2007. It was expected to be introduced in the near future in the Netherlands and Spain. Nurse prescribing is prominent in the UK, where nurses have extensive prescription privileges.
Overall, there is increasing evidence of the benefits of nurse prescribing. Patient acceptability has the strongest evidence, with numerous studies reporting high levels of patient satisfaction.
There is also evidence that nurse prescribing can increase the effectiveness of healthcare and improve patient access to medicines.
Given the increasing demands on the Australian healthcare system, the increasing workforce of highly trained nurse practitioners and midwives authorised to prescribe augurs well for the future.
An international context for the Australian experiment in primary health care
Lynsey Brown writes:
Australia’s complex health care system is currently in the throes of reform.
According to this recent article by an Australian research group, the need for reform stems from international evidence that a strong primary health care system results in reduced costs and health inequities, and improved health outcomes and patient satisfaction.
This narrative piece discusses the manner in which the experience and impact of the Divisions of General Practice have informed and supported recent changes to the health system.
By presenting the key characteristics of primary health care systems (comparing Australian and international models), describing governance frameworks and identifying the functions of meso-level primary health care organisations, the authors provide an understanding of how Australia’s primary health care organisations are positioned on a world stage.
Divisions were the original, local, meso-level primary health care organisations.
Coordinated by general practices but funded by the federal government, these primary health care organisations aimed to improve access and quality of care based on local community needs.
That is, Divisions have supported initiatives around national practice accreditation, quality improvement, multidisciplinary teams, linkages with practice nurses and allied health, regional integration, information technology, and education and training. Divisions have offered programs that specifically address prevention, early intervention, population health, chronic disease and integrated care practices.
Described by the authors as ‘the Australian experiment’, the Divisions have been instrumental in progressing primary health care.
During the last two decades there has been a shift from emphasis on individual practitioners to a professional collective local voice. The authors credit the National Primary Health Care Strategy with affirming the direction for primary health care in Australia and supporting a system that is comparable to international examples.
As key players in this 2009 Strategy, Medicare Locals (MLs) represent larger primary health care organisations than Divisions, allowing greater representation with connections across community, health professional groups and business/management sectors.
Medicare Locals are charged with ensuring better use of primary health care as they provide a regional governance framework through their emphasis on integration of services both within primary care and in other sectors e.g., Medicare Locals will work closely with Local Hospital Networks in each region.
The authors acknowledge the continuing challenges for the Australian health system with increasing rates of chronic disease and fragmentation related to funding, accountability and responsibilities.
In ensuring equitable access and an adequate workforce, the authors encourage learning from international models and Australia’s previous practices. That is, recommendations are provided around promoting fiscal mechanisms such as the use of incentives to encourage coordinated care; ensuring high-quality communication; developing an effective governance arrangement to promote better primary/secondary care integration; continued investment in infrastructure; and sharing of resources.
Introducing Divisions and expanding into Medicare Locals has allowed the government to promote engagement with the majority of general practices, with emphasis on patient-centred care as a core value.
• Nicholson C, Jackson CJ, Marley JE, & Wells R. (2012). The Australian Experiment: How primary health care organizations supported the evolution of a primary health care system. Journal of the American Board of Family Medicine, 25(Suppl. 1), S18-S26. DOI: 10.3122/jabfm.2012.02.110219
These two articles above featured in the PHC RIS eBulletin.
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Previous PHC RIS columns at Croakey
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