TV Interview - Study Looking at Pharmacists in Regional Areas Taking A Larger Role in Treating Depression

COMPERE O'KEEFE: The theory is there are not enough medicos in these regions, so pharmacists can step in to help out. But is this going to compromise patient care? Dr Bill Glasson heads up the AMA, the Australian Medical Association, and Professor Ian Hickey is from depression support group, Beyond Blue. Good morning to you both.

Now Bill, if I can ask you…

DR BILL GLASSON: Morning, Andrew.

COMPERE O'KEEFE: Morning. If I can ask you first, is this proposition going to be stepping on doctors' turf and, if so, is that a bad thing?

BILL GLASSON: No, not at all, Andrew, I think any initiative that improves patient care we'd be supporting. But I suppose the question is where do you draw the line as far as what pharmacists should or shouldn't be doing. And we feel that the pharmacists' role should be limited largely to the dispensing of drugs. That's all sorts of drugs, talking about the side effects of those drugs, and the interactions.

Now we would support the education of pharmacists across the board as we would the broader community.

But I think, if you're talking about pharmacists actually diagnosing mental disorders such as depression and then initiating treatment, then I think that is probably going too far in the sense that I don't think that's good patient care. I don't think it's holistic patient care and I don't think pharmacists either have the training nor the physical set-up in their pharmacies to actually discuss these sorts of issues with patients.

COMPERE DOYLE: Ian, what do you think? Are pharmacists able to do this or offer such extra support?

PROFESSOR IAN HICKEY: I think there are two important issues, Mel. One is the reality is that people go into their pharmacy and ask for advice regularly. And we know when it comes to issues like depression, people often have trouble taking those issues up with doctors and other health professionals. So increasing training of pharmacists…

COMPERE DOYLE: So why do they have trouble?

IAN HICKEY: People are reluctant at times, because of the stigma that surrounds mental disorders, so often they ask off-the-cuff questions, informal questions, seek advice before they get to the doctor. And it's sort of typical of people they'll ask will include a pharmacist.

So we know from other studies when people do that, they're actually more likely to consult a doctor if they've received encouraging advice in the first place. Second area, a lot of the issues around medication, people are very reluctant about it and people don't generally want to take anti-depressant medications.

And so some discussion about the roles of medications, the roles of other treatments which pharmacists can provide also encourage people to think actively about treatment and then to actually take that information to the doctor to discuss the issues. So I think it's an issue of complementary roles.

COMPERE DOYLE: Can I just back up, though. One thing you said is often that they might - a patient might make an off-the-cuff comment to a pharmacist.

Are pharmacists trained to pick up on that off-the-cuff comment and then either point a person in the right direction or I mean that's something that could easily be missed?

IAN HICKEY: That's right, and one of the key issues here is the study being proposed by the pharmacists at Sydney University is about training pharmacists. It is about better training. It's recognising that if people make off-the-cuff comments, what they might mean; what they might be asking; and how to pick up and recognise that the person may have that condition.

Now I agree with Dr Glasson, it doesn't go as far as actually making a formal diagnosis or certainly starting medical treatments like anti-depressant drugs. But I think we have to be realistic. There is a real doctor shortage in country areas. That lack of services contributes to suicide rates in rural Australia, and is also a major problem with continuing treatments. People find it hard to go back to the doctor, get sufficient information, follow up about side effects.

So really I think we need to encourage this complementary role between doctors and other key health professionals like pharmacists.

COMPERE O'KEEFE: Yes, we'd like it to be complementary obviously but - oh yes, sorry Bill. What's that?

BILL GLASSON: Andrew, I would agree with Ian in the sense that it has to be complementary. And the issue is about people acting independent here. And I suppose independent practitioners, whether it be nurses, pharmacists or whatever, the GP has to be the cornerstone of the system is what we're saying. And that I'm all for educating pharmacists across the board full stop, but I suppose the issue comes about diagnosing and dispensing or prescribing a drug. And I think that's the difference here.

I think that the better educated the pharmacists are - they're often the first point of contact; they're the person that can actually indicate to the patient, yes, you should see the doctor about this problem. So we would support that wholeheartedly.

We don't support a system that fragments medicine, that fragments care and I suppose where the pharmacist acts independent of the psychiatrist or general practitioner concerned.

So we'd support education across the board full stop. We support education of the community. And as Ian said, one of the issues in relation to psychiatric services in rural areas, we do not have sufficient GPs or psychiatrists and therefore we're turning to a concept such as telemedicine where you actually have consultations through a video system with the GP and patient at one end in the rural area and the psychiatrist in the major city.

So we are trying to address this issue but the important thing, as I say is to keep in the context, the holistic context of treating the whole patient and not just treating the mental condition in isolation.

COMPERE O'KEEFE: Yes, that's interesting.

COMPERE DOYLE: Yes, absolutely, makes sense. Bill, thank you.

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