As a consultant and GP pharmacist, Brooke Shelly MPS, based in the regional Victorian town of Mildura, offers a holistic healthcare service to patients.

‘I love the time I can afford patients as a consultant pharmacist, [however], the wrap-around care I can deliver by also solving problems collaboratively in GP practice is what I love most about my dual role,’ she said.

This is how Ms Shelly approaches care for Jakob Richards – a 22-year-old non-verbal patient with cerebral palsy and quadriplegic spasticity.

Jakob was initially referred to Ms Shelly for a Home Medicines Review (HMR) after he was discharged from the Young Adult Complex Service in Melbourne to a local GP.

Having only minor involvement throughout the years in Jakob’s care, the GP was at a loss about how to address his polypharmacy.

According to Jakob’s mother Tae Richards, Jakob is on 13 medicines, with some prescribed for over 20 years. This includes chloral hydrate – which sets the family back a significant amount in expenses.

‘We spend $150 a month just on medications alone,’ she said. ‘As time has gone on, my husband and I were thinking that something isn’t working. ‘He’s on a muscle relaxant [but] he’s still as stiff as a board, he’s on sleeping medicines and he doesn’t sleep.’

The impact of optimising medicines and shared care

With complex medical cases like Jakob’s, medical teams may place higher significance on other pieces of the puzzle, said Ms Shelly.

However, starting from the ground up by identifying issues such as constipation and sleep can be life changing for patients living with disabilities.

As a consultant pharmacist and GP pharmacist, Ms Shelly was able to complete the HMR process and start a shared care model, allowing her to sit in on each of Jakob’s GP appointments to work through problems as they arose.

‘I was able to formulate a plan with the patient’s GP that has seen the reduction in the use of expensive and complex drugs,’ she said.

As Jakob is weaned off chloral hydrate and melatonin is slowly introduced, having Brooke on hand for ongoing care has made life significantly easier for the Richards family, who often wait up to 6 weeks for a script renewal as Mildura battles an ongoing GP access crisis.

‘I didn’t know how much I could [increase melatonin], and how quickly I had to decrease chloral hydrate, so I was able to ask Brooke who said “you have to decrease it extremely slowly”,’ said Ms Richards.

The impact so far has been profound. ‘For the first time in 22 years, we’re having better sleep,’ she said. ‘We’re a single income family, so Brooke has also been able to make sure it’s cost effective for us.’

More can be done

While Ms Richards was ‘mind blown’ that the government provides funding for pharmacists to perform in-depth services such as HMR’s, she was equally surprised that such an essential service could not be accessed on an ongoing basis through the National Disability Insurance Scheme funding model.

To provide the best possible care to patients like Jakob, pharmacists should be able to work to top of scope, including allowing GP pharmacists to collaboratively prescribe, Ms Shelly believes.

‘When Jakob is stable, it’s a much better use of my time and skills to continue or alter therapy as per the goals the GP, patient and I have set, and refer back to the prescriber when health circumstances change or if there is a need for diagnostic expertise,’ she said.

Providing funding for pharmacy services would also take the pressure off GPs, said Ms Richards.

‘Waitlists would decrease because you’d be able to get an appointment with the likes of Brooke for a simple script,’ she said. ‘That would free up GP’s appointment times for other things.’

Looking forward, Ms Richards plans to continue working with Brooke to optimise Jakob’s medicines.

‘It will be a slow process, but I’m happy to take the time to do what we need to do,’ she said.