If there was one conclusion reached at the second international symposium on pharmaceutical care, held in Melbourne recently (see p626), it was that pharmacists cannot make progress with this type of practice model by themselves. Speaker after speaker emphasised the importance of developing the concept with the knowledge of and with the agreement of the medical profession. One said that it was crucial for pharmacists to work in partnership with physicians. Another advocated face-to-face meetings with general practitioners as a means of developing that partnership.
It was all the more distressing, then, for the only doctor who spoke at the symposium to profess that he had never heard of pharmaceutical care. None of the pharmacists he worked with had told him about it or whether they were providing it. Clearly, there is much still to be done to promote the kind of relationships that will allow this new service to flourish.
But it is not just a matter of working with the medical profession. The symposium heard that pharmacists needed to work with each other if the concept was to take off. Assessing the pharmaceutical needs of patients, developing a care plan and following that plan through to fruition is intellectually challenging and practitioners of pharmaceutical care need the support and guidance of their peers. One speaker referred to practitioners as "warm coals" who needed to be with other like minded colleagues in order for the fire to stay alight. But co-operation among pharmacists was necessary for another reason as well. As a second speaker at the symposium said, the profession needed to build capacity for pharmaceutical care otherwise it would be ignored. Payers would not bother to work out payment systems if practitioners providing the service were few and far between.
Sadly, there were few signs evident at the symposium that the necessary critical mass is being developed. Pharmaceutical care is being practised in a number of localities in America, Australasia and Europe, but there is no widespread adoption of the practice. Australia and New Zealand seem to have taken the matter further than anywhere, but, generally speaking, it is still only being pursued by enthusiasts in a small number of places.
One of the reasons for the slow uptake could be that there is no consistent message being presented to governments, the public and health practitioners about what pharmaceutical care is and how it can improve drug therapy. There is not even a consistency in relation to nomenclature. "Pharmaceutical care" is used interchangeably with "medicines management" in some locations and has been replaced by it in others. It is also used to describe almost anything that a pharmacist might do. If pharmaceutical care is to be promoted it has to be described and explained in a way that will be readily understood beyond the confines of the profession. Until that happens, developments in this important area will continue to be sporadic.