Problems in reaching international understanding on what exactly is meant by pharmaceutical care were emphasised during an update presentation on pharmaceutical care given on September 9 to introduce an FIP community pharmacy section continuing professional development session.
Describing the FIP community pharmacy section’s programme on pharmaceutical care over the past six years, Professor DICK TROMP (professor in pharmacy practice, University of Groningen, the Netherlands) said that what was obvious was that pharmaceutical care was not static but developed in different countries in different ways, depending on the health care system as a whole and the pharmacy culture. |
Dick Tromp: pharmaceutical care depends on the health care system and the pharmacy culture |
Developing the theme further, Mr FOPPE VAN MIL (lecturer at Groningen university and community pharmacist) highlighted the fact that in the US, where the concept had first been developed, pharmaceutical care had been redefined several times. The most recent definition (from Professor Linda Strand, Minnesota) was "a practice for which the practitioner takes responsibility for a patient’s drug therapy needs and is held accountable for this commitment”. The Dutch definition, developed in 1998, was "the care of the pharmacy team for the individual patient in the field of pharmacotherapy, aimed at improving the quality of life.” |
Foppe van Mil: Confusion still reigns about the definition of pharmaceutical care |
The activities in a pharmacy could be described in terms of a pyramid. At the base were the activities common to pharmacists everywhere in the world — in other words making sure that the patient received the right drug at the right moment, which involved buying good quality drugs and dispensing accurately. Higher up the pyramid was clinical pharmacy. Largely a disease oriented activity, involving for example, looking for drug interactions and adverse drug reactions, clinical pharmacy was something that some — but not all — pharmacists did. Pharmaceutical care, the pinnacle of the pyramid, represented the added value to the dispensing process and direct application of clinical pharmacy to patients. Indeed, without clinical pharmacy, there could be no pharmaceutical care.
So, what was pharmaceutical care? Was it care around pharmaceuticals, which anyone, including a nurse, doctor or pharmacist, could do? Or was it the care of the pharmacist around the patient? It was vital that this latter description was the one that was used, Mr van Mil emphasised. Unpacking this description, he said that pharmaceutical care was " a way for pharmacists to deal with patients and their medication — a concept that deals with the way people should receive and use medication and should receive instructions on the use of medicines. Implicit in this description was the professional responsibility of the pharmacist, medication surveillance, counselling and outcomes of care.
Confusion still reigned among pharmacists about pharmaceutical care. For example, a 1998 survey of 30 countries had shown that only six used Strand’s classic definition and 12 used significantly different definitions. These differences had several origins, not least linguistic difficulties. For example, the English word "care” meant emotional and personal care combined with professional qualities. In France and Germany, however, "care” had a much more emotional connotation. And the Scandinavians had such difficulty with translating the word that they used the English. International differences in pharmacy practice also led to differences in perceptions of pharmaceutical care. For example pharmacists in some countries (eg, the UK and the Netherlands) worked with doctors whereas this happened less frequently in others such as France and Spain.
Another factor to consider, according to Professor TROMP, was the fact that some countries (eg, France, Italy and Spain) had a monopoly situation with pharmacies being the only outlet for medicines whereas other countries (eg, the UK, the US, Australia, Canada, Germany, Japan and the Netherlands) did not. Moreover, pharmacy size and type varied considerably between countries, with pharmacies in Northern Europe being much larger, employing more staff and serving larger populations than those, for example in the UK and Spain. Opportunities for providing pharmaceutical care — particularly in terms of time and space in the pharmacy — varied between countries, although such factors could be used by pharmacists as an excuse to do nothing.
Although the international understanding of pharmaceutical care was that it was "the professional care for the individual patient in a pharmacy” and all definitions therefore had the same intent, it was not necessarily appropriate to copy what was being done in other countries. Of course, it remained important to learn from other situations and adopt the good ideas, but these ideas still needed to be adapted to each individual country’s health care system, Professor Tromp concluded.