Introduction The need for patient information at the climacteric is well documented1. The concordance model2 places emphasis on considering the patient's health beliefs during a consultation. This makes it mandatory to provide evidence based information to enable an informed patient decision for ongoing management. It was envisaged that patients attending the menopause clinic at a London district general hospital would appreciate having information provided by the specialist pharmacist on the menopause, hormone replacement therapy (HRT) and associated issues. Over two years, patients in the waiting room were offered pharmacist led discussion sessions. This paper reports on a study assessing patient acceptance and satisfaction with the service.
Method With ethics committee approval, a randomly selected sample of patients (160) attending the clinic between September and November, 1997, were mailed a questionnaire originating from the hospital audit department but designed by the menopause team. The patients were divided into two groups: Group 1 patients (80) had seen the specialist pharmacist; Group 2 patients (80) attended the clinic during the study period, but had not spoken with the pharmacist. Group 2 patients were asked for their views about the service were it to be offered to them.
Results With a 70 per cent (112) response, 80 per cent of the patients rated the care received as "good to excellent". Ten per cent more patients in Group 1 rated their care as excellent. Patients wanted to discuss osteoporosis (78 per cent), "diet and calcium intake" (70 per cent), and side effects with HRT preparations (70 per cent). Around 50 per cent wanted other relevant issues addressed. Interestingly, 43 per cent did not want to discuss contraception or smoking.
Group 1 (52, analysable): Two thirds of the patients saw the specialist pharmacist once, with half spending five to 15 minutes with her. Thirty-five per cent patients returned to speak with the pharmacist after their appointment. Fifty per cent indicated a preference for seeing the pharmacist, either before their appointment, after or both. Nearly 50 per cent patients asked about HRT preparations; 40 per cent stated that HRT side effects and osteoporosis protection were discussed. Ninety-six per cent indicated that they found the specialist pharmacist knowledgeable, approachable, caring and available; 87 per cent found the discussion relevant to their needs.
Group 2 (51, analysable): Ten per cent said they were still unclear after having spoken to the doctor and would have liked to have spoken with the pharmacist, with 14 per cent stating there were some questions they forgot to ask. Twenty-four per cent indicated they "did not know what a specialist pharmacist does."
Finally, far more patients in Group 1 reported having had a discussion with their community pharmacist about the menopause and HRT, than in Group 2.
Discussion It was important to establish whether these patients would discuss menopausal issues with the specialist pharmacist. Patients were told they were speaking to a pharmacist, and assured that they did not have to discuss any problem with her if they did not wish to do so. Discussion took place in the waiting room or in a private consultation room located nearby. This ensured minimum disruption to normal clinic running, as they did not miss their appointment with the doctor or clinical nurse specialist when called. Around one in 10 patients refused a discussion session; usually as they felt well and any "worries" had been previously addressed. Accepting that menopausal patients appreciate a "chat" with anyone presenting sympathetically to them, it is important to appreciate the level of evidence based information that these patients requested or were provided with when discussion took place. A high percentage of patients stated they were unsure of what a specialist pharmacist's role was. Patients need to be informed of the establishment of the pharmacist service so they can take advantage of an additional health professional resource for information and advice. For the menopausal patient a holistic management approach is advocated3 with medication management as one important component. Within this secondary care clinic setting, with professional liaison it is geographically possible for the specialist pharmacist to implement a high standard of pharmaceutical care for patients. Additionally patients utilising the specialist pharmacist service may begin to perceive the community pharmacist as a source of evidence based information regarding menopausal issues.
Conclusion The specialist pharmacist has been accepted by patients attending the menopause clinic. At least a quarter of Group 2 respondents believed they would have benefited from a discussion with the pharmacist. Patients need to be better informed about the service. Benefits observed by patients should enhance the profile of community pharmacists.
*Menopause clinical and research unit, Northwick Park and St Marks NHS trust, Harrow; +pharmacy practice group, King's College, London; **now pharmacy school, University of Nottingham