Three service profile sessions looked at clinical services provided by pharmacists throughout Europe.
In the first session, Dr Franca Goffredo (director of pharmacy, Institute for Cancer Care, Turin) warned that the clinical activities of pharmacists were often neglected due to lack of staff and lack of time. She advised that it was important to evaluate a ward's needs and the resources of the pharmacy and to consider automated systems to manage routine procedures.
Dr Goffredo described a computer program which had been developed to provide cancer patient profiles and individualised patient information. The program had been used to generate a database of information on the types of patients treated, the drug protocols used, costs and consumption of drugs as well as a record of data on drug stability, compatibility and the most appropriate anti-emetic therapies. Dr Goffredo described how a drug administration schedule could be prepared for each patient by associating the protocol with the patient's personal data. The program had been distributed to members of the Italian Society of Hospital Pharmacists, she said. This allowed data from other Italian hospitals to be compared in order to optimise the quality of care given. Dr Goffredo concluded that the program was a valid instrument, helping pharmacists reduce routine work and devote more time to clinical activity.
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Franca Goffredo: consider automated systems
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Omission of therapeutic monitoring for certain drugs was considered by some to be unethical and even negligent, advised Dr Manuel Alos-Alminana (director of pharmacy, General Hospital of Castillon, Valencia, Spain). Pharmacokinetic and pharmacodynamic studies had become increasingly important for improving drug delivery strategies and the outcome of cancer chemotherapy, he said. Dr Alos-Alminana described the use of pharmacokinetic principles to individualise cancer chemotherapy and to identify patients at risk from toxicity due to chemotherapeutic agents.
A pharmaceutical care programme for patients with AIDS taking antiretroviral triple therapy was described by Mrs Belen Montanes (resident pharmacist, General Hospital of Castillon, Valencia, Spain). Since 1996, the pharmacy service had been involved in a programme designed to counsel patients with AIDS about their medication.
At the first interview, the patient's own knowledge about their medication was evaluated, with concern focused on the dose and administration of drugs, the goal of the treatment and side effects. The patient was also advised of the result of non-compliance, said Mrs Montanes. At subsequent interviews, adherence to therapy was checked and new laboratory data were added to the patient's record.
In a study to evaluate the effect of the care programme on compliance, Mrs Montanes said that, out of the 60 patients included, good compliance was achieved in 78 per cent of patients compared with 57 per cent prior to the pharmaceutical care programme. Mrs Montanes added that no difference in the CD4 count was observed during the study but that the viral load had had a tendency to drop over the same period.
Commenting on the care programme, Dr Foppe van Mil (community pharmacist, Zuidlaren, The Netherlands) advised the audience that there were computer programs available from the manufacturers of newer antiretroviral agents that generated dosing schedules for the triple therapy regimes. These programmes were updated every three months for the newest commercially available drugs and took into account interactions with other drugs and food, meal and bed times and could greatly assist patients with their adherence to complex regimes.
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Foppe van Mil (left) addresses the meeting as Manual Alos-Alminana looks on
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