Pharmaceutical care is a practice model that is gradually gaining acceptance on a world-wide basis. It has three components: critical assessment of a patient's medication, development of a care plan to achieve therapeutic goals and follow-up evaluation to see if those goals are being achieved. Government reimbursement is being developed in New Zealand and pharmaceutical care looks like being required in the United States for elderly people covered by federal insurance (see p885). There is progress in Europe, particularly in Spain (PJ, April 22, p627). Sadly, despite the fact that pharmaceutical care is being adopted in many countries, this is not the case in Britain. One of the reasons for this is that the body which sets professional standards, namely the Royal Pharmaceutical Society, has not up to now had pharmaceutical care on its agenda in any concerted way. Indeed, the Society was criticised by a speaker at a recent symposium in New Zealand recently for not driving pharmaceutical care hard enough (see p886). On the face of it, the criticism seems to us to be justified.
Britain is in danger of being left behind by the rest of the developed world in the practice of pharmacy. We are not saying that there is no activity here on the pharmaceutical care front. That is certainly not the case. For example, Aberdeen school of pharmacy has opened its pharmaceutical care centre and is teaching the practice to students (PJ, April 1, p515). Other schools of pharmacy are developing pharmaceutical care teaching. The Pharmaceutical Services Negotiating Committee has developed plans for a trial of medicines management, a form of pharmaceutical care (PJ, January 29, p187, and February 5, p200). The Community Pharmacy Research Consortium has adjusted its research agenda so that it might finance work in this area (PJ, April 15, p582). And the pharmacy postgraduate education bodies in England and Scotland, as we report this week (p868), are to hold a course to develop team leaders in pharmaceutical care.
All these are highly commendable and welcome developments and the Society has a hand in some of them. But, we would suggest that these initiatives are unlikely to be effective if the general environment in which pharmacy is practised stays as it is. The Society, above all bodies, must take the leading role in promoting the necessary change.
We would add by way of a postscript that we hope that the philosophical discussion on pharmaceutical care being led from the London School of Pharmacy (PJ, April 15, p603, and this week, p880) is aimed at strengthening the practice and not undermining it. Pharmaceutical care may have flaws in the eyes of a philosopher, but we would aver that any such flaws are as nothing compared with those in the present supply-orientated system of pharmaceutical service.
Pharmacists have much more to offer in ensuring that medicines are used to best effect. Practical experience with pharmaceutical care is showing that that is so.