Everyone who entered the Pharmaceutical Care Awards should be considered to be a winner and not only those who had been recognised with prizes, Professor Douglas Hepler (Department of Pharmacy Health Care Administration, University of Florida) said. Congratulations needed to go to everyone who had submitted an entry.
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Douglas Hepler: a great deal of dedication |
During a visit last summer, two main impressions had stood out for Professor Hepler. The first had been the quality of pharmacy practice research at Manchester university. The second, and the more important one, so far as the care awards were concerned, was the tremendous potential opportunity for community pharmacy that was developing in the United Kingdom.
"I think that the opportunity for community pharmacy advancement in the UK is higher than it is in the US by far and is as high as I have found in any of my travels," Professor Hepler said.
He said that most general medical practitioners saw drug therapy as a key component of clinical governance. There was an emerging international recognition that bad outcomes occurred because of inadequate and unsafe systems for medicines use.
"We have evidence that medication use systems are inadequate and unsafe in the US, Canada, Denmark, the UK, Germany, Switzerland and France," Professor Hepler said. Medicines had been judged to be safe and effective in controlled clinical trials; that was how they got licensed in most of the industrialised world. There were occasional epidemiological accidents, but most people needed to recognise that what happened to good medicines that no longer looked good after they had been in use for some time was that the systems they were put into were not able to support their use.
Clozapine, an essential medicine for the management of schizophrenia proved the point. The US Food and Drug Administration had not wanted to approve clozapine because it was not convinced that necessary weekly white blood cell counts would be reliably carried out. That was a terrible indictment and indicated that the problem lay with how medicines were used by clinicians, pharmacists and patients.
To show that systems were defective, Professor Hepler said that preventable drug morbidity in the US was ahead of diabetes, asthma, myocardial infarction, and on a par with neoplastic disease. US data for 1996 indicated that the cost of correcting preventable drug-related morbidity was $70 for each consultation between a patient and a doctor. Even if the cost was half that, countries were carrying burdens that they could not bear.
Considering how it was that this matter had yet to be addressed, he suggested that the cost was so great that people could not accept that it applied to their own practice.
"That is certainly true of most pharmacists," he said. "When I give these numbers to pharmacists, they say ‘those are certainly not my patients, I would know if my patients were being injured by medicines in that way'. The fact is that we have done research which shows that they do not know and that often pharmacists do not know because they do not ask."
Professor Hepler said that the emphasis on clinical governance, and on using medicines in clinical governance, meant that the likelihood of somebody realising that community pharmacists were a necessity to the management of medicines was high. The worry was no longer whether it would be realised how important community pharmacists were, but whether they would be ready when the call came.
It was essential that pharmacists responded with new ideas. There was evidence that what pharmacists did changed outcomes.