World Congress of Pharmacy

Dr NICOLA GRAY (research associate, School of Pharmacy, University of London, England) described the concept of the "expert patient", in which patients were given information to manage their conditions more effectively. Pharmacists had a key role to play in that education, but there was an argument for encouraging resulting "expert patients" to develop and use skills that would make them a "patient who was a professional". In short, patients could develop skills beyond self-management, which could then be used to help other patients. And it was important to distinguish between the "expert patient" and the "patient as a professional".
Moreover, there was an opportunity for pharmacists to develop partnerships with patients to enhance patient care. Illustrating her presentation with case studies, including the difficulties a patient could experience in trying to taking large single doses of lactulose (because of its sickly taste) or the side effects experienced following a dose of controlled release morphine, Dr Gray pointed out that health professionals could be poorly prepared for understanding and sharing these experiences. A study of the credibility of information providers about non-prescription medicines had provided some evidence for this in that the research revealed that professionals scored highly on trustworthiness and expertise, while family and friends scored highly on empathy and trustworthiness.
So, for "expert patients" to be able to give objective and meaningful information to other patients, required a development of that expertise such that other patients could see that the "expert patient" really was an "expert". Referring to the activities of the National Endometriosis Society (NES) in the UK, Dr Gray explained, again by way of illustration, how that organisation used its network of members to support other sufferers. One of the activities in which members got involved was the telephone helpline. The helpline was staffed by specially selected volunteers, all of whom had endo-metriosis and who were trained to work according to guidelines. Volunteers had to respect patient confidentiality, have the ability to listen and be non-judgmental, and to have patience and show empathy. The NES had recognised that volunteers needed to be able to move beyond their own experience, in that they had to be aware of the objective information and research associated with the condition concerned even if their own experience did not support it. So, this was an excellent illustration of the expert patient moving towards the patient as a professional, Dr Gray said.
In addition, the patient had an increasing role in the training of health professionals. An initiative had been developed at the School of Pharmacy in London in which undergraduate pharmacy students initially learnt about long-term conditions from patients rather than academic lecturers. Students met patients in hospital and at the university. In the hospital, students were taken round the wards where they interviewed patients about their conditions and they then went back to the university to research issues brought up in those conversations with the aim of compiling a case study, which they presented to their tutor for marking. It was now being planned for patients to visit the university where students could take a medication history and discuss the effects of therapy with them.

Nicola Gray: pharmacists and patients are natural partners

According to Ms SUZETE COSTA (National Association of Pharmacists, Lisbon, Portugal), one of the challenges for professional associations and pharmacists was to be on the frontline of the changes occurring in health care and the pharmacy setting and to sustain these changes by promoting the highest standards of practice behaviour.
Pharmacists were endorsing pharmaceutical care and shifting from a product-oriented towards a patient-oriented approach in care delivery, and this paradigm shift demanded a mix of skills and a broadening range of knowledge in areas such as health care systems, pharmacoeconomics, epidemiology, disease management and psychosocial subjects. It also meant working with other professionals in a shared care approach.
Potential partners for pharmacists in the "new world" were first and foremost patients. But the media came a close second, and pharmacy associations had to put communication with the media high on their agendas.
However, opinions expressed in the media about pharmacy reflected the care that individual journalists received in pharmacies, and if pharmacists wanted their national pharmacy associations to have a successful advocacy role with the general public, pharmacists also had to "do their bit".
The need to work with practice-based physicians and nurses was clear enough, but this involved more than attending educational and training events together.

Suzete Costa: professional partnerships, not professional isolation

Dr Melissa Murer (executive director, Pharmacy Technician Certification Board, Washington DC, United States) highlighted the importance of the pharmacy technician within the pharmacy setting. Several countries had found that appropriate use of a pharmacy technician's skills could enhance workflow in the pharmacy and free the pharmacist to take on a more clinical and patient-oriented role.
In the US, the Pharmacy Technician Certification Board (PTCB) had been established in 1995 and had since certified over 70,000 pharmacy technicians. Until recently, roles for technicians in the US had not been as clearly defined as in some other countries, but the increase in prescription volume and number of pharmacies, together with the advent of pharmaceutical care, was creating manpower challenges that had forced the US to look closely at the use of pharmacy technicians. But to get technicians to do more than "help out" required them to be properly trained, and this had led to the development of the technician certificate programme.
Despite earlier concerns, the growth in technology had not led to a dramatic reduction in the need for staff. No matter how effective the technology, people were still required to manage and check, and making maximum use of the current workforce's skills went hand in hand with advancing the use of technology. Technicians could have an increasing role in the distribution process and inventory management and, as in other countries, technicians could check each other. This helped to free the pharmacist from routine tasks to focus on patients.
Workflow patterns were also an area of interest in the US, and some pharmacies had redesigned their work areas to allow for staff to have specific responsibilities, designated work stations and segregated tasks. So, technicians entered customer and prescription information in the computer and filled the prescription, while the pharmacist screened the prescription and counselled the patient.

Melissa Murer: give technicians tasks and responsibilities