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The Pharmaceutical Journal Vol 265 No 7114 September 16, 2000
Pharmacy Practice Research
Papers presented at the British Pharmaceutical Conference, Birmingham, September 10 to 13, 2000 pR59

Pharmaceutical care provision across the health care interface: an evidence-based approach

By C. Bateson and C. Duggan*

Introduction Since the introduction of pharmaceutical care in the United States in 1990,1 there has been much debate around how this philosophy translates into practice. Until recently, studies have concentrated on the intervention delivered by pharmaceutical care, rather than its effects on patient outcomes.2,3
For the philosophy to be fully translated into practice, we need an evidence base to support the effect of pharmaceutical care. This approach has been successful in proving the benefit of providing information regarding medicines prescribed at discharge to community pharmacists.4
This study aims to take an evidence-based approach; to develop and test a model of pharmaceutical care effective across the health care interface and beneficial through defined patient outcomes. This abstract describes the initial stages of the study on how both current and ideal practice have been used to inform the development of the pharmaceutical care model.

Method Four methods were used to collect evidence:

  • content analysis of the hospital protocols and guidelines to provide a management perspective of the application of pharmaceutical care
  • observations of the pharmacists providing different levels of ward pharmacy to gain a practical insight
  • qualitative interviews with the pharmacists to explore perceptions of current practice and ideal models of care, involvement in guideline production and effects on professional esteem
  • a review of the literature to establish the theory and philosophy behind pharmaceutical care.

Focal points

  • Is pharmaceutical care a philosophy that can translate into practice in the UK?
  • The missing elements of the pharmaceutical care process are documentation and follow-up, both of which can be improved by the transfer of information across the health care interface, using pharmaceutical care plans
  • An evidence-based approach to developing a model of pharmaceutical care has highlighted this group of pharmacists' dissatisfaction with certain aspects of their current role
  • Empowering these pharmacists and involving them in the development of the pharmaceutical care model will test the theory that pharmacists themselves are the biggest barriers to pharmaceutical care provision.

Results Several themes emerged from the analysis of all four methods used. Conflicts between the professional and supply role were expressed and observed. Pharmacists felt frustrated and dissatisfied by the limitations of the supply role and time constraints on developing further expertise. The protocols and guideline at the trust aim to standardise practice and have an educational value. However, awareness of protocols appears to be limited to those relating directly to a specific practice area where they are used as guidelines. Pharmacists felt that their clinical role was not fully perceived by other health care professionals and that they lacked full involvement in decisions around patient care.
During the interviews, both a limited vision of ideal pharmaceutical care and a narrow understanding of the concept were expressed by the pharmacists, even at a mid-management level.

Discussion The emerging themes relate to the concepts of dissatisfaction and a lack of vision. The pharmacists were dissatisfied with their involvement in patient care but, at the same time, had no real vision of their ideal role, instead passively waited for change to come from senior management. Empowerment of these pharmacists, as autonomous professionals, may be the key to moving pharmaceutical care forward, while testing the theory that pharmacists themselves are the biggest barrier to professional development.
This study aims to empower both the hospital pharmacists by involving them in the development of the pharmaceutical care model and the community pharmacists by providing them with more information regarding drug therapy decisions made during the patient's hospital stay. The effect of this information transfer will be tested through a randomised controlled trial to improve pharmaceutical care provision and medicines management in the future.

Centre for practice and policy, School of Pharmacy, University of London, 29-39 Brunswick Square, London WC1N 1AX; *academic department of pharmacy, Barts and the London NHS trust, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE

References

1. Hepler C, Strand L. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm 1990;47:533-42.
2. Smythe M, Shah P, Spiteri T, Lucarotti R, Begle R. Pharmaceutical care in medical progressive patients. Ann Pharmacother 1998;32:294-9.
3. Summers R. Pharmaceutical care: a planned approach. Aust J Hosp Pharm 1996;26:37-9.
4. Duggan C, Bates I, Hough J, Feldman R. Reducing adverse prescribing discrepancies following discharge. Int J Pharm Pract 1998;6:77-82.