Professor Dick Tromp (the Netherlands) outlined the history leading to his
team’s project, which was intended to prepare a cadre of practitioner researchers
who could address policy issues of importance to pharmacists and health care
decision makers world-wide. He told the audience that the FIP had asked the
project group about the real contribution of pharmacy to health care today and
about areas that needed to be developed in future to stimulate best practice.
Their task was to provide a model which could prove the added value of pharmacy.
The project group had met during FIP congresses in 1998, 1999 and 2000 to work
on this. The working group consisted of, among others, six core members, four
observers and three researchers. The support group consisted of eight members
with help from around 23 people in seven countries.
Professor Tromp emphasised they were trying to provide a model of best practice.
There were differences in practice, semantics and what was regarded as added
value globally. They had experienced difficulties in moving the project between
countries and in implementing national protocols due to these practice variations.
These cultural variations had to be taken into account and he emphasised that
remuneration for services was sometimes not enough incentive to ensure best
practice.
Mr Mark Mobach (the Netherlands) stated that “the value of the profession
of community based pharmacy is in adding value” but then posed the question
“adding value to what?” He took a systems approach that focused on
the properties of the pharmacy system and to what extent these added value.
The expected project outcomes would be separated into community and hospital
pharmacy practice. The project group hoped to develop a model of both practice
areas applicable world-wide to assess the value added. These could then be used
for targeted practice research. He outlined their achievements to date and described
their model of community pharmacy. This was separated into four activity domains
— product, care, service and impact. These were further broken down into
numerous subdomains and then into levels: level one implied no value added and
level four reflected best practice.
Results
Dr Foppe Van Mil (the Netherlands) reported the project group had had disappointing
results so far in trying to link a specific activity to a significant outcome.
They had piloted 23 community pharmacy model questionnaires between June and
August, 2000, with universities, professional organisations and community pharmacists
in nine different countries. The whole work of assessing pharmacy practice in
different countries was very difficult. Defining the best level of an activity
had proved to be problematic. The language used in the questionnaire required
redefining, eg, what was meant by dispensing, counselling, professional judgment,
ethics, etc. The answers they received had also depended on the political intent
of the people they asked. Their problem now was “who are the right people
to ask to receive the real information?”
Outlining future work, Professor Tromp informed the audience that the model
would be validated by December, 2000, with the first report at the Singapore
congress in 2001. The pilot hospital results would also be presented in Singapore
with the final integrated report at the Nice congress in 2002. However, the
group required recommendations as to “how to move to best practice”.
There was a lack of research relating to whether pharmacists’ interventions
improved outcomes. The group still needed to assess the effect of remuneration
of the uptake of services and the pharmacist’s performance. Professor Tromp
stated that the project was a valuable, inspiring one, but it required support
with data collection and analysis. He hoped the FIP would continue to support
the project in the future.