Pharmaceutical care is a philosophy of practice that is increasingly being
accepted both in the United Kingdom and throughout the rest of the world. Unlike
dispensing, where the pharmacist’s responsibility may be limited to a single
encounter with a patient in the pharmacy, pharmaceutical care involves the pharmacist
in a much wider and ongoing responsibility for all the patient’s drug related
needs, including the outcomes of medication. Such a responsibility cannot be
taken on lightly, and, not surprisingly, one of the biggest barriers to providing
pharmaceutical care is pharmacists thinking that they cannot do it.
However, the paper by Krska et al in this issue of The Journal (p656)
provides encouraging new evidence that pharmacists can deliver pharmaceutical
care. In their study, which involved 332 patients aged 65 years or over from
six general medical practices in Grampian, the researchers demonstrated that
two clinically trained pharmacists could identify problems with drug therapy
and, in collaboration with the patient and the GP, help to resolve these problems.
An average of 7.7 medication related problems —– or pharmaceutical
care issues — were identified for each patient, showing that pharmaceutical
care is not only possible, but also necessary.
Moreover, problems related to drug therapy — the main drivers for pharmaceutical
care — are recognised in the Government’s recently released strategy
for pharmacy in England, which includes a commitment to helping patients get
the best from their medicines through medication review and other kinds of pharmaceutical
care.
Although patients in Krska’s study were visited at home by pharmacists
working in general medical practices, such an approach, as the authors point
out, should also be possible for community pharmacists working with patients
in the pharmacy. Indeed, the long-term relationships that community pharmacists
already have with many patients should actually help pharmaceutical care, which
cannot get off the ground without an individual relationship between pharmacist
and patient.
Several barriers to pharmaceutical care still exist. Not least of them is a
lack of remuneration, but payment will be unlikely to be forthcoming without
evidence of benefit. This study has provided much needed fresh evidence on the
value of pharmaceutical care and also that pharmacists can successfully deliver
it.