Forum

Society of Hospital pharmacists of Australia

Practical clinical concepts

The biennial clinical conference of the Society of Hospital Pharmacists of Australia was held on the Gold Coast, Queensland, from October 20 to 22, 2000. Its theme was “Practical clinical concepts”. The conference looked at the changing focus of contemporary clinical pharmacy. A short report follows

The first plenary session examined the role of clinical pharmacists in the treatment of hypertension and hyperlipidaemia. Professor Tom MacDonald, of the University of Dundee, Scotland, looked at the use of aldosterone antagonists and examined the incidence of primary aldosteronism as the underlying aetiology of many patients' hypertension. Professor MacDonald, who is director of both the hypertension research centre and of the MEMO department of clinical pharmacology at Dundee university, suggested that as many as 15 per cent of hypertensive patients had aldosteronism as the primary cause. This had a profound influence on prescribing for these patients with spironolactone having a potentially important role, even though it was not licensed in the UK for the treatment of essential hypertension.

Dr David McNaughton (research pharmacist, University of Dundee, and director of the Abertay Pain Management Research Centre) examined the role of the clinical pharmacist in hypertension and hyperlipidaemic clinics. He focussed particularly on the practical aspects. The roles of both the pharmacist and the physician were defined and a particular emphasis was placed on the clinical pharmacist appraising individual patients' drug regimens. Other key issues for the pharmacist included review of all the patients' medicines (including over-the-counter medicines), concordance and compliance issues, understanding of the medicines from the patients' view, adverse event monitoring, and the production of an individualised pharmaceutical care plan for particular patients.

Boundaries

The second plenary session was entitled “Moving the boundaries” and the speakers examined the role of clinical pharmacists in primary care.

Dr McNaughton explained how the role of pharmacists as advisers to general medical practitioners had developed in the UK. He used examples from the early days of fund-holding in the UK to the present primary care pharmacist posts to show how the initial emphasis on cost-cutting in prescribing had been developed into a qualitative approach to prescribing. Although the clinical pharmacist's role in primary care was crucial in developing both evidence-based and cost-effective prescribing, Dr McNaughton explained that clinical skills alone were of little use without a thorough understanding of the primary care environment and an appreciation of the communication skills needed.

Dr Lynn Weeks (chief executive, National Prescribing Service, Australia) followed Dr McNaughton in emphasising that an amalgam of good clinical skills and communication skills was needed to support quality prescribing in primary care. The National Prescribing Service has been running national and local programmes with a strong emphasis on general practice. Clinical pharmacists' knowledge was proving vital in both clinical audit and medication review activities. Dr Weeks expressed concern about the shortage of suitably qualified individuals.

Mr Grant Kardachi (a community pharmacist who has been working to develop professional services away from the traditional supply function) outlined the role of a clinical pharmacist mentoring project where a hospital clinical pharmacist worked as a mentor to support the community pharmacists' clinical role. The function of the mentor was supportive and to act as a knowledge source. With the shortage of clinical pharmacists in primary care, the role of mentor and teacher might be one to develop and might allow community pharmacists to provide extended clinical services.
— Contributed.