A return to basics

What model of care should pharmacists be striving to offer? There are so many strands to good practice, as Dr Terry Maguire eloquently describes in Broad Spectrum this week (p651) that it is easy to be confused by the options. He argues that the model of care should not be limited to pharmaceutical care, pharmaceutical care practice and concordance, but should also embrace health promotion.

Health promotion is fundamental to improving a patient's quality of life and should be part of any package of care on offer. The model that Dr Maguire advocates includes this as a dimension of “primary care health promotion practice”. He defines this model of care as the active and evidence-based promotion of health, patient empowerment and the facilitation of lifestyle changes to ensure maintenance of good health, prevention of illness and assurance of disease management.

Dr Maguire also argues that this definition should be at the core of all United Kingdom medicines management programmes. Far from confusing or restricting pharmacists to a particular model of care, it should be liberating: what should be used is what works best, so long as the key strands of lifestyle and medicine use are addressed.

Concordance is a key part of the mix. This is currently defined as a new approach to the prescribing and taking of medicines. Although reciprocal, concordance is an alliance in which health care professionals recognise the primacy of patients' decisions about taking the recommended medicines. It is an agreement reached after negotiation between a patient and a health care professional that respects the beliefs and wishes of the patient in determining whether, when and how medicines are to be taken.

Both primary care health promotion practice and concordance are desirable hooks to hang pharmacy practice around, but there is a danger that the more current practice is refined and defined, the further removed it becomes from the day-to-day experience of most practising pharmacists.

There is a case for a return to using more straightforward vocabulary and ideas to describe the activities and interactions of pharmacists and patients. The difficulty for pharmacists working in a busy hospital department or community pharmacy is having the time to explore what level of information patients need and want. But if the patient does not buy into the partnership from the first moment, there is no chance of the greater hopes for pharmacy practice being achieved.

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