Clinical Pharmacy News summary

New ways for pharmacists to help patients manage their medicines

Developments in concordance are the focus of the June 2001 issue of the International Journal of Pharmacy Practice. Health care professionals seem broadly positive towards concordance but there is a significant minority who are not. In particular, pharmacists have the least favourable attitudes, according to Professor Theo Raynor, division of academic pharmacy practice, University of Leeds, and colleagues.

In a questionnaire-based study of 81 newly qualified pharmacists, doctors and nurses, 25 per cent of respondents disagreed or strongly disagreed with the concordance concept, and pharmacists had the least positive attitude. The researchers comment that if this finding is replicated in other samples of health care providers, it would suggest that a significant number still adhere to the orthodox paternalistic approach.

“If concordance is to be adopted, changes in education and training are needed,” they conclude (International Journal of Pharmacy Practice, June 2001, p81).

Meanwhile, “a major gap” in the health care system for helping individuals to manage long-term medication regimens effectively was identified by Dr Betty Chewning, director, Sonderegger Research Centre, School of Pharmacy, University of Wisconsin, United States, and colleagues.

The researchers examined medication management and self-care roles in 689 patients with osteoarthritis or rheumatoid arthritis. Overall, as the number of drugs in a regimen increased, there was a trend for more patients to consider changing or deciding to change the regimen themselves without seeking advice. About 50 per cent of patients were taking eight or more medicines.

Of 603 patients, 22 per cent were using non-steroidal anti-inflammatory drugs or H₂ antagonists purchased over the counter. Of these patients, 61 per cent had made the decision to use the medicines without advice. Only 2 per cent of respondents consulted pharmacists in self-care decisions, despite the fact that pharmacies sell many of the most commonly used self-care products. “Pharmacist education of patients about monitoring drug benefits and side effects could be extremely useful,” the authors conclude. A further 33 per cent of the patients consulted physicians about using self-care products.

The authors further conclude that patients could improve their quality of life even more if a health professional acted as an ongoing consultant for their entire regimen. They add that, to move the concordance agenda forward, gaps in health care systems need to be identified and reforms proposed to help patients manage long-term conditions with as much dignity and control as possible (ibid, p71).

Positive for pharmacists

Patients like being visited at home by a pharmacist, a study conducted by David Coleman, community pharmacist and research associate, department of pharmacy and biomedical science, University of Portsmouth, and colleagues have found.

Domiciliary visits to 100 patients were carried out by a pharmacist. Of these, 14 patients were assessed as confused and were managing their medicines poorly. Strategies such as the use of unit dose management systems were subsequently introduced by the pharmacist. Serious risk of adverse drug reactions were identified in 11 patients and hoarding of medicines in eight.

Of 76 responses after the visits, 50 patients said they felt more confident about using their medicines and 70 thought that talking to a pharmacist about their medicines (as opposed to another health professional) was important or of great importance (ibid, p127).

Abstracts for the IJPP are available on The Journal’s website.

Other articles in the IJPP

• Concordance: what is the relevance for pharmacists? (F. Stevenson)
• Pharmacy students have more positive perceptions of medicines than students of other disciplines (R. Horne, et al)
• Medication compliance devices in primary care: activities of community-based nurses (D. Stewart, et al)
• Pharmacist medication history interview of elderly patients in a teaching hospital in Nigeria (O. Babalola and W. Erhun)
• Understanding lay explanatory models of illness is a prerequisite for concordant consultations (K. Pollock)
• The training experience of primary care pharmacists (J. Jesson, et al)

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