Development of medicines management in community pharmacy
and how it is enshrined in Government policy
Opening his presentation on the medicines management
trial run by the Pharmaceutical Services Negotiating Committee, Allen
Tweedie, chairman of the pharmacy leadership committee on medicines management,
said that medicines management is now enshrined in Government policy and
it is time for pharmacists to move towards providing cognitive services.
The PSNC medicines management trial is one of the
two major initiatives in England, the other one being the national medicines
management services programme co-ordinated by the National Prescribing
Centre. The main difference between the two is that the PSNC scheme is
designed to deliver the service from community pharmacies, while the NPC-based
scheme will deliver services within the multidisciplinary context of primary
care organisations.
Both are essentially pilots, and Mr Tweedie explained
that the main part of the PSNC pilot will run from January to December
2002, with a pre-pilot in November this year. Evaluation will be ongoing
throughout the trial.
Three regions have been chosen for the pilots. Each
region has one research fellow and three local co-ordinators and the study
is being conducted in collaboration with three universities — Aberdeen,
Keele and Nottingham. Designed to have a study group and a control group
the pilot will involve 71 community pharmacies, 94 community pharmacists,
43 GP practices, 76 GPs and 3,000 patients.
The service itself includes four steps in a cyclical
process, starting with pharmacist review of the medication on the patient’s
prescription. This is followed by discussion between the patient and the
pharmacist, after which the pharmacist will make recommendations to the
GP if appropriate, then any changes will be implemented and reviewed.
Joint training for pharmacists and GPs will be provided before the start
of the study and this will include communication skills, cardiovascular
case studies, instruction on measurement of outcomes and documentation
of the intervention.
London project
A medicines management project based in Barking
and Havering was described by Hemant Patel, a member of the Royal Pharmaceutical
Society’s Council and secretary of Barking and Havering Local Pharmaceutical
Committee. Like the PSNC trial, this project is based in community pharmacy.
Mr Patel said he believed that community pharmacy has a number of advantages
over other primary care settings in terms of ease of access, a network
that is familiar to the public and the fact that 80 per cent of people
use the same pharmacy. Issues of privacy and confidentiality need to be
addressed, he said, but more consultation areas will undoubtedly be created
in the future.
Medicines management services should be informal,
he said, and community pharmacists are good at talking to patients using
simple language. Moreover, community pharmacies keep patient medication
records which show what has been dispensed, not what was prescribed, and
there is some evidence that patients are more open with pharmacists than
GPs in relation to issues of non-compliance.
The aim of the Barking and Havering project is to
investigate the impact of community pharmacist review of patients on four
or more medicines. Medicines covered in the scheme include those for cardiovascular
disease, diabetes, asthma, as well as proton pump inhibitors and non-steroidal
anti-inflammatory drugs. The two-year scheme is looking to recruit 5,000
patients by the end of the second year and to identify 1.5 clinical issues
per patient, half of which should be resolved. A further target is a 20
per cent reduction in prescribing costs of the medicines involved and
enhanced control of chronic disease.
The original intention is to recruit and retain
50 per cent of community pharmacists in two health authority areas. Already,
however, recruitment is nearing 100 per cent and there is a waiting list,
Mr Patel said. The project, which is planned to run as a randomised controlled
trial, will be starting soon, and a training programme is due to start
this month. Results will be evaluated on an ongoing basis with the expectation
of being able to publish them in two years’ time.
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