Pioneer of pharmaceutical care rounds off special year
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Douglas Hepler: medicines management
and pharmaceutical care should be part of all practice
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A year-long programme of celebratory events to mark
the 150th anniversary of the Royal Pharmaceutical Society's presence in
Scotland came to an end on 18 December when Professor C. Douglas Hepler,
one of the pioneers of the concept of pharmaceutical care, gave the Scottish
Sesquicentenary Lecture at the Society's house in Edinburgh.
Professor Hepler is distinguished professor in the
Department of Pharmacy Health Care Administration and director of the
DuBow Family Centre for Research in Pharmaceutical Care at the University
of Florida. He is also a visiting professor at the School of Pharmaceutical
Sciences, University of Manchester.
Speaking on his third visit to Scotland (and also
on his birthday), Professor Hepler began by revealing that, although he
was a New Englander, his mother was Scots, and so he felt a special affinity
for the country.
In an address on "Reflections on the road to medicines
management systems", Professor Hepler explained that the terms "medicines
management" and "pharmaceutical care" were often used interchangeably
but in his view the latter was only a part — albeit an important part
— of the former. Both should be part of all practice, and not just for
pharmacists with time to spare or with a special interest.
Neither medicines management nor pharmaceutical
care was currently considered to be the de facto standard of pharmaceutical
health care delivery, even though several recent papers had shown that
many patients had enjoyed substantial benefits from their application.
Professor Hepler said that drug-related morbidity
was a substantial problem. In 1996 it had accounted for about five in
every 1,000 hospital admissions — second only to cancer. Causes included
prescribing errors, drug delivery (dose errors, dispensing errors, non-compliance)
and lack of follow-up procedures. Follow-up constituted by far the biggest
problem in community practice while prescribing errors were the most significant
in the hospital environment. The solution was a team approach with co-operation
between all health professionals, because medicines management was not
the sole responsibility of the pharmacist.
Professor Hepler said there were many obstacles
to the initiation of pharmaceutical care, not the least being a recognition
of the need for change. He then outlined work being carried out in a number
of centres to develop performance indicators that could serve as basic
tools to monitor progress in medicines management systems.
He concluded his address in a philosophical mood,
using the ideas of faith, hope, charity, honesty and courage to justify
his commitment to medicines management.
The lecture was sponsored by Merck Sharp & Dohme.
Professor Hepler told The Journal that his
widely reported ideas on pharmaceutical care had emerged during preparations
for a keynote lecture at a conference organised by the Association of
American Colleges of Pharmacy in 1989. His talk had represented a strategic
vision of the work being carried out with his colleague Linda Strand.
The talk had seemed to catch colleagues' imagination and it was published
in the American Journal of Pharmacy Education later the same year.
He had subsequently spoken on pharmaceutical care
in over 20 countries. In Europe, Denmark had been the first country to
take on the concept, but Scotland was catching up fast. And he was particularly
impressed by progress in New Zealand.
Special year
Professor Hepler was introduced to the meeting by
the chairman of the Society's Scottish Executive, Alison Strath, who said
that 2001 had been a special year for pharmacy in Scotland. Celebrations
had included a dinner at the palace of Holyroodhouse, a reception for
Members of the Scottish Parliament, a magnificent banquet at Stirling
Castle and finally a lecture on a subject that was already proving to
be of great significance to Scottish pharmacists. With the setting up
of model pharmacy schemes and the imminent publication of the pharmaceutical
care strategy by the Scottish Government.
Ms Strath said that the newly published Audit Commission
report for England and Wales (see p873) stated that 12,000 deaths occurred
annually. Pharmacists had an opportunity and responsibility to contribute
to reducing this figure.
— From our Scottish Correspondent.
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