The Pharmaceutical Journal
Vol 269 No 7216 p406-407
21 September 2002

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International Social Pharmacy workshop

The challenges of shaping pharmacy practice in the future

The conference started with JOHN BRONGER, national president of the Pharmacy Guild of Australia, outlining the main factors driving changes in pharmacy practice in Australia. He described these as budgetary pressures, consumers' increasing awareness of health and medication issues and the pharmacy profession itself embracing new areas of professional practice that other health professionals have failed to deliver. This recognition has resulted in three five-year pharmacy/government agreements which reinforce the role of pharmacy in the health care of the nation and help to deliver the government's national medicines policy. The guild is currently preparing to negotiate for the fourth five-year agreement and hoping that it may provide even more opportunities for pharmacy to fulfil its role in areas such as the identification of undiagnosed diabetes, the monitoring of asthma patients and assisting people to comply with medication regimens.

Dr CECILIA BERNSTEN, director of the Medicines Unit, National Board of Health and Welfare, Stockholm, Sweden, described health policy factors influencing pharmacy practice in Europe. Participants were reminded that government policy makers tend to focus on cost for society and patient safety. She explained that although cost and safety might seem to be separate areas, they are in fact closely linked together. Good quality and safety also lead to better cost benefit for society in the long run. She discussed three important factors influencing pharmacy practice in Europe at the moment:

1 A political belief that market forces, examples of political decisions including privatisation of health care and deregulation in drug and pharmacy areas, are better than detailed government regulation and will solve many problems

2 Technological developments leading to increased use of electronic communication (including transferring prescriptions and patient records) and the internet, allowing better access to information about drugs for patients, prescribers and pharmacists

3 Organisational deficiencies in the health care systems that lead to inadequate knowledge of drug use and the effects of drug use

She concluded that modern health care systems still have inadequate mechanisms for following up and analysing the cost and health effects of drug use due to historical reasons but also due to a lack of understanding of the differences between clinical trials and large scale use of drugs. The dramatic increases in government spending on drugs are now generating demands for better knowledge of drug use and the health effects of drug use. This will lead to new demands on health care organisations and pharmacy practice, and their interaction with governmental agencies.

Professor STEVE CHAPMAN, head of the Department of Medicines Management, Keele University, discussed the many health policy organisational factors influencing pharmacy practice changes in the United Kingdom. He described the NHS plan, national service frameworks, the National Institute for Clinical Excellence, clinical governance, primary care trusts, strategic health authorities, local pharmaceutical services, medicines management pilots and the advent of supplementary prescribing by pharmacists. Some of the participants appeared bemused by the complexity of it all and commented that "everything seems very complicated in the UK". Professor Chapman concluded that these major policy initiatives alongside the increasing new information technology, are empowering pharmacists to become critical parts of health care teams in both primary and secondary care, and key players in moving the medicines management agenda forwards.

Research and change in pharmacy practice

Professor SI (CHARLIE) BENRIMOJ, dean of the Faculty of Pharmacy, University of Sydney, Australia, asked the critical question: "Has all this pharmacy practice research over the years made a difference to the profession, policy makers, the health care system and patients who receive services from pharmacy?" In Australia, pharmacy practice research has evolved primarily from investigator-led research, with its slow and limited impact, to policy-driven research with relatively rapid impact on health care policy and subsequent professional pharmacy practice. Over the past 10 years there has been a concurrent move in the type of research, from small scale, qualitative and attitudinal research to large scale, focused, quantitative research providing resultant models of practice with clinical and economic indicators as major outcomes. Research teams with membership from other disciplines, such as health economists, clinicians and psychologists, have gained ascendancy. Driven by policy makers, with funding as the major incentive, most researchers have adopted their research designs to provide models of practice which increase the role of pharmacists while providing benefits to the health care system. Collaboration with other health care providers has become central to much of this focused research.

He concluded that Australian pharmacy practice research has developed and significantly matured. An example was given of a research project which has had a major impact in Australia. It involved medication reviews by pharmacists in the patients' homes and resulted in a model being agreed, remuneration being achieved and it being implemented on a national basis in 2001. However, his final questions were "Does predominantly focused research benefit research, researchers and the community in the long term? Should consideration not be given by pharmacy practice researchers to research which benefits the community as a whole despite its impact on the profession?"

Changing pharmacy practice: provider perspectives

JEANINE MOUNT, associate professor of social and administrative pharmacy, University of Wisconsin-Madison School of Pharmacy, United States, explained that understanding provider perspectives regarding changing pharmacy practice requires addressing three core questions: Who or what is a provider? What is pharmacy practice? What is change? In the model that has dominated pharmacy practice research over the past three decades, providers are identified as individuals, pharmacy practice is seen as equivalent to patient care activities, and change is conceptualised as rational, goal-directed efforts.

Alternative approaches recognise providers as groups or organisations, pharmacy practice as encompassing all aspects of the work of a pharmacy, and change as encompassing dynamic alterations to non-rational factors, unplanned events, evolutionary adaptation, institutional influences, and so on. Such approaches focus on pharmacy as a cultural system, thus increasing the range of relevant research questions, theories and methods. She concluded that although many view experimental and quasi-experimental designs as the standard for pharmacy practice change research, the research agenda for the coming decade demands greater emphasis be placed on naturalistic inquiry into pharmacy and pharmacy's cultural system.

Changing patients' expectations of pharmacy services

Dr JON SCHOMMER, associate professor, Department of Pharmaceutical Care and Health Systems, University of Minnesota, US, highlighted research findings from a stream of research conducted over the past decade that addressed four questions:

1 Why are patients' expectations and knowledge of pharmacy services important?

2 What do patients expect from pharmacists?

3 How are the patients' expectations of pharmacist services formed?

4 How can patients' expectations be changed?

It was shown that patients' expectations are important because they influence how effectively pharmacists can provide services and can affect how patients evaluate pharmacist services.

Longitudinal data collected at three-year intervals have shown that many patients lack an understanding about the services that pharmacists are prepared to provide. Pharmacists and patients did not share common expectations about pharmacists' roles in health care. Pharmacists have viewed their role as one that adds value to a patient's health care above and beyond a level that can be provided by a physician alone. However, patients have viewed the pharmacists' role as one that fits into their overall health care and is controlled by their physician. There is some evidence that patients' expectations can be changed through educational, social learning and marketing approaches.