The Pharmaceutical Journal
Vol 274 No 7341 p332
19 March 2005

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Communicating information about medicines needs a national standard

By Sharon Steel

In August, I will have been a member of the Royal Pharmaceutical Society of Great Britain for 20 years. After registering in 1985, I spent six months managing a community pharmacy. During the next 11 years I pursued a career in clinical pharmacy within the hospital sector reaching the post of principal pharmacist in a large London teaching hospital. I established and delivered specialist clinical pharmacy services to mental health and HIV/AIDS directorates and gained extensive experience in therapeutic drug monitoring, development and delivery of clinical pharmacy training programmes and financial control of medicines.

In 1997 I moved into primary care establishing an independent consultancy specialising in prescribing and medicines management. During the past eight years, I have worked with many primary care organisations in and around London and close to 100 GP practices.

Familiar comments

At two practice visits recently, GPs made the same familiar comment about problems with medicines as patients move between primary and secondary care. One GP referred to the frequent occurrence of patients being discharged from hospital on combined treatment with aspirin and clopidogrel after cardiac surgery. He reported that, in his experience, no reference was ever made in the discharge information from secondary care about how long to continue the combination of antiplatelets or, who should be responsible for discontinuing clopidogrel. The second GP described the case of a confused, frail elderly woman recently discharged from a geriatric ward on a variety of new medicines with no clear indication or comment about duration of treatment.

The lack of seamless care at the primary/ secondary care interface has been an issue since I qualified. The realisation of this prompted me to reflect on my career to date and to acknowledge my frustration that despite endless national and professional initiatives to improve medicines usage, we are still failing to tackle a number of crucial issues.

First, despite plenty of research to demonstrate that patients are more at risk of things going wrong with medicines when they move between care settings, GPs are still not receiving sufficient information about medicine changes made during hospital admission or, at outpatient clinics. Hence, treatment changes initiated in hospital frequently fail to be implemented accurately in primary care.

There are some examples of good practice, but communication about medicines between sectors is still not standardised or routine. The Society is producing a toolkit called “Discharge planning and medicines” with recommendations for good practice but, since there are national standards for medication review to support widespread implementation, why do we not seek a national standard for communicating information about medicines?

To resolve this issue once and for all, we need an agreed template for documenting medicines-related information and specific national targets for timely communication of medicines information between care settings on admission to and discharge from hospital.

Secondly, suitably trained pharmacists should be accessible to all GP practices to review incoming medicines information from secondary care, to update GP computer systems accurately and in line with quality targets in the new GP contract, and to follow up vulnerable patients after discharge. This service should complement annual medication review for all patients on repeat medicines and could be included as an enhanced service within the new community pharmacy contract.

Thirdly, more needs to be done to tackle the 50 per cent of patients with long-term conditions who do not take their medicines as prescribed. Concordance has evolved as a concept to involve people more in decisions about treatment and thereby enable them to get the most out of their medicines. The process of concordance involves eliciting patient’s views on the possibility of having to take medicine, exploring those views with the patient, informing the patient of the pros and cons of taking and not taking medicine, and involving the patient in the treatment decisions.

Surveys of public opinion clearly show that people want to be involved in decisions about treatment but they lack the information they need about treatment options and about the risks and benefits of medicines. All prescribers and pharmacists who interface with the public have a role to play here and there are several opportunities to support shared decision making about medicines within the new community pharmacy contract.

However, communicating risk is not simple and I have identified this as one of my own personal development needs. Substantial numbers of patients have poor numeracy or literacy skills and unless probability data are expressed in a meaningful context for all patients, treatment decisions will not be informed at all. An article titled “Strategies to help patients understand risks” (BMJ 2003;327:745–8) made three observations about the future of risk communication in health care:

· Health care professionals need specific training in communicating risk to patients
· More research is needed on how different strategies, particularly use of visual aids, help patients to understand risk
· Research should assess further how differences in culture, age and gender affect patients’ perception of risks

In order to implement concordance properly, practitioners need access to tried and tested evidence-based tools including visual aids, that describe the relative risks and benefits of different treatment options and the consequences of no treatment for a range of common minor ailments and long-term conditions.

With respect to medicines, pharmacy is in the best position to lead the way, undertake the research and develop the tools. Furthermore, research suggests that patients extract the gist of any information, not the detail, to make decisions and that patients’ assessment of risks is primarily determined by emotions rather than facts. Here is a golden opportunity for the profession to develop and deliver a multidisciplinary package of training to support practitioners in communicating risks about medicines to patients. Ideally, however, the research and training should have been made available in parallel with the introduction of related service developments in the new national community pharmacy contract.

Continuing professional development

Continuing professional development is described by the Royal Pharmaceutical Society as a cyclical process of reflection, planning, action and evaluation.

I have reflected here on two decades of pharmacy practice and on what I believe, from my vantage position, to be the priorities for improving medicines management services to patients.

I have planned and taken action to write this article and I hope that, in the not too distant future, I will be able to evaluate the impact that this CPD has had on my day-to-day practice in primary care.