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Letters to the Editor
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Dispensing
Compliance aids are not the solution to all problems
From Mr D. R. Green, MRPharmS
Paul Kirby’s letter (PJ, 29 July, p132) about dispensing medicines
in compliance aids seems to be missing one fundamental point; that most
dispensing into compliance aids does not comply with the patient needs
assessment and requirements of the Disability Discrimination Act. If
pharmacists were to be asked to provide evidence of such an assessment
before initiating such services and before the new contract was introduced,
it would generally not be forthcoming. Since the new contract, there
is some activity to ensure appropriate use of compliance aids, but this
is sporadic and not co-ordinated nationally. This also reflects the huge
variation in implementation of the single assessment process by primary
care trusts and involvement of local contractors.
My understanding of the DDA is that, where a patient requires medicines
to be dispensed in a manner other than the standard system and to support
his or her ability to remain independent, the pharmacist has a legal
obligation to try to meet that patient’s needs. This could be something
as fundamental as not using child-resistant closures or providing large
print labels. Our own experience has demonstrated that carrying out assessments
using tools adapted from Medicines Partnership, few patients would benefit
from compliance aids. The challenge is that, having identified a variety
of other simple solutions which would help patients, neither ourselves
in the hospital sector nor pharmacists in community have the facilities
to deliver most of these solutions.
The fundamental problem within any pharmacy environment is that patients’ needs
are not routinely assessed in advance, so that when a prescription is
presented we are not aware of their problems or the solutions. Medicines
use reviews are perhaps a route for developing this aspect of the dispensing
service, but I have not seen evidence that MURs are being used in this
way with long-term planning in mind. Repeat dispensing has not been grasped
as an opportunity for this aspect of patient support either. I am generalising
but where there are examples of good practice let us hear about them
and build on any successes.
We have to move away from perpetuating the dispensing of compliance aids
as a solution to all problems because this is not the case. I would suggest
that most patients receiving such a service before the new contract would
not meet the requirements of a robust needs assessment. Having spent
many years working in community pharmacy I do not recall ever having
carried out such an assessment.
We have an opportunity to develop a better, patient-focused service within
the requirements of the DDA and the new contract, rather than perpetuate
a service based mainly on poor foundations.
David Green
Interface Development Pharmacist
Essex Rivers NHS Trust
Large companies shun extemporaneous dispensing
From Mr D. R. Lee, MRPharmS
I welcome the new book ‘Pharmaceutical
compounding and dispensing’,
by four experts from Aston University (PJ, 29 July, p143) but will the
large retail chains also be so welcoming?
I have been extemporaneously preparing medicines for many years, as taught
at Aston University, where I was a student just before it gained “university” status.
When, however, I sold my pharmacy and took up locum work I was not able
to prepare items extemporaneously due to company policy.
I was employed one day a week at a pharmacy and a prescription came in
that required two ointments of 15g each to be mixed together. I asked
for an ointment slab only to be told that it had to be done by the manufacturing
department of the company. I said that it would take me two minutes to
do it since I had been trained in this technique. No luck, it had to
be ordered and returned to the pharmacy a few days’ later. The
necessary paperwork took longer than the preparation would have done
and the patient had to wait a few days instead of two minutes.
I suppose the charge to the pharmacy and the NHS was quite large for
what would have been negligible if I had done the preparation myself.
Profit comes before anything else these days.
David Lee
Paignton, Devon
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