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Letters to the Editor
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Concordance
Patients should have control over their treatment
From Mr J. S. Khela, MRPharmS
How many times have we, as community pharmacists, recommended an over-the-counter
product for a patient, only to find that they have ignored our advice
and purchased something different, or even not purchased anything at
all? I will certainly be the first to put my hand up.
Perhaps a more common personal experience is where a patient or consumer
insists on purchasing a branded medicine and may refuse to purchase the
clearly more cost effective, generic equivalent.
These particular scenarios may be considered as undermining to our role
and we, as professionals, may be kicking ourselves every time this happens.
However, pharmacy’s secret weapon is that the patient should have
absolute control (or perceived control) over their treatment. This should
exist at the pharmacy counter and dispensary and not just during medicines
use reviews and other consultations. It should exist without affecting
our professional obligations and discretion.
Principal Four of the revised Code of Ethics emphasises the need for
patient involvement in decision making about their care. My recent work
with a GP has demonstrated how patient participation has encouraged greater
concordance and compliance with therapy. Engaging patients in the solutions
to the issues involved with their condition has been paramount. Simply
asking them for their suggestions has given the patients a greater perception
of control. By doing this I have found patients are more willing to comply
and listen to my suggestions. I have also got a lot more respect from
my patients (simply through their positive feedback).
Although I cannot quantify how my service has improved, I can anecdotally
state that patients are more willing to buy the products I suggest and
have become more confident and aware from the questions that they ask
me. I would be interested to hear from anyone who may have done studies
or research in this field.
Jagjiwan Singh Khela
English National Board Election
Candidate
Eastleigh, Hampshire
Pharmacy care programme is a success
From Mr P. Williams, MRPharmS
I read, with interest, your article about the results of the recent
Journal of the American Medical Association study into the effectiveness
of pharmacy care programmes (PJ, 18 November, p597). We have been calling
for a study into the true effectiveness of pharmacy-based concordance
support for a number of years, based on the extensive and compelling
anecdotal evidence we hear from pharmacists every day. There is no doubt
in our minds — and in the minds of all the pharmacists that we
speak to — that such services have an immense impact on patient
care, particularly for the more vulnerable patients.
The study of 200 patients over the age of 65, which included a monitored
dosage system provided by MTS Medication Technologies, found such support
did lead to better adherence to treatment and resulted in improvements
in blood pressure and cholesterol measures.
I know, as was mentioned in the article, that comments have been made
about there being some bias in the validity of the study due to different
levels of observation, but I believe the results are compelling.
At long last — an extensive, well-funded and executed study into
concordance support. For once and for all, this supports what pharmacists,
including myself, have been saying for years; that, when properly executed,
these solutions really work and the impact of rolling out properly funded
programmes within the pharmacy chain will have a major impact on the
health of society’s vulnerable.
Peter Williams
Managing Director,
MTS Medication Technologies
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The
Pharmaceutical Journal