Older patients at home resist pharmacists' advice
Pharmacists’ ability to perform medication reviews in patients’ homes
has been called into question in a recent study (BMJ
Online First, 20
April 2007). Published with the tag line “I haven’t
even phoned my doctor yet”, the study reports that the advice offered
by pharmacists was often resisted or rejected by patients.
Community pharmacists provided medication review consultations for 29
of 758 patients previously recruited to the HOMER investigation of medication
reviews (PJ, 22
January 2005, p71 and 21
May 2005, p620). No details
of patient selection criteria or patients’ requirement for medication
review were provided in the study.
The authors conclude that advice-giving by pharmacists in consultations
with patients aged 80 years or more could undermine and threaten patients’ assumed
competence, integrity and self-governance. The authors say: “Advice
given was often unsolicited and invariably in the absence of a patient-initiated
problem or request for advice.”
However, Nina Barnett, consultant pharmacist for older people, Northwick
Park Hospital and London Eastern and South East Specialist Pharmacy Services,
told The Journal that, while the study highlights the need for pharmacists
to improve their consultation skills, there are a number key points to
consider when interpreting this work.
Since most pharmacists have not historically undertaken home-based medication
reviews, Ms Barnett believes that they may need more practical experience
before performing this specialised role.
Ms Barnett said: “The conclusion is unsurprising given that the
patients did not request these medication reviews, nor does the study
describe any interaction between the patient, the pharmacist and the
GP in initiating these reviews.” She also pointed out that the
study does not describe any objectives for the review agreed between
these parties.
“I suggest that if the study took place in a setting where the
pharmacist was known to the patient, and worked with the GP as part of
the health
care team to conduct medication reviews, we might see a different set
of results,” she added.
Heart failure patients
Home visits by community pharmacists did not reduce hospital readmissions
for patients with heart
failure, seen twice within two and eight
weeks of discharge, a BMJ study finds (BMJ
Online First, 23 April 2007).
The researchers randomised 293 patients to receive the pharmacist intervention — which
included providing medicines and lifestyle advice and information about heart
failure — or standard care.
No significant difference in the number of readmissions was seen between the
groups. However, the study reports that nearly three quarters of patients considered
the pharmacist visits to be “extremely or very useful” in a satisfaction
survey.
The authors admit that the pharmacists who participated were not specialists
in heart failure care but had undertaken seven hours of special training. |
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