FIP Congress 2006
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Lindsay McClure reports from the congress “students’ day”, which looked at advancing patient care in community pharmacy practice
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 The World Congress of Pharmacy and Pharmaceutical Sciences,
the 66th International FIP Congress, was organised by the International
Pharmaceutical Federation in association with the Federal
Council of Pharmacy of Brazil.
It took place in Salvador da Bahia from August 26 to 31, 2006
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Focus on patients, not on products
One vision of the future is that medical practitioners will one day
routinely diagnose a condition and decide to manage the patient with
medicines;
a pharmacist will then initiate the patient’s medication and monitor
his or her progress. This was the view expressed by John Bell, a community
pharmacy owner from Australia.
Developing clinical services is a natural evolution for the profession,
said Mr Bell, with cost-pressures on remuneration for dispensing motivating
pharmacists to develop other income streams.
The terminology used to
describe these “clinical services” varies around the world,
with terms currently in use including pharmaceutical care, cognitive
pharmaceutical services, medicines management and advanced or enhanced
services.
Although there is much debate on definition differences, in
essence, all these terms describe philosophies, professional practices
and services that encapsulate the evolution of the role of the community
pharmacy and pharmacist from “product to patient orientation”.
Services range from those provided independently of other health professionals,
such as services associated with non-prescription medicines, to services
that rely or require an interaction, collaboration or consultation with
other health professionals (for example medication reviews and disease
management). In some cases, pharmacists may simply be regaining a role
that has previously been taken by others, such as providing nutritional
advice.
The pharmacist’s role may also be a substitute for that
of other service providers, for example, in the provision of immunisation
services, or it may be supplementary to another provider, such as in
the education of patients with diabetes.
In recent years there has also been the emergence of novel services,
for example, the development of pharmacy-provided medication review services
in a number of countries.
All these services are aimed not only at providing optimal health outcomes
for individual patients but also at improving the health care system
in financial and organisational terms.
A question that can be asked in almost every country is why a profession
that is said to be close to the needs of the community is slow to react
to this patient-focused approach. What is important is not necessarily
the philosophy but how it is implemented. “We need to transfer
ideas into action,” said Mr Bell.
Particular consideration needs to be given now to how university curricula
can be changed to be fit for the future. For example, university training
is often conservative and is aimed at sustaining existing models of practice.
Much could also be done to improve training after graduation. For example,
training is often not embedded in the workplace and may have limited
practice orientation.
Mr Bell described a “very positive initiative” in
New South Wales, Australia, namely, the development of a successful in-pharmacy,
practice support programme, after it was recognised that didactic training
alone will not help change behaviour.
Turning to remuneration, Mr Bell said it is a key facilitator of change,
with the pharmacy payer being in a position to create financial incentives
for the delivery of certain services. The pharmacy layout must be conducive
for the delivery of pharmacy services and, to free pharmacists’ time
for delivery of new services, consideration needs to be given to staff
levels and skill mix.
Other facilitators of change include the provision
of support from professional organisations, developing good inter-professional
relationships and ensuring that patients have appropriate expectations
about what services are available.
Implementing new community
pharmacy services in Portugal — barriers
to change
 On
the theme of implementing new services, Ema
Paulino, a community
pharmacy owner from Portugal, questioned whether community pharmacists
can maintain these services in the long term.
Although there are
a number of cognitive services being offered by Portuguese community
pharmacists, including drug use reviews, there are few systems
in place to document, manage and sustain these services.
Few programmes have given “change” a high priority. For
change to be successful, pharmacists must first consider their strategy
to achieving change, for example, putting in place new organisational
structures, business models and business processes, and considering
the impact on the individuals involved in the change.
“Ultimately
change starts from within us and changing personal attitudes can
be one of the greatest barriers to change, for example, being prepared
to relinquish the traditional dispensing role to other members
of the pharmacy team,” said Ms Paulino.
In Portugal there has
been reluctance among some pharmacists to accept pharmaceutical
care as “pharmacist’s work” and some pharmacists
have found it difficult to cope with an increased responsibility
for patients.
Research in Portugal and Australia has shown that those pharmacies
that are early adopters of cognitive services tend to have a higher
financial turnover, a larger number of staff and good teamwork,
and employ staff with a desire to help people and who value professionalism.
The other major barrier to change has been how doctors view the
profession and new services; they may perceive pharmacists as “doctors’ checkers” or “businessmen”.
In Portugal, the professions’ territories are clearly delineated
and this can make dialogue difficult. There is a general attitude
of mistrust, not between individuals but between professions.
Barriers
to improving this situation include a lack of opportunity for communication
between individual doctors and pharmacists, great diversity in
the services that pharmacies across Portugal currently offer and
the
wrong financial incentives. For example, there is currently no
financial incentive in Portugal for community pharmacies to offer
services
that would require collaboration with doctors.
A recent survey of Portuguese doctors asked what they believed
would facilitate collaboration with pharmacists. Responses included
improving
opportunities for institutional and organisational interaction,
joint training for both undergraduate and postgraduate health professionals,
marketing campaigns to improve understanding on the roles of different
health professionals and guidelines for joint working.
It is important for Portugal to learn lessons from positive experiences
of collaboration among health professions in other countries, for
example pharmacotherapy consultations in the Netherlands, quality
circles in Switzerland, home medicines reviews in Australia, collaborative
practice agreements in the US and supplementary prescribing in
the UK. “The simple message is that it can be done,” Ms Paulino
concluded. |
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The
Pharmaceutical Journal