FIP Congress 2006
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Imogen Savage reports from a session organised by
the Community Pharmacy Section
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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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Innovations in pharmacy practice: from consumer educators
to new OTCs
Consumers should be involved in the design of interventions to improve
pharmaceutical care, Tim Chen, from the University of Sydney, told the
meeting.
Citing the use of expert patients in mental health teaching as one example
of an innovation in Australian pharmacy practice, he said that using
simulated patients in undergraduate tutorials has proved to be too artificial.
In
Sydney, they are now using real patients who have been accredited as “consumer
educators” to provide authenticity. These patients
also have a growing role at practice level. Dr Chen explained that pharmacists
are often reluctant to counsel people with mental illness, and so those
patients could have unmet medicine information needs. His group is currently
working with these consumer educators to provide patient-focused mental
health training for community pharmacists (see pF13).
Concordance awareness
Theo Raynor, from the University of Leeds, UK, said a Medicines Partnership
taskforce had raised awareness of concordance but there is still a “real
need for someone to talk to patients”.
Patients still get insufficient information to help them make decisions
about a medicine; they also think that pharmacists are too busy to ask.
People who have had a medicines use review have told researchers that
it was “nice just to talk to someone”, said Professor Raynor.
Future pharmacists already get communication skills training, but he
thought they also need specific training in “patient informatics” or
the art of helping patients to use the information they find. This would
become increasingly important as the provision of web-based medicines
information develops. The full potential of this medium has yet to be
realised.
Professor Raynor pointed out that there has been a tremendous change
in the provision of information to patients in recent times. Little more
than 30 years ago, patients were not told the names of the medicines
they had been prescribed; the label just said “The Tablets”.
Now information leaflets are mandatory, people can search the web for
information, and patients can report adverse drug reactions via the yellow
card scheme.
His team has recently completed a systematic review on medicines information
for the UK Health Technology Assessment programme. This has identified
that consumer medicines information has to serve two distinct purposes.
Before starting a medicine, people want information on risks and benefits,
and treatment choices. Once they have started a long-term medicine, they
want to know about side effects and what to do about them.
Research suggests,
Professor Raynor said, that health professionals see the primary aim
of information as improving compliance with treatment. Patients do not
see it this way at all: they want information to help them make decisions.
They want to know how their medicines work, and the chance of them doing
good or harm.
It is clear from the review that patients’ first preference is
for spoken information on medicines. Written information is a back-up,
something which could be taken away but not “a substitute for conversation”,
Professor Raynor said. Ask questions
Christine Bond: consumers must expect to be asked questions |
Christine Bond, from the University of Aberdeen, UK, said that consumers
must expect to be asked questions when they asked for an over-the-counter
(OTC) product.
The deregulation of medicines, enabling them to be bought without prescription,
comes first on her list of innovations that have changed pharmacy in
the UK. (The other two are pharmacist prescribing and pharmacy-based
health promotion.)
In the 1990s, general practitioners were overloaded,
there was pressure on drug budgets, and industry needed to extend the
life of its drugs. The emphasis on self-care and convenient access to
medicines has shifted focus away from the doctor’s surgery towards
the pharmacy, and pharmacists’ relationships with other health
professionals, and their own aspirations, have started to develop, she
said.
The trend had started with deregulation of new products for familiar
conditions already managed in pharmacies, such as acute diarrhoea and
indigestion. Then, new OTC indications for existing OTC products started
to appear. Finally, pharmacists gained a new area of care with the deregulation
of the lipid-lowering drug simvastatin.
“But these new OTC products are a privilege,” said Professor Bond, “and
we have to make sure we manage them well.”
Research on OTC sales suggests that, although pharmacists say guidelines
are “very important”, in practice they want to keep customers
happy and are nervous of losing them. Sales are often made by assistants
who do not ask relevant questions, and customers often use products,
such as ibuprofen, in a risky way. Analgesics like ibuprofen are a particular
concern.
Professor Bond said the risks involved in OTC medicines use must be quantified
and understood, and systems for pharmacovigilance must be improved. With
many OTC medicines available from non-pharmacy outlets, this is a challenge. “We
do need a single integrated record,” she said.
New class of medicines in US
In the US, the over-the-counter decongestant pseudoephedrine
is set to become a pharmacy-only product, Eugene Lutz, from the
American
Pharmaceutical Association, told the meeting. Concern over the
drug, which can be used to synthesise methylamphetamine, has
prompted the creation of a new class of medicine. Emergency hormonal
contraceptives
will also fall into this category.
Speaking on new service delivery systems, Dr Lutz said the concept
of a personal physician, or GP, has largely been lost in the US.
Patients see many different practitioners and there is little
co-ordination between them. People also use
e-pharmacy and mail order to get their prescriptions filled, and
OTCs are sold “just about anywhere”. This all increases
the need for what used to be called “pharmaceutical care” but
is now termed “medication therapy management.”
A consumer survey carried out as part of American Pharmacist Month
found that the most important thing people think pharmacists could
do for patient safety is to know the patient’s name, and vice
versa. The idea of a “pharmacist of record”, a named
person responsible for a patient’s care, is taking hold. |
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The
Pharmaceutical Journal