Workshops were held at the Council of Europe seminar in Strasbourg where the role of the pharmacist was debated in relation to the topics presented during the plenary sessions. The conclusions reached are given below:
The group felt that the image of the "family pharmacist", who was a credible source of personalised information on symptoms, lifestyle and medicines should be promoted. His or her ability to identify symptoms, assess risk, find solutions, guarantee quality and refer, as necessary should also be emphasised. Pharmacists were an accessible accountable profession, and the profession should build on its relationships with patients, health care providers and the pharmaceutical industry with the ultimate goal of improving patient welfare when self-medicating.
Most gene therapies were based on experimental research and pharmacists were well-placed to ensure that good manufacturing practice and biosafety techniques were used for clinical applications. In this workshop, it was thought that in order to be experts on new technologies, all pharmacists would need to be given training in new biological developments, total quality management, economics and epidemiology. Some might then wish to become specialists in areas of new technology. Pharmacists were ideally placed to undertake post-marketing surveillance and provide outcome data for new therapies. They could also be involved in discussions regarding access to treatments and the extent of insurance coverage for patients that were deemed to be eligible for therapy.
Pharmacists in many branches of the profession had an important role to play in preventing counterfeiting of medicines, according to this group. Pharmacists in industry, who were involved in manufacturing pharmaceuticals, should be urged to devise sealed packaging that carried a distinctive mark (like the metallic thread that ran through bank notes). Manufacturers should also be encouraged to prosecute all offenders. Inspectors specialising in the punishment of offenders should be appointed, who would ensure the verification and validation of documents and ensure traceability of products. It was felt that governments should not apply low price policies over-rigorously, as this might result in counterfeiting. Non-governmental organisations could help officials working in developing countries to prevent counterfeit production.
Medicines in wholesaler's warehouses could be subjected to additional testing by pharmacists, as was the case in Belgium, and quality controllers should supervise all stages of the distribution process.
Community pharmacists and their customers should be made more aware of the existence of counterfeits.
Only members of the workshop group from the Netherlands and the United Kingdom had any experience of electronic prescriptions, although Ireland would be moving to a paperless system over the next five years. The group identified the following barriers that had to be overcome. First, the law did not keep up with the advance of technology. There was no guidance on electronic signatures and as yet these had not been implemented. Patients could choose which pharmacy they went to and their medical notes might not be accurate if they forgot their record card or did not comply with treatment. It would be difficult to determine what was the "original" in a paperless system, and what would happen if the system failed or messages were lost. Security of data must be paramount and all access should be on a "need to know" basis. A system of levels of access would be needed depending on the use to which the data was to be put. For example, access requirements would be different for anonymised data-gathering for research, creation of prescriptions or dispensing of prescriptions. The technology for creating and transmitting electronic prescriptions was available and was less labour intensive than paper systems. It might be difficult to persuade both patients and professionals of the benefits initially, but both groups, ultimately, would receive an improved service and a better level of information would be available when it was needed.
It had been suggested in the plenary session that parcels containing medicines should be vetted in post offices by pharmacists in order to determine the quality of the contents. However, the group felt that it would be almost impossible for customs officers to detect that parcels contained pharmaceuticals, because of their small size and innocent appearance. It was difficult for the manufacturer to be responsible for their products once they had been sold but the pharmacist could play an important role in informing the public of the hazards involved in buying medicines via the internet. There needed to be exchange of information between government and consumer organisations, journalists, regulatory bodies and the pharmaceutical industry. Good distribution/dispensing practices should be developed in an international context, and advertising regulations had to be harmonised. The laws of the country of destination, rather than those of the country of origin, should be applicable to mail order goods and other legislation regulating the sale of medicines via the internet should be developed and enforced. However, some patients might prefer to use the internet for medical supplies and it was important to provide quality sites for these people. It was noted that medicines often cost more when bought through the internet than they did from conventional sources.
Health care networks were being developed but currently differed between countries. Methods of building networks included use of an intranet, the internet and smart cards. The workshop group thought that it was important that patient data was kept separate from commercial data and that only appropriate people had access to appropriate levels of information. Networks would improve co-operation between pharmacists and doctors at all levels, in hospitals, primary care and general practice. There could be greater interaction between the professions with regard to education, professional organisations and local projects. This would increase mutual trust and respect, which would ultimately improve patient care. Drug information networks could be made available to health authorities, insurance organisations, pharmacists, doctors and academic institutions.