Medicines Management
Issue no 2, p9-10
March/April 2002
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Medicines Management |
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Features |
Why wholesalers are joining the party and helping set up new services
However, if such schemes are to be successful, several obstacles must be overcome, including issues around remuneration and managing the workload to enable pharmacists actually to do the work. What UniChem is offering Pharmacy Alliance was established by UniChem to bring together community pharmacists who wanted to become more involved in service provision and expand the range of services offered to consumers. Pharmacy Alliance says that it recognises that pharmacists are in an ideal position to facilitate optimal use of medicines by patients, and has helped to develop a number of professional programmes to support them. Its programmes include support to help pharmacists identify patients who may be receiving sub-optimal therapy, and suggestions of appropriate interventions as well as when to refer them back to their GP; providing information about drug therapy and disease management; counselling to support adherence with drug therapy; developing programmes with other health care professionals; and training in health promotion. Managing director Nick England says that the company realised there was a need to provide a framework around medicines management to support pharmacists. "The sort of focus we aim for is ensuring that the patient understands their medicines, why they have been prescribed the medicine, whether or not it is working and whether there are any side-effects from it," he says. So far, there are 812 pharmacists taking part in various medicines management programmes, covering therapeutic areas like asthma, angina, Parkinson's disease, eczema, osteoporosis, hypertension and migraine, or related to treating cancer pain and offering anticoagulation monitoring. Some pharmacists on the PA scheme actively review GP prescribing, and feed back the results of changes suggested to medication to local GPs. Others do not. Mr England says that before pharmacists begin a medicines management programme, PA insists that they get the buy-in from local GPs. Before any training begins, the GP and pharmacist are sent briefing packs about what it entails. Training and feedback Training takes between two and three hours, and is done face to face in the evenings. It covers the role of the pharmacist and other pharmacy staff, how to identify suitable patients, obtaining consent and how the referral process to the GP works at local level. Pharmacists are paid per intervention suggested under the various medicines management schemes, based loosely on the time taken. Mr England adds that every time Pharmacy Alliance launches a training programme, it monitors the feedback from patients, pharmacists and GPs. From about 300 forms returned to Pharmacy Alliance, 81 per cent of pharmacists found the materials and training provided "very supportive", and 18 per cent "supportive". And he adds that GPs have also been enthusiastic about the service. "Once you explain that the patient is at the centre of the programme then they are all for it," says Mr England. One third of the GPs who sent in feedback forms rated the information and medicines management scheme very helpful, and a further third "of some help". Outcomes are collected on the various schemes, but Mr England says that these differ depending on whether or not a pharmaceutical company or alliance of companies is funding the initiative. Data may be collected on the persistence with a particular product, what the patient switched to or the number of referrals to GPs for a change in prescribing. Mr England cites data from its asthma programme, which involves pharmacists asking patients about their quality of life and control of asthma. In all, 82 referrals were made to GPs covering 74 recommended changes to the prescribing. Suggestions included a change in strength of drug, change in therapy, addition of a spacer device or change of device, all based on monitoring changes in the patient's quality of life. Emphasis on service provision Mr England says he is in no doubt that pharmacists are changing to become service providers. But he adds that remuneration issues will have to be resolved at some point. "The PSNC is looking to establish a model of medicines management that works, and sorting out remuneration details, but I think it largely depends on what will come into the contract for local pharmaceutical services. If the money is there to pay pharmacists then it will happen. But you have to question how long pharmacists will do this for nothing, or for money from pharmaceutical companies or fees from small trials," says Mr England. And he adds that although pharmacists clearly have the expertise to do the work, there may be other professional groups who may in future take it on, such as specially trained nurses or PCT pharmacists. What AAH is offering Meanwhile, AAH Pharmaceuticals is about to launch an extensive programme of support on service delivery to pharmacists within the next month. Marketing manager Mandeep Mudhar says that the company's approach to medicines management will be in line with the collaborative medicines management schemes taking place nationally. Battle for hearts and minds He says that the battle for the hearts and minds of pharmacists to convince them of the need to provide this type of service is only just beginning. "What we've found from focus groups of pharmacists who tend to be involved in new initiatives is that so far the medicines management pilots have not really touched their lives," says Mr Mudhar. AAH's philosophy and strategy will be aimed at supporting pharmacists and persuading them of the need to change to become more involved in service delivery, as opposed to just processing prescriptions. Mr Mudhar says: "If they don't begin to change then the writing may well be on the wall for some of them, and our future is obviously connected with them, so we have to change too. What we are looking at is a fundamental change in the way that pharmacists will work, in order to free them to have the time to do things like medicines management." He adds that AAH is completely supportive of the pilot schemes, but realises that pharmacists will have to adapt to take advantage of them. "We will be looking at ways of helping them to become service providers, because you have to remember that perhaps 99 per cent of a pharmacist's NHS income is generated by processing prescriptions. "If a pharmacist is also being asked to find two or three hours a day to do medicines management then there need to be other incentives." Extra training Mr Mudhar also adds that extra training might allow front of shop staff to take on more responsibility, freeing pharmacists to do other work. And there are issues around work flow and time management that the wholesaler believes could help support medicines management in the pharmacy, especially around repeat prescribing for chronic conditions. "At this stage things like dispenser technician training can make an impact on speeding up the processing of prescriptions," explains Mr Mudhar. He adds that another area in which there may be significant time-savings is in ordering, buying and selling of pharmacy products. AAH pharmaceuticals as a wholesaler may be able to help rationalise this process, and free up more time. Three years ago AAH launched a range of professional services for pharmacists, including diagnostic and screening services like cholesterol testing, but Mr Mudhar says that only a few pharmacists have persisted in providing these services. "Out of 300 pharmacists who began offering these services, only five regularly still offer them. Unfortunately many in the profession think that it is about making money from dispensing, and that is what we have to change, but slowly," says Mr Mudhar. Another area that AAH says it can support pharmacists with is services connected with medicines management, such as offering a repeat prescription review service. But emphasis will also be put on encouraging more customers to come into the pharmacy. "We want the pharmacist to be seen in a different light by customers, and there will be a strong marketing programme to support this," says Mr Mudhar. Self-motivation will be key AAH's programme will use a softly, softly approach, and Mr Mudhar warns that self-motivation and a willingness to change among pharmacists will be vital. He adds that in future, primary care organisations might also play a greater role in offering more of an incentive for pharmacists to become service providers. "Especially now that the Government has tightened up on areas like generic prescribing, the profit opportunities have been restricted. "But there is still a big issue about motivating pharmacists to do more, because unfortunately too often the focus is solely on money. They won't do anything extra unless there is money in it," he emphasises. |
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©The Pharmaceutical Journal
Both
the National Prescribing Centre and the Pharmaceutical Services Negotiating
Committee are best known as supporters of medicines management. Now pharmaceutical
wholesalers are recognising that they too can join the party, and UniChem
and AAH Pharmaceuticals are developing programmes to support pharmacists
involved in medicines management.