J. W. Foppe van Mil

Pharmaceutical care, European developments in concepts, implementation, teaching, and research: a review.

This article discusses the concept of pharmaceutical care especially from the European perspective. It tries to clarify the current status of pharmaceutical care research and implementation, and if and how it can be part of the practice of pharmacy. Pharmaceutical care basically means improving the medication use process in order to improve outcomes, including the patients’ quality of life, and that involves a focus change for pharmacy from product to patient. This change in focus also implies that the pharmacy curriculum should be adapted, in order for the pharmacist to be able to acquire new knowledge and skills. In most countries this change currently is taking place but not in very deliberate or structured manner. Some basic decisions have to be made, in order to guarantee that every patient receives pharmaceutical care when needed.

Pharmaceutical Care in Community Pharmacy: Practice and Research in the Netherlands:

OBJECTIVE To describe the pharmaceutical care activities and research in community pharmacy in the Netherlands. FINDINGS Pharmaceutical care is well advanced in Dutch pharmacy practice. This is largely due to the fact that clinical pharmacy was already an integrated part of community pharmacy practice by the end of the 1980s. Activities of the International Pharmaceutical Federation (FIP), some wholesale companies, and influential individuals in the Netherlands stimulated universities and the Royal Society for the Advancement of Pharmacy to advance the implementation of pharmaceutical care. DISCUSSION Not all pharmacies in the Netherlands provide pharmaceutical care at the same level, although medication surveillance (concurrent and prospective medication analysis) is part of everyday practice. Implementation of quality assurance systems in community pharmacy practice could be helpful in assuring high levels of care. Similar to those in other countries, Dutch pharmacists are torn between the wish to provide pharmaceutical care and economic considerations, although the financial status of most pharmacies is still (very) healthy. New entrants into the market, such as supermarket and pharmacy chains, seem to put little emphasis on care provision. CONCLUSIONS Pharmaceutical care has been implemented in many Dutch community pharmacies, but not everywhere to the same extent. Due to excellent automated medication surveillance; structured, high-quality medication counseling; and the fact that patients usually visit the same pharmacy, Dutch patients are well protected against many drug-related problems.

The challenges of defining pharmaceutical care on an international level

The objective of this article is to gain insight into the place of pharmaceutical care in health care and into the different interpretations of the term “pharmaceutical care” around the world. Based upon a literature review, communication with peers and results from an international questionnaire, the different influences on and interpretation of the terminology are outlined, and the place of pharmaceutical care within the health system is defined. The Dutch situation with regard to pharmacy and pharmaceutical care is used as an example of the national development of a definition. Different linguistic and cultural influences on the construction of the definition are discussed.

Changing a profession, influencing community pharmacy.

The authors set out to describe the possible impact of the continuing education activities of the Community Pharmacy Section (CPS) of the International Pharmaceutical Federation (FIP) on the profession in the period from 1980 to 2002 (approximately the last two decades of the 20th century) by reviewing and interpreting documents of the Community Pharmacy Section of the International Pharmaceutical Federation. The educational activities of the CPS have resulted in a high level of satisfaction among the participants. The CPS has also coordinated international practice research and the dissemination of the concept of pharmaceutical care. Additionally, the sections activities have informed the members of national pharmaceutical associations about new concepts, and stimulated projects on the added value of pharmacy. There are reasons to believe that the activities have created agents of change. It seems that the activities of the section have had some effect, although the exact impact remains difficult to measure because no structured evaluation method has been applied from the beginning of the continuing education activities.

Medical care and drug-related problems: Do doctors and pharmacists speak the same language?

Optimal communication between physicians and pharmacists is important for patient care. However, pharmacists and doctors do not always seem to understand each other. They have been professionalized differently, and do not always speak the same language. Especially in the areas of prescribing, medication review, and medicine use, there can be differences in views. This contribution clarifies some essential concepts that doctors and pharmacists use. Thus we hope that our commentary contributes to a better understanding of each others role and the importance of interprofessional cooperation for the benefit of the patient.

Terminology, the importance of defining

Multiple terms and definitions exist to describe specific aspects of pharmacy practice and service provision. This commentary explores the reasons for different interpretations of words and concepts in pharmaceutical care and pharmacy practice research. Reasons for this variation can be found in language, culture, profession and may also depend on developments over time. A list of words is provided where the authors think that currently multiple interpretations are possible. To make sure that the reader understands the essence, it seems imperative that authors include a definition of the topics that they actually study in their papers, and that they clearly cite existing definitions or refer to collections of definitions such as existing glossaries. It is important that presenters, authors and reviewers of pharmacy practice papers pay more attention to this aspect of describing studies.

Influences on prescribing

Although it stands at the beginning of the chain, one of the important elements in pharmaceutical care that pharmacists try to influence is the prescribing of medicines. This proves not to be so simple, though. Many physicians probably think that no-one – certainly not a pharmacist – has the right to influence their professional behaviour. But there are many other influences on prescribing, of which doctors seem to be unaware. One of the major players in this field, of course, is the pharmaceutical industry (‘big pharma’), which regards health care as just another commercial market. Drug promotion is an important part of the budget of the pharmaceutical industry. A lot of the promotion comes through their representatives (‘drug reps’) in the form of food, flattery, friendship, and free samples. The average Indian doctor receives 20 visits from sales representatives a day! According to Zarowitz et al. [1] it has been estimated that drug company representatives have an annual budget of

Pharmaceutical Care and Dispensing Medicines

8000–

Citations and science

13,000 for each physician they call on, but most of it is spent on specialists [1]. Depending on how one defines ‘promotion’, the industry spends a significant part of its turnover on promotional or marketing activities. It is therefore not surprising that it is difficult to counterbalance such a force. Under the title ‘Drug promotion: What we know and what we have yet to learn’, a major report into pharmaceutical promotion has been published by the WHO Department of Essential Drugs and Health Action International Europe (HAI). The collaborative project involved the analysis of over 2700 journal articles, books and other materials contained in a single database (to be found at http://www.drugpromo.info). Research studies from the database were analysed and form the basis for the four reviews contained in the report. The authors are recognised experts in pharmaceutical promotion.

Yvonne Bowman-Boer, V’lain Fenton-May, Paul Le Brun (eds): Practical pharmaceutics

Dispensing prescription medicines is the most frequent activity performed by pharmacists worldwide. It offers pharmacists and their staff the opportunity to discuss the medications with patients and therefore to contribute, “to the care of individuals in order to optimize medicines use and improve health outcomes” (PCNE). By providing pharmaceutical care around the dispensing of medication, pharmacists may help the patients make the most of their medicines and of treating/controlling their disease(s). A number of protocolised services can be recognized in practice in different countries. For new medicines that are dispensed for the first time, there are several examples of pharmacy services that try to pre-empt non-adherence, amongst others. For repeat prescriptions, maintaining the therapeutic relationship, checking for problems in those most at risk and avoiding normalizing poor and declining health are activities that the pharmacist and the pharmacy staff can take to help patients. Whatever activity pharmacists and their staff undertake, they must be based on the Good Pharmacy Practice guidelines, and be properly documented like all healthcare activities.