Th. F. J. Tromp

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.

European barriers to the implementation of pharmaceutical care

Objective — To establish the perceived barriers to the implementation of pharmaceutical care into community pharmacy practice in different European countries and the relative importance of these barriers.

Effect of an external resistance to airflow on the inspiratory flow curve

Inhalation is a convenient way to deliver drugs to the respiratory tract in the treatment of respiratory diseases. For dry powder inhalers (DPIs), the principle of operation is to use the patient-generated inspiratory flow as energy source for emptying of the dose system and the delivery of fine drug particles into the respiratory tract. Resistance to airflow of the inhaler device is a major determinant for the inspiratory flow profile through the dry powder inhaler that can be generated by the patient. Therefore, resistance to airflow is one of the design parameters for DPIs, that could be used to control the inspiratory flow profile, and is one of the parameters to optimise particle deposition in the airways. In this study the effect of resistance to airflow on different parameters of the inspiratory flow curves as generated by healthy subjects, asthmatics and COPD patients was determined. As a result of increased resistance to airflow, the peak inspiratory flow (PIF), the flow increase rate (FIR) and the inhaled volume to reach PIF is decreased. On the other hand, the total inhalation time as well as the 80% dwell time is increased. In general, tuning of the resistance to airflow in the design of a dry powder inhaler may improve the drug deposition in the respiratory tract.

Complex pharmaceutical care intervention in pulmonary care Part B. Patient opinion and process survey

AbstractObjective: The IPMP study (Interventions on the principle of Pulmonary Medication Profiles) investigates and describes the results of complex pharmaceutical care interventions provided to selected pulmonary patients to improve their drug use. This paper describes the patients’ opinions about the care provided and the results of the intervention. Method: Questionnaires investigating patients’ opinions about provided pharmaceutical care were sent to 185 patients participating in the IPMP study after the intervention by their pharmacists had been finished. One year after the start of the intervention, patients were invited to a final consultation by their pharmacists to evaluate their drug use and their symptoms (n = 138). At this point in time pharmacists investigated the knowledge of the patients about the medication and their inhaler technique again. Main outcome measure: The influence of the intervention on patients’ symptoms. Change in drug-related problems, knowledge and skills concerning pulmonary medication after intervention. Satisfaction of the patients with the provided pharmaceutical care. Results: In total 141 out of 185 patients completed the questionnaire. Patients were satisfied with the intervention by their pharmacists and considered it important. The majority (67%) reported that they had learned more about their medication or the inhaler technique, resulting in significantly improved coping behaviour with their pulmonary medication compared with patients who valued the intervention as a nice conversation with their pharmacist only. Patients with improved ability to cope reported statistically significantly fewer symptoms compared with patients reporting no change in behaviour (chi-square test, P < 0.05). In the final consultation of 138 patients, pharmacists observed increased knowledge and skills and decreased drug-related problems. The patients concerned were pleased with the change in treatment and were more satisfied with their current medication as compared with their earlier reports. Conclusion: Patients can be influenced effectively by the tailored intervention of pharmacists resulting in improved ability to cope with pulmonary medication and in fewer reported adverse effects and symptoms. Patients attributed these results to the intervention of the pharmacists.

Interventions in seamless care

Objective: The aim of this study was to investigate whether good collaboration between community pharmacists and hospital pharmacists prevents medication errors. These errors might occur when a patient is discharged from hospital. Both disciplines can complement each other in medication management for the patient.Method: The documented interventions of eight teams consisting of a community pharmacist and a hospital pharmacist, were collected and interpreted with a focus on structural problems and also on positive and negative items, that could influence the intensive collaboration between both disciplines.Results: The registered interventions can be grouped into five categories. Most interventions were registered in the category where the major problem is a lack of communication with the patient. Due to collaboration between the hospital and community pharmacist, all identified problems were resolved properly.Conclusion: When communication between community and hospital pharmacists is optimised, patients will face fewer problems with their medication when they are discharged from hospital.

Computer-assisted medication review for asthmatic patients as a basis for intervention Constructing and validating an algorithmic computer instrument in pharmacy practice

Objective: To construct and validate a computer instrument that identifies asthma patients receiving – theoretically – suboptimal drug therapy in community pharmacies, by the use of patient medication records. This selection enables the pharmacist to assist these patients in using medicines appropriately.Methods: According to Dutch asthma guidelines which describe a stepwise approach and in order to define correct profiles for the use at each level of these guidelines, the optimum use of drugs in the different levels in asthma treatment was expressed in defined daily doses (DDDs) per pharmacological drug-group during a period of one year. An algorithmic computer instrument was developed to select patients with medication use deviant from these profiles. By using nine different selection profiles, the computer instrument stratified patients according to the medication records filed in the pharmacy computer. Patient medication records in four community pharmacies were investigated to validate the selection profiles as indicators for theoretically suboptimal drug use by asthma patients. The validation was performed by comparing the professional judgement of participating pharmacists with the selections made by the computer.Main outcome measure: Positive predictive value and negative predictive value of the selection made by algorithmic computer instrument. Rate of false-positive results.Results: The computer instrument identified asthma patients using theoretically suboptimal drug therapy with approximately 95% predictive value compared with the professional judgement of the pharmacists. The rate of false-positive results was 5%.Conclusion: The results of the algorithmic computer instrument and the professional judgement of the pharmacists are in close agreement. The instrument will be utilised in further research in the IPMP study (Interventions on the principle of Pulmonary Medication Profiles) investigating the role of Dutch community pharmacists in counselling patients who are at risk of suboptimal drug use in the treatment of their asthma.

APOM-project : a survey of pharmacy organization and management

In 1994, a Ph.D-study started regarding pharmacy, organization and management (APOM) in the Netherlands. The APOM-project deals with the structuring and steering of pharmacy organization. This article describes the summary of the empirical results of a survey in a relatively large sample (n = 169). Generalization to the population of pharmacies in the Netherlands was made. Thought results comprised a total number of seven clusters of priorities of pharmacy mixes. Most pharmacy managers were observed with product and customer activities in the first position; pharmaceutical and customer activities were perceived as the most important. Action results comprised a total number of five clusters of activities of pharmacy mixes. Most pharmacy managers were observed with product and process activities in the first position; pharmaceutical and process activities were performed most frequently. The results showed that the traditional conception of the work in the community pharmacy is still vividly present.

Pharmaceutical care in the Netherlands. History, definition and projects

The evolving concept of Pharmaceutical Care knows different interpretations in different countries. In the Netherlands community pharmacists already perform several functions which may be part of the Pharmaceutical Care concept. The Dutch concept of Pharmaceutical Care is tested in the TOM and OMA-projects. Patients ecognise the educational aspects of Pharmaceutical Care and in general are content about the provision thereof.

The ICPC coding system in pharmacy : developing a subset, ICPC-Ph

The ICPC system is a coding system developed for general medical practice, to be able to code the GP‐patient encounters and other actions. Some of the codes can be easily used by community pharmacists to code complaints and diseases in pharmaceutical care practice. We developed a subset of the ICPC codes for community pharmacists. This article describes the method used and the resulting ICPC‐Ph list.

APOM-project: an investigation of pharmacy organization and management.

Recently, in a joint cooperation of Stichting VNA, SAL Apotheken, the Faculty of Management and Organization, and the University Centre for Pharmacy, University of Groningen in the Netherlands, a Ph.D-study started regarding Apot(he)ek, Organization and Management (APOM). The APOM-project deals with the structuring and steering of pharmacy organization. The manageability of the internal pharmacy organization, and the manageability of the direct environment of pharmacy organization is the subject matter. The theoretical background of the APOM-project is described. A literature study was made to find mixes of objectives. Three mixes of objectives in pharmacy organization are postulated; the product mix, the process mix, and the customer mix. The typology will be used as a basic starting point for the empirical study in the next phase of the APOM-project.