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Encouraging self-care and improving access to medicines are fast becoming the mantras of healthcare systems across Europe and recent research underlines the critical contribution of pharmacy
BSc MSc PhD FRPharmS FCPP(Hon)
Two recent studies, one in Finland and one in the UK have independently arrived at very similar conclusions – community pharmacists providing services that help patients to manage their own treatment can reduce healthcare costs as a result of fewer GP visits and reduced frequency of hospitalisation.
The estimated annual savings in the Finnish research project were 500 million Euros. The scope of the UK study was more limited but the estimated savings were still £7000 per month for an area covered by just two primary care trusts. These are considerable sums of money by anybody’s reckoning. The Finnish researchers pointed out that their project brought not only economic benefits but also a social benefit. They argued that because there are grave shortages of general practitioners in some European regions, it makes sense to make good use of pharmacists. Actually, it makes sense to make good use of pharmaceutical expertise regardless of whether family doctors are in short supply or not.
What has this to do with hospital pharmacy? The answer is ‘Quite a lot’. All pharmacists are part of the greater pharmacy family. Decisions to change treatment or to start a particular type of treatment are often made in hospital. But patient care is more than prescribing alone. This is where the pharmacist comes in. There is a school of thought that says just having a medicine without additional information about how to use it effectively is just not good enough – what is needed is a package that combines the two. This goes beyond ensuring the patient information leaflet is in the packet – it is about ensuring that patients have personalised information that enables them to manage their particular set of diseases and treatments to achieve the goals that they have determined through an informed process.
Increasingly in a world where people have chronic diseases for long periods (as a consequence of living longer) treatment will be long-term and understanding how to manage it will be critical. Some treatments simply require adherence but often the picture is more complex. For diseases that run a relapsing and remitting course such as eczema, psoriasis or asthma it is important to understand how to recognise when treatment should be altered and to know how to do it.
In times past we talked about shifting the pharmacy focus from products (medicines) to patients and patient care – which in practice often meant ensuring that medicines were selected appropriately and dosed correctly. The next step along this road is ensuring that patients are equipped to manage their own medicines. Only then will we have achieved a genuinely patient-centred service.
An essential part of patient-centred service will be access to medicines when they are needed – and this might call for some different care pathways from those that we have known in the past. It may not be practical or cost-effective to equip each patient with a personal pharmacy but technology such as remote dispensing terminals opens new options for improved access to medicines and professional advice. Two more things will be important in developing this new way of working – first, patients themselves need to be involved in the planning and design of services and second, hospital pharmacists need to build public profile to ensure that their role as ‘medicine coaches’ is widely understood by the public and other healthcare professionals. There are already pockets of activity all over Europe where good projects have been developed. Our task for the next ten years should be to pull these together and establish some recognisable standards of service, applicable across the whole of Europe.
One thing that must be recognised from the outset is that this cannot be done by pharmacists alone – a service that is to operate for patients must involve patients in the planning. If this sounds daunting it is worth remembering that a good start might be to work closely with patient support groups. Many such groups are run by articulate, well-educated people who have a good understanding of mass communication media. These people do not expect to be mere passive recipients of healthcare but expect to have a say in the process. Together we could make a powerful team.
Giving people the information and skills to use their medicines effectively could be the very best thing we do with our expertise – but the way we go about it needs to embrace some new thinking.