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Clinical service provision and workforce capacity require improvement in hospital pharmacy, EAHP finds

Progress needs to be made to support the development of hospital pharmacists in clinical service provision, according to the findings of a recent report published by the European Association of Hospital Pharmacists (EAHP).

The ‘Investigation of the hospital pharmacy profession in Europe: assess and advance hospital pharmacy’ aimed to evaluate the state of the pharmacy profession and gauge the level of implementation of the European Statements of Hospital Pharmacy within EAHP’s member countries.

The statements, which were adopted in 2014, express commonly agreed objectives which every European health system should aim for in the delivery of hospital pharmacy services.

With survey responses from 35 countries between November 2022 and March 2023, Keele University was commissioned to analyse the results and measure pharmacists’ progress against the statements and identify key barriers and drivers of success.

‘Pharmacists are the medicines expert‘

The results showed considerable variation in clinical activities undertaken by pharmacists between countries, largely as a result of differing expectations, levels of practice and national legislation.

‘The role of the “clinical pharmacist” where the pharmacist is visible on the ward and in clinics in a patient-facing role, while well-established in some countries, is still a rarity in others,’ the report said, adding that ‘pharmacist prescribing is established in countries like the UK, USA, Canada and New Zealand but is not legally permissible in the majority.’

In its report, the EAHP voiced its concern ’that in some countries clinical pharmacy services are not well developed’ despite pharmacists being ’the medicines expert’.

For example, when it came to the statement of ‘all prescriptions are reviewed and validated as soon as possible by a pharmacist’, a total of 60% of respondents from all countries gave a positive answer.

While this was an improvement from the previous statement survey (56%), the EAHP noted that this ‘important part of medication safety systems’ is not happening in 40% of cases.

For the United Kingdom, Spain, Portugal, the Netherlands and Bulgaria, 100% of respondents gave a positive answer to the statement on timely prescription checks by pharmacists.

However, among other countries, the most common reason for a negative answer was limited capacity (30%), followed by it not being considered a priority by managers (21%) and having limited capability despite wanting to achieve it (14%).

Similar findings were observed in previous iterations of the survey in 2016, 2017/18 and 2018/19.

Widespread capacity and capability issues

Just over half of respondents (52.5%) answered positively to the statement ‘the pharmacists in our hospital work routinely as part of the multidisciplinary team’.

This is despite the EAHP position that ‘hospital pharmacists help to ensure safe, effective and optimal use of medicines in collaboration with multidisciplinary teams throughout healthcare systems’.

The main reasons for a lack of multidisciplinary working were limited capacity (36%), it not being considered a priority by managers (20%), having limited capability despite wanting to achieve it (16%), and reluctance from medical and nursing staff (14%).

Indeed, the report found a clear correlation between workforce numbers and skill mix and the implementation of clinical service provision.

As such, the report said: ‘Consideration needs to be given on how to support hospitals to develop the capacity and capability to deliver clinically orientated services.’

Few barriers were identified for hospital pharmacies to engage in the procurement, compounding and the distribution of medicines. The EAHP said the positive responses were ‘not surprising since this has always been a core function of hospital pharmacy’.

It added: ‘This is a very important role and the work of pharmacists in reducing the risks associated with these functions should not be underestimated as pharmacists engage in more clinically focused roles.’

Supporting clinical service provision

The report acknowledged the impact of the Covid-19 pandemic in creating extreme pressure on all health systems, exacerbating capacity issues and diverting pharmacy staff from day-to-day duties to support vaccination efforts.

Looking forwards, the report concluded that further work is needed to support the development of hospital pharmacists in clinical service provision.

In its recommendations, EAHP highlighted the need for robust hospital and clinical pharmacy services in the hospital setting to provide better outcomes for patients.

It also encouraged the sharing of good practice initiatives and business cases so that countries in which clinical pharmacy services and multidisciplinary working are more established can support this development elsewhere.

Commenting on the investigation and report, Darija Kuruc Poje, EAHP vice president, said: ‘Hospital pharmacists are constantly facing challenges where traditional roles are still very important but new roles [are emerging] as well. As the healthcare landscape continues to evolve, the insights gained from 2022/23 EAHP investigation reflect the profession’s commitment to delivering high-quality patient care. However, the hospital pharmacy profession should gain more visibility in order to preserve and further develop medication expertise.’

The EAHP aims to use the results of the investigation to support its advocacy and policy work at both national and European levels, and to tailor its projects and initiatives to better meet the needs of member associations.

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