Marie-lise Biscay
PhD
Chief Pharmacist
Centre Hospitalier des Pyrénées
29 Avenue du Marèchal Leclerc
64039 PAU Cedex
France
E:[email protected]
Medicinal treatment involves three professionals – the doctor, the pharmacist and the nurse – whose actions and responsibilities are complementary and should contribute to quality assurance in medication use.
In France, healthcare professionals are obliged to inform the patient about their medicinal treatment, complying with the regulations according to their fields of action and competence.
The doctor prescribes medicines to the patient and must provide the patient with information to make sure that they understand the prescribed treatment and reinforce the therapeutic alliance.(1)
The pharmacist, when dispensing, must supply information about the correct use of the medicine.(2)
The nurse has the task of distributing and administering the medicine to the patient, and must also explain and educate the patient by providing useful information.(3)
What is the pharmacist’s role?
The regulatory structure of the pharmacist’s duties is defined by French law (of 9 December 1992, and put into application by the decree of 26 December 2000).
The pharmacist must ensure total integrity when dispensing medicine and is responsible for all aspects associated with drug delivery, including:
- Pharmaceutical analysis of the prescription.
- Eventual preparation of the doses to be administered.
- Making available information and necessary advice for the correct use of the medicine.
The pharmacist also has responsibility to:
“Lead or participate in all communications about the medicines, equipment, products, or objects, as well as all promotion and evaluation of their correct use, to contribute to their evaluation and to concur with vigilance regarding pharmaceuticals and materials”(4)
and
“Lead or participate in each action likely to contribute to the quality and security of the treatment and care, in areas of the pharmacist’s competence.”(4)
Methodology
In our region in the south of France, pharmacists worked together, and in collaboration with other medical staff such as psychiatrists and nurses, to devise certain “tools” to respond to the demands of communicating with patients suffering from mental illness. This led to the “Atelier du Medicament(®)”(Medicine Workshop), which was piloted in 1995 in two hospitals in the south of France (Pau and Toulouse).
The Medicine Workshop is a method for the pharmacist to communicate with patients suffering from mental illness. It takes the form of a verbal expression group, centred on the use of medication, and is offered to patients with mental illness during their inpatient hospitalisation and later when they transfer into the day hospital environment.
The aim of the workshop is to provide patients with the chance to freely discuss their experiences with the medication and ask the pharmacists any questions.
It is an opportunity to inform and educate the patients, allowing them to acquire knowledge and aptitude, with the objective of making the patient an active party in their own treatment.
Patients are given a more honest and objective picture of psychotropics, de-dramatising their use and improving compliance by improving the patients’ knowledge.
Each Medicine Workshop comprises eight to 12 patients, with diverse pathological symptoms, such as psychosis, schizophrenia and bipolar disorders. Patients are referred to the group by their psychiatrist, in concert with other medical staff. Choice of patient depends on:
- The patient’s capacity to listen, to concentrate for a period of up to one hour.
- The patient’s behaviour pattern – those who have experienced a relapse of symptoms because they have abandoned medical treatment.
- Whether medical staff believe that the patient can benefit from the group.
The workshop is presided over by a pharmacist, collaborating with one or two nurses. Their roles are complementary: the pharmacist vouches for the quality of the pharmacological and pharmaceutical information given, and his/her neutral and objective position reinforces the patients’ confidence; the nurse vouches for the therapeutic environment.
Following this first session, we offer two other kinds of workshops – one for inpatients and one for outpatients.
Inpatients
This workshop takes place once or twice a month and lasts for about one hour. The premise of the workshop is to provide information and reply to questions brought up by the patients. Some of the most frequent questions asked are:
- What does this medicine do?
- What are the undesirable effects?
- How long will I have to take it for?
- Is there a risk of becoming dependent?
- What will happen if I stop taking the medication?
Outpatients
This if for patients whose pathology has “stabilised”. It takes the form of five or six sessions every other week, with the same group of patients. This workshop is more educational – it allows patients to talk about their experiences or their difficulties with treatment. Questions are grouped into different themes, which are treated and illustrated by the patients’ own experiences.
The first session provides general knowledge about the medication – its creation, its manufacture, its effects and so on. The aim is to reassure and sometimes correct any wrong impressions that patients may have.
The second session tackles patients’ knowledge of antipsychotics. The objective is to help patients spot the beneficial effects of the treatment. It is important to make them aware of the improvement in their psychological state, and the attending nurse can reinforce this situation.
The third session examines the undesirable effects (adverse drug effects), focusing on the viewpoint of the doctor, and helping to differentiate between iatrogenic effects and pathological effects.
The following sessions look at the other types of psychotropics (antidepressants, anxiolytics and hypnotics) and how they react to stimulants (alcohol, tobacco and drugs). They also look at correct usage of the medication – compliance, abandoning treatment and relapse, self-medication, and so on.
Leaflets produced by the pharmacist are offered to the patients if they want them, which allows them to review the information given during the workshop.
Written “exercises” are also used, which include some simple questions that the patients answer as true or false. These exercises are done during the workshop or at home, and are discussed by the group during the sessions.
A global evaluation is made at the end of each session: nurses, the pharmacist and psychiatrist share their points of view, and this collaboration can sometimes lead to adaptation of the treatment.
Evaluation
The evaluation of the impact of the workshop on the patients is done by a questionnaire (a set of 17 questions), filled in by the patients before the first session and after the last session. Analysis takes into account the evolution of replies, by comparing the replies to the first and second questionnaire for each patient. The results generally show an improvement in knowledge and a better comprehension of the treatment by the patients.
Conclusion
Treatment of patients with mental illness is evolving and, according to the ANAES (National Agency for Health Accreditation and Evaluation), the “work of informing and educating the patient concerning his/her illness and treatment is necessary to ensure its continuity of taking charge at the release from the hospital”.
Providing information about psychotropic medicines opens forums for debate and allows questions to be asked. It also improves society’s image of mental health, and can help improve the relationship between those looking after and those being looked after.
The pharmacist is in a perfect position to inform patients about medicines and reinforce the work of other healthcare professionals. This requires the pharmacist to know how to propose and debate his/her project, and make it sufficiently attractive for a team of nurses or doctors to want to use the project as part of their programme of therapeutic activity.
References
- Decree no. 95-100: 07/06/1995. Medical deontology.
- Decree 03/31/1999. Hospital drugs prescribing and dispensing rules.
- Decree no. 93-221: 02/16/1993. Nurses professional issues.
- Law no. 92-179. Pharmacy and medicine.
