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As pharmacists make the patient the centre of their practice, they must still keep in mind the medicines being used – including issues such as new biopharmaceuticals and bioavailability
Ray Fitzpatrick
Consultant Editor
HPE
Over the last few decades the practice of pharmacy has changed significantly. There has been a move away from the preparation of medicines to a more patient-centred approach to practice. In the UK there have been a number of landmark publications which have endorsed this more clinical approach. The most recent is a white paper entitled Pharmacy in England: building on strengths, delivering the future.[1] This sets out the government’s vision for the future of the profession in England. There are numerous recommendations and policy statements in this white paper. However, a single message comes through loud and clear: pharmacy must be clinically focused, with the patient at the centre. Clinical pharmacy has become standard practice in hospitals in the UK, as recognised in this white paper, but the vision is that it should apply to all sectors of the profession.
Although this is a strategic document for England, what it says will resonate with pharmacists all over Europe, which is clearly evident from the articles in this edition of HPE.
For example, the white paper sets out a vision of more integration of hospital and community pharmacy services, and in this edition of HPE the meeting report “Quality, safety, improvement and efficiency” describes a number of approaches to integrated medicines management across primary and secondary care in Northern Ireland and Sweden. Furthermore, the report of the recent EAHP meeting in Maastricht highlights numerous studies showing how pharmacists are contributing to the safe and economical use of medicines – echoing one of the stated aims of the white paper, to underpin pharmacy practice with a strong evidence base.
The EAHP report also highlights the complexities of new medicines, particularly biologicals. Increasing the range of complex formulations of established medicines raises the old pharmaceutical problem of differing bioavailability. Bioavailability differences can have disastrous consequences even with newer medicines, as evident in a recent UK National Patient Safety Agency report on the risk of confusion between the different formulations of amphotericin.[2] The report highlights the point that confusion between the lipid and nonlipid formulations of amphotericin can result in death. This report makes salutary reading at a time when the use of powerful antifungals in high-risk patients is increasing, as illustrated in the meeting report from the European blood and marrow transplantation (EBMT) conference in this edition of HPE.
As newer formulations of powerful medicines are developed, we as pharmacists must remain vigilant to these bioavailability differences. This may seem like routine pharmacy practice, but as the NPSA report clearly illustrates, getting it wrong can quite simply prove lethal.
Although we have moved away from the preparation of medicines to a more clinical approach to practice, it is vital that we retain one of our unique strengths as pharmacists: our understanding of the science, pharmacology and formulation of medicines. Therefore, as we make the patient the centre of our practice we must still continually bear in mind the medicines being used. ■
1. UK Department of Health. Pharmacy in England: building on strengths, delivering the future. London: HMSO; 2008.
2. National Patient Safety Agency. Risk of confusion between nonlipid and lipid formulations of injectable amphotericin: rapid response report 2. London: NPSA; 2007.
