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Published on 1 July 2006

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Pharmaceutical care or medicines management?


Ray Fitzpatrick,
Consultant Editor

In this edition of Hospital Pharmacy Europe we have a broad spectrum of articles from across Europe and the USA with a clear focus on patient care. The article from Italy deals with the important issue of reporting medication errors, and describes one way of overcoming the reticence among practitioners to report their own errors. The theme of hospitals learning from mistakes is emerging in many health systems, and one UK government document dealing with this issue has even been titled An Organisation with a Memory.

The two articles from the USA describe the pharmacist’s involvement in the treatment of dyslipidaemias and diabetes. The US system of collaborative care agreements described in these articles is similar to what we would call supplementary prescribing in the UK. The benefits of nonmedical ­prescribing have prompted a change in legislation that now allows nurses and pharmacists to become independent prescribers in their own right. The article from France describes yet another approach to promoting cost-effective use of medicines through a retrospective review of danaparoid use. Drug use review (DUR) is an established way in which prescribing and medicines policies can be influenced at a macro level.  Finally, the article from Spain describes a system for electronic recording of pharmacist interventions, which is important if we are to demonstrate effectively our contribution to patient care.

So what have all these various articles in common? They are all aimed at promoting safe, rational and cost-effective use of medicines, and describe the pharmacist’s contribution to this aim. There have been attempts to define this activity, and the term “pharmaceutical care” has emerged. Hepler and Strand defined this originally, and it has been subsequently refined as “a practice in which the practitioner takes responsibility for a patient’s drug-related needs and holds him or herself accountable for meeting these needs”. More recently, the term “medicines management” has been used to describe various activities that pharmacists undertake to facilitate safe, rational and cost-effective use of medicines. My own definition of medicines management as described in issue 18 of Hospital Pharmacy Europe is “influencing the availability and policies on medicines at an organisational level, as well as the prescription, supply and use of medicines at an individual patient level”. There has been a debate in the pharmaceutical literature on whether these terms mean the same thing. Clearly, pharmaceutical care can be applied to the articles in this edition that involve pharmacists directly ­dealing with patients, but the term does not sit as easily with those articles relating to medication error reporting or DUR. However, medicines management as an umbrella activity does embrace both direct and indirect patient activities at a more corporate level. Indeed, in issue 18 of Hospital Pharmacy Europe, I suggested that the first part of the medicines management definition describes strategic medicines management, and the second part more operational medicines management. However, what I have called operational medicines management is closer to the established term “pharmaceutical care”.

Therefore, I suggest that what we do as pharmacists can best be described as medicines management, but within that umbrella term sits pharmaceutical care, which describes our role and responsibilities when dealing directly with patients. It is important that, when describing what we do, we use terminology that has consensus, because if there appears to be muddled understanding over our “mission”, this could undermine our efforts to further develop our profession for the benefit of our patients.

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