Chemists urged to get more involved in primary care

PHARMACISTS MUST consider moving away from the traditional chemists “shop” model and become more centrally involved in the primary care team, a leading primary care specialist has said.

In an editorial in the current issue of the British Journal of General Practice, Dr Colin Bradley, professor of general practice at University College Cork, says the pharmacy profession must make a significant move if it wishes to achieve its declared role of providing optimal care for patients. "Effective delivery of this function may require a more significant move into the fold of the primary care team – possibly even abandoning the shop – and learning new ways of interacting with patients and medical colleagues," he says.

Noting that pharmacists have been seeking to redefine themselves and develop new and extended roles in recent years, Prof Bradley says evidence in favour of such a move has largely been based on US research suggesting there may be economic benefits. “However, recent reviews that have sought to quantify the benefit of medication reviews conducted in primary care by pharmacists or others, in terms of adverse effects, hospital admissions and deaths, have been disappointing.”

The UCC professor admits these findings are difficult to explain given the ample evidence that misuse of medicines, particularly in older people, is associated with increased morbidity and mortality, and the obvious role for pharmacists to address this issue.

“A hint of what might be going wrong is provided by a qualitative study which examined transcripts of consultations between pharmacists and older patients in a trial of pharmacist-led pharmaceutical care for heart failure,” he notes.

“In this study it was found that advice from pharmacists was usually quite didactic and was often resisted or rejected by patients for whom the advice was largely unsolicited and not related to information sought by them.”

“However, the recurring failure of well-conducted clinical studies to demonstrate an unequivocal benefit for pharmacists in their new pharmaceutical care role does constitute something of a problem for the profession,” Prof Bradley adds. He suggests that the problem lies with the position of the pharmacist as still rather semi-detached from the primary care team, and that his or her interventions come too late in the prescribing–dispensing sequence. “It may be an overstatement to assert that primary care pharmacy is in a crisis but it is certainly facing something of a dilemma,” he concludes.