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WOULD a pharmacist working within a general practice environment help to improve medication safety for patients?
It’s one of the questions Queensland pharmacist and PhD candidate Chris Freeman hopes to answer in a survey about the role of pharmacists in medical centres.(1)
Freeman said he was conducting the survey because the role of the pharmacist in primary care was not well defined, resulting in a lack of research in this area. Most published literature about the role of pharmacists comes from the United States, the United Kingdom and Canada, and cannot be directly applied in an Australian setting.
In a paper co-written by Freeman and published in the Australian Family Physician, the authors proposed that a senior pharmacist should be part of the general practice multidisciplinary team.(2)
The proposed role would be to provide multiple risk management strategies to improve medication safety, with no prescribing or dispensing duties. It would focus on interventions for high-risk patient groups and disease states.
The authors said the evidence of adverse drug reactions (AEDs) in primary care was “sobering”, citing one study that found these events were one of the most “significant causes of morbidity in the Australian community”.(3)
They said a general practice pharmacist would be ideal for collecting data on AEDs, which would enable the development of prescribing standards.
Freeman’s survey asks doctors about their attitudes to pharmacists having a more active role in general practice, whether pharmacists in general practice would impact on community pharmacies and whether pharmacists should be able to prescribe within a general practice. It also asks about possible funding options.
“The survey aims to provide a greater understanding regarding the potential role of a pharmacist within the general practice environment,” Freeman said.
He estimates the 30-question survey will take about 10 minutes to complete.
The results, to be published in MJA InSight, are expected to be available in April.
– Kath Ryan
1. Practice Pharmacist-Doctor Survey.
2. Aust Fam Physician 2010; 39: 163-164.
Posted 21 February 2011
Most of us learn better on the job than from attending conferences, lectures or even at university. The real life experience + our basic education in university helps us hone our skills. Whilst RayT may be correct in saying that many pharmacists lack the skills, he really is saying that these pharmacists did not have the opportunity to hone the skills necessary to co-work with the doctor in private practice. A hospital-trained pharmacist will be different given that he/she works with the doctors all the time. Even here it depends in where the pharmacist has worked. If the pharmacist works mainly in dispensing rather than in clinical areas he/she would still be inadequate.
A good clinical pharmacologist may be more help than most pharmacists who, sadly, seem to know as much about the pharmaceutical items they dispense as about the “alternative treatments” they peddle. That said, I’ve known some very “on the ball” pharmacists, but they have been a minority.
Medication ‘reconciliation’, if it happens at all, tends to occur only on transition from one site of care to another, for example from GP to hospital and vice versa, or, more rarely, as part of an annual or semi-annual ‘brown bag’ review with the patient’s GP. In an ideal world, a patient would have a face-to-face review of every new prescription with a pharmacist. He/she would pick up prescribing errors, incompatibilities, allergies, etc, and help the patient use the medication correctly – acting as a safety net for the fallibility of the prescriber. A sledge-hammer to break a nut? I don’t think so. There are many published studies to show that errors of omission in prescribing (failure to monitor, failure to note contraindications, etc,) are as common as the wrong drug/wrong dose errors of commission.
After direct knowledge (cognitive) failures, the two biggest areas of patient harm in general practice are prescribing errors and failure of follow up. There are now some IT safety nets in both areas, but they are far from foolproof.
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I come from the UK, as part of a research project we had a clinical pharmacist working with us in our Primary Health Care Team. It was great. Her roles were many, discharge summaries – about 10% were shown to have errors in the drugs, patient education, assessing the claims of drug companies, direct patient contact with medication reviews and many other roles including keeping the GPs up to date with prescribing.
Yes.
It may benefit the patient if GP and pharmacist can agree on the best price and preparation of an agent for the appropriate condition as members of a multi-disciplinary team, if there is a need for such an arrangement.
It is not for a pharmacist to question the decision of the GP in front of a patient, though. Prescribing or recommending medicine by a pharmacist to a patient directly is not the job of a pharmacist.