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The AJP paper
outlines a study where 10 community pharmacists, after a suitable
training programme, collaborated with 37 general practitioners
in 10 practices to offer a range of specific pharmacy services.
These ranged from adherence assessment to medication reviews to
preventative care services depending on the patient's need.
A very positive outcome resulted from this process but much of
the success was dependent on having an outside body "run
with the concept" and adequately funding ($80/hour) the pharmacists.
As far as I'm concerned, until local medical practitioners can
be persuaded that it is worthwhile actually paying pharmacists
to work for them there will continue to be difficulties in increasing
pharmacy cognitive inputs in GP practice on an ongoing basis.
This brings to mind a similar case in Adelaide where DVA set up
a study attempting to increase uptake of medication reviews for
veterans.
The SA State Office employed a doctor to head up the trial group
that created a framework within which local medical officers could
refer appropriate veterans to accredited pharmacists for MMRs.
The trial proved very successful, with this particular group of
doctors generating over half of the referrals in the country,
while it was running.
There were some storm clouds however, with some of the participating
doctors, while admitting that the results of the reviews were
proving to be of benefit, still questioning whether pharmacists
should be doing more than just dispensing scripts!
It is an unfortunate fact that, once DVA stopped doing most of
the administrative work, the number of referrals dropped back
to almost nothing after the trial ended.
Once again, unless there is an outside body driving the collaboration
between doctors and pharmacists it seems that "never the
twain shall meet".
Why is it that the "tribes" within the health sector
appear to have trouble working together?
Many nurses dislike the medical profession, doctors rail about
nurses trying to diagnose medical conditions, pharmacists look
to be wound care experts in opposition to the nursing profession,
doctors seem to have a block against accepting advice from pharmacists,
nurses want to prescribe and dispense medicines, etc.
It appears that no-one in health wants to work with, and accept
the specific expertise of anyone else. Where is the patient in
all this?
Often, sitting on the periphery of the fight wondering "what
the hell is wrong with this mob?"
I get tired of the mantra "the patient comes first"
when in most cases it is actually "me and my colleagues come
first".
Possibly I'm becoming jaded by the continual infighting between
the health professions, all trying to protect their little patch?
Never mind, I'll keep the words of the Sinatra song in mind and
continue to have "High Hopes" that pharmacy will find
a way to gain acceptance (and payment) as a source of cognitive
knowledge.
I'm lucky, my DVA business card says "Pharmacy Adviser"
so I suppose my total income is generated by my professional knowledge.
Unfortunately there are not many of us in Australian pharmacy
who can make such a statement.
PS. It seems
that even in the home of the Practice Pharmacist (the UK) there
is some soul searching about the efficacy of the service.
In a recent "Pharmacy Journal" there was a comment that
the major role of the practice pharmacist seemed to be in controlling
drug costs, with cognitive services coming a poor second!
Oh well, another bubble burst.
Suppose we will have to fight the good fight and see if the OFT
recommendations are taken up in the UK bring about a change in
thinking.
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KEN STAFFORD