Published by Computachem Services

P.O Box 297.
Alstonville. 2477
NSW Australia

Phone:
61 2 66285138

From the days in pharmacy when I accepted a bunch of scripts with the request "I'll have one of each" with no thought as to the necessity, the cost or what this hotch botch of drugs was doing to the requester I have been determined to address the whole issue of Quality Use of Medicine as a pharmacist.
These were the days of 'free' medicine to the patient so it was a seemly time ago. Nevertheless this situation still occurs despite the "free" bit going and the challenge is to analyse and understand the various causative factors that preclude QUM and to address them.

I am happy to report now that I am in a position to do something towards a changed culture in managing the QUM programs in the Division of General Practice in the later part of my career as a pharmacist.
To start with there is now an awareness of the pitfalls of neglecting QUM issues in the community and perhaps a greater fervor in addressing the costs to the community by improving quality use of medicine.
QUM was not even thought of when I accepted and grudgingly dispensed the myriad potions and pills in those days.
Older pharmacists will remember the buckets - literally- of potions we mixed up.
Some made from grizzled up roots and the orange peel from our lunch!
And then the cough mixtures - enough to make you choke!
And on and on it went - corks in small eye drop bottles - never sterilised and gooy ointments and smelly liniments.
And to top it off there was a preserved mystery in all of this as each was labeled with its generic description of "The Mixture" or "The Ointment" or "The Tablets".
No wonder the poor patient asked for one of each - there was no knowing which was which and I bet they knew very little of what each was for.
Ignorance was bliss and trust in the doctor next to godliness.
Funny that so little of this medication is known or used today?
How much of what is prescribed and dispensed today will be with us in another 30 years?
Do you ever wonder?
When I visited a museum with a lovely old pharmacy in Benalla a few weeks ago I was transported back to a romantic and fascinating time - a bit before my time - but it bought back memories of the pharmacy I began my career in and I have to admit there was a certain pleasure in it all that is lost these days.
I question if we have progressed when I hear reports of pharmacists 'dispensing' up to 400 scripts a day.
At least they are named I suppose and the customer who is paying just gets what they want.
Presumably they know about their medicines although with 400 scripts to do in a day I can imagine they are not counseled much.
A QUM issue is then the pressure to dispense.
Also to prescribe.
Many patients still present to their equally busy GPs with what amounts to shopping list of scripts they require.
And then there are the patient's expectations of what they want to take.
Antibiotics for the sore throat they are suffering or the child's sore ear.
It takes time to educate and convince a patient of a perceived need that can be addressed in another more appropriate, evidence-based manner.
It takes time to persuade the young man with a high cholesterol that a change in diet and exercise will reduce his low risk of a cardio vascular event to an even lower risk and avoid his initiation of a lipid lowering drug for life with its attendant unknown long term safety or the minor side effects that will change his mind in 6 months down the track anyway.
A QUM issue is then for an increase in time to talk to patients at the prescribing time and also at the dispensing time.
Time is money, so QUM costs.
Are these costs outweighed by the benefits?
To make QUM decisions the GP must be informed by the most evidence based data on the condition prescribed for.
The National Prescribing Service (NPS) through the Divisions of General Practice across the country provides a program of Practice visits to GPs to inform them of this independent evidence.
It is most satisfying as one of these GP visitors to engage in a one to one conversation with a GP offering well researched materials and patient 'life scripts' that will modify prescribing behaviors towards a QUM agenda.