What is Pharmaceutical Care?
Pharmaceutical care, or a more intensive patient follow-up by the pharmacist, can be described as guaranteeing that the patient uses his medication as correctly, efficiently and safely as possible. The pharmacist, trained as an expert in medicines, is the last health care provider to be in contact with the patient during the start-up or continuation of a drug, and at the same time he is also his first point of contact with respect to questions about the medicine. He can therefore inform and supervise the patient – in addition and in consultation with the physician – with respect to the correct use of medicines, medication adherence and self-medication.
In concrete terms, pharmaceutical care in the community pharmacy consists of the following activities:
Advice in case of prescribed medicines
The pharmacist provides information on the patient’s treatment when delivering the prescribed medicines. It has in fact been demonstrated (and it is clear from practice) that the patient actually remembers only a fraction of the explanation given by the physician because he has to process a lot of information during a visit to the doctor. It is therefore recommended that this message, in the first place with respect to the correct use of the medicines, is repeated by the pharmacist, so that the medicines prescribed by the doctor are used as correctly, safely and efficiently as possible. For example: pharmaceutical care in case of asthma includes the teaching of the correct use of inhalers and the encouragement of medication adherence with respect to the maintenance medication.
Advice in case of self-care medicines
Patients with mild health complaints often go to the pharmacist for an OTC medicine before they consult a doctor. In such cases of requests for advice, the pharmacist should be able to evaluate the complaints correctly and he has to distinguish between complaints that require him to refer to a doctor and complaints that can be dealt with by self-medication. In the latter case it is the intention that the pharmacist helps the patient to make a rational, evidence-based choice within the range of available OTC medicines and that he provides him or her with professional self-care advice.
Avoiding medication errors
In order to reduce the risk of medication errors as much as possible, the pharmacist actively traces (clinically relevant) drug interactions, he is alert for prescription errors and keeps an eye on cases of self-medication by patients (e.g. self-medication with OTC-NSAID medicines in patients using oral anticoagulation).
Health education and prevention
Pharmaceutical care also implies that health education and prevention is carried out in the pharmacy (orally and/or written by means of posters/folders). This can be done by encouraging vaccination (e.g. influenza vaccination in risk groups), providing support in the detection of diseases (e.g. diabetes) and by referring the patients when complications of existing diseases occur or worsen (by stimulating e.g. diabetes patients to go for regular foot and eye examinations). It is recommended to work out regional arrangements between doctors and pharmacists with respect to such health education in order to provide the patient with an unambiguous message.
Cooperation with the (family) doctor
Pharmaceutical care is a form of multidisciplinary cooperation, which means that pharmacist and physician (and possibly other care providers) join forces to arrive at an optimal treatment of the patient.
For a number of specific items, concrete deliberation with the (family) doctor is possible:
- Repetition of the same message to the patient with respect to the use of medicines, dissuasion of use (e.g. in case of abuse), life style, food, …
- Informing the doctor and assisting in drug-related problems (e.g. side effects, interactions, abuse of medication, …).
- Consultation with respect to generic medicines (e.g. what to do if a prescribed generic drug is not available).
- Agreements with respect to stand-by duty.
- Referring patients from the pharmacy to the family doctor in case of certain complaints (cp. self-care) or drug-related problems.