Medical care and drug-related problems: Do doctors and pharmacists speak the same language?

Optimal communication between physicians and pharmacists is important for patient care. However, pharmacists and doctors do not always seem to understand each other. They have been professionalized differently, and do not always speak the same language. Especially in the areas of prescribing, medication review, and medicine use, there can be differences in views. This contribution clarifies some essential concepts that doctors and pharmacists use. Thus we hope that our commentary contributes to a better understanding of each other's role and the importance of interprofessional cooperation for the benefit of the patient.

Comparative effectiveness research: evaluating pharmacist interventions and strategies to improve medication adherence.

One very effective strategy to achieve good blood pressure (BP) control in primary care is the use of physician/pharmacist collaborative management. Interventions by pharmacists in both community pharmacies and primary care clinics have been shown to significantly reduce BP by both improving medication adherence and intensifying medications. This review will evaluate the strengths and weaknesses of various health services' research study designs that assess various pharmacy interventions to improve BP control. We will also evaluate strategies to measure medication adherence used in research studies, and in some cases, clinical practice. Although poor medication adherence is a major cause of inadequate BP control, suboptimal medication regimens are often more common reasons for poor BP control in typical primary care practice. This review proposes strategies to implement stronger interventions and more robust study designs in comparative effectiveness trials that evaluate team-based care for improving BP control.

Inappropriate drug use by Portuguese elderly outpatients--effect of the Beers criteria update.

OBJECTIVE: To characterize the use of medicines and to evaluate the inappropriateness of drugs in elderly outpatient population. SETTING: Twelve community pharmacies in different districts of Lisbon-Portugal. METHOD: Observational cross-sectional survey, in a sample of 213 elderly outpatients (age>or=65-years-old) presenting a prescription with two or more drugs, for their own use. MAIN OUTCOME MEASURES: Drug use pattern and prevalence of potentially inappropriate medication. RESULTS: We have studied 213 outpatients, who were taking a total of 1,543 drugs, with an average of 7.23 per patient. The drugs were distributed mainly in the following 3 ATC (Anatomical Therapeutic Chemical Classification) classes: C (cardiovascular system), N (nervous system) and A (alimentary tract). Using the 1997 Beers Explicit criteria, 75 occurrences of inappropriate medicines were detected in 59 patients (27.7%), while with the 2003 Beers Explicit criteria we detected 114 cases of inappropriate medication in 82 patients (38.5%). The occurrence of inappropriate medicines was significantly associated with the consumption of a high number of drugs. According to the ATC Classification, more than one half of the cases of inappropriateness were related with long acting benzodiazepines and with ticlopidine. The 2003 version detected a significantly higher prevalence of inappropriate drug use having potentially adverse outcomes of high severity. CONCLUSIONS: The application of the updated Beers criteria lead to higher rates of potentially inappropriate medication, and especially those responsible for more severe adverse outcomes. The results suggest that there is a need for interventions to improve instructions for safe drug use in the elderly patients and to decrease the number of medications whenever it is possible. This study suggests a high prevalence of potentially inappropriate drug use by the elderly patients of Lisbon region, Portugal.

Atención farmacéutica en Holanda, trabajo en equipo para el paciente / Pharmaceutical Care in the Netherlands, teamwork for the patient

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Atención farmacéutica en farmacia comunitaria en europa, retos y barreras / Pharmaceutical Care in Community Pharmacy in Europe, challenges and barriers

El concepto de la Atención Farmacéutica se ha introducido en la mayoría de los países durante la conferencia de la FIP en Tokyo en 1993, en el programa de formación continuada de la sección de farmacia comunitaria. De algún modo esto también abrió el debate sobre la definición de la Atención Farmacéutica. ¿Es la atención sobre los medicamentos o la atención proporcionada por farmacéuticos? La Atención Farmacéutica parece ser la filosofía práctica de los farmacéuticos comunitarios en la mayor parte de los países de la Europa occidental. El concepto en la Atención Farmacéutica se basa fundamentalmente en unos conocimientos básicos y algunas habilidades. Los conocimientos y las habilidades son analizadas en este artículo.Las asociaciones farmacéuticas en la mayor parte de los países avanzan y actualmente tratan de estimular a sus miembros a proporcionar Atención Farmacéutica a sus clientes. Si tienen éxito dependerá de dos factores. Uno es el hecho de que en el campo de la sanidad todavía está pendiente la prueba del efecto de la Atención Farmacéutica. El otro factor es la magnitud de las barreras de implantación experimentadas por los farmacéuticos.La investigación de la PCNE (Pharmaceutical Care Network Europe) sobre las barreras de implantación mostraron que la formación del farmacéutico es una de las importantes. Hay países donde la farmacia clínica, las habilidades de comunicación, la farmacia social o los sistemas sanitarios no son parte (todavía) de la formación de la farmacia comunitaria. Otras barreras de la implantación pueden encontrarse en el campo de los recursos, habilidades y actitudes, fuera del entorno sanitario (AU)

The concept of Pharmaceutical Care has been introduced to most European countries during the I993 FIP conference in Tokyo, at the continuing professional development program of the community pharmacy section. ln a way this also started the debate on the definition of pharmaceutical care. ls it «care around pharmaceuticals» or «care delivered by Pharmacist»? Pharmaceutical care appears to become the practice philosophy of community pharmacists in most western European countries. The concept of pharmaceutical care is largely based upon a defined knowledge base a number of skills. The required knowledge and skills are analyzed in the article. The pharmacists' organizations in most countries are moving forward and currently try to stimulate their members to deliver pharmaceutical care to their clients. If they will succeed, depends on two factors. One of these factors is the fact that the field of health care is still waiting for the proof of the effect of pharmaceutical care, which has not been sufficiently disseminated due to a lack of good publication platforms. The other factor is the magnitude of the implementation barriers experienced by the pharmacists in the field. The PCNE (Pharmaceutical Care Network Europe) investigation into implementation barriers shOWed that the pharmacist education is an important one. There are countries where clinical pharmacy, communication skills, social pharmacy or health systems are no part (yet) of the community pharmacy education. Other implementation barriers can be founding the field of resources, skills and attitudes, apart from the health care environment (AU)