Pharmacists - adherence superheroes?
An interesting national program in New Zealand aims to change the focus of pharmacists from mainly dispensing services to delivering the clinical skills these healthcare professionals have been trained to have more effectively and appropriately.
By on May 19, 2009An interesting national program in New Zealand aims to change the focus of pharmacists from mainly dispensing services to delivering the clinical skills these healthcare professionals have been trained to have more effectively and appropriately.
The national framework of pharmacists services launched in 2007 provides specifications for five key expanded services.
Under the framework, pharmacists incorporate medicine dispensing with:
Medicine use review and adherence support where pharmacists work with patients to review their understanding of their medication and to check whether they are taking it properly.
Medicine therapy assessment where pharmacists review the medication a patient has been prescribe and makes recommendations regarding any changes that may optimize therapy for that patient.
Comprehensive medicines management which involves a more comprehensive assessment and may involve pharmacist prescribing.
Health education services for the public which involves pharmacists in health education campaigns, such as stop smoking efforts.
Medicines clinical information support for doctors/prescribers
Those behind the programs in New Zealand say the increasing and differing needs of the countrys population groups such as those with acute medication needs, long-term conditions and specific disease and public health programs can be better met with the new service structure.
And a new study in the April 2009 Journal of Allergy and Clinical Immunology strongly supports that theory. The report from a team of researchers at the University of California, San Francisco says asthma patients who spend as little as 30 minutes with a healthcare professional in a clinical setting to develop a personalized self-management plan show improved adherence to medications and better disease control.
Tailored education, the group says, is more effective than standardized programs because patients find it more personally relevant. In a 24-week randomized, controlled trial to determine if individualized instruction in asthma self-management adds significantly to the effects of self-monitoring alone on patient adherence to inhaled corticosteroids, 84 adults self-monitored their symptoms. Among them, 45 were randomly selected to receive a personal 30-minute session that included asthma information, personally relevant allergen exposure reduction, a personal action plan and instruction on the correct use of their inhalers.
The studys authors say many with asthma dont receive the full advantage of their inhalers because they dont breathe deeply enough or sometimes swallow the medication. And different models of inhalers require different techniques to operate effectively. A personalized approach helps patients develop skills specific to their own allergies, the researchers say.
Adherence is consistently higher, the group says, within the intervention groups.
This is just the kind of role that pharmacists are uniquely positioned through their training and close proximity to patients to play. It is a vantage point that offers a unique connection to patients and a clinical skill set that has largely gone untapped which clearly could stand to make profound differences in patient adherence and healthcare outcomes that we can no longer afford to overlook.
How long can we afford to let these frontline experts go under-utilized and waiting on the sidelines as we battle to improve adherence with perhaps less intelligent and effective approaches? It's time to put pharmacists in the game for more than just dispensing medications.