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Pharmaceutical care will soon be widely practised across the UK and elsewhere, according to Professor Linda Strand

Professor Strand, vice president of Medication Management Systems and professor emerita at the University of Minnesota, urged delegates at last month's Pharmacists' Defence Association conference in London to take advantage of the opportunities that pharmaceutical care offered, or else risk losing out. She said: €The fact that you're not doing it today puts you behind. I believe we're all going to have the same healthcare system. The world is getting smaller €“ a patient care service that works in the US will work here, I can guarantee it.€

Pharmaceutical care was now being widely adopted in the United States. And many of the concepts linked to pharmaceutical care might also soon be adopted by NHS England, because its new chief executive, Simon Stephens, had previously worked with her while he was chief executive of United Healthcare in the US. Mr Stephens was likely to bring trend management opportunities such as population risk stratification, care management services, contracting initiatives, episodes of care and capitation fees from the US to England, said Prof Strand. €Our systems are going to look way closer than they do today.€

The PDA has been working with Professor Strand in developing its Road Map vision for the future of pharmacy, which was based upon pharmaceutical care. It was, she said, a model that had recently been adopted by the Scottish Government in its Prescription for Excellence practice vision. And it was a new standard of care that pharmacists would be held to, she told delegates at the PDA conference on April 6.

Reclaiming professional territory

Pharmacists had to bring value to patients, said Prof Strand. €We're the profession that's supposed to be protecting people from drug therapy problems and we're not. If you really want to reclaim your professional territory, quit talking about it and start doing it. Drug therapies represent more than 85 per cent of treatment modalities in both our countries, so if we don't have control of medicines we don't have control of patients.€

Pharmaceutical care had achieved return on investment levels of 12:1 in US studies. This compared with returns from vaccination of 4 or 5:1. Prof Strand and colleagues had documented the pharmaceutical care of nearly a million patients in the US and the findings turned some common assumptions on their head. €The problem that pharmacy has focused on really isn't the main problem at all. We've been told that we live in over-medicated societies and that's not true, but we do exist in inappropriately medicated societies. Almost a third of our patients required more drug therapy. But that's not to say we didn't take drug therapy away as well.€

The US studies had revealed that non-compliance levels were as low as 14 per cent, dosages were too low in 23 per cent of cases, and 34 per cent of patients required additional drug therapy. Only 5 per cent of patients were taking unnecessary drug therapy, and adverse drug reactions had only been found in 11 per cent of patients.

Don't focus on compliance

Dosages were often too low because in a litigious society doctors were concerned about triggering adverse drug reactions. And non-compliance was relatively low because pharmaceutical care required looking for problems and solving them in chronological order. This meant that there was no need to look for problems if a drug was not indicated in the first place. €If you're trying to improve compliance when the patient is on an inappropriate, ineffective and unsafe medication you're part of the problem and not part of the solution,€ Prof Strand said.

Pharmacists must put the patient first if they wanted doctors to listen to them, said Prof Strand. And they must have reproducible standards of care if they wanted to sell the service. Thousands of US pharmacists were paid for practising pharmaceutical care because their standards were uniform. €When physicians don't know what to expect they don't trust us.€

Prof Strand outlined five standards necessary to deliver successful pharmaceutical care. The service must:

1. Be described simply, in terms of what it could do for the patient 
2. Be based on standards of care so that it could be delivered consistently from one practitioner to the next, and from one patient to the next
3. Integrate with the rest of the healthcare team in terms of consistent terminology, philosophy, care process and standards of practice
4. Be able to generate measurable results, which were reproducible
5. Be paid for in the same way that patient care was reimbursed. Pharmacists must provide unique added value if their services were to be adopted into a wider healthcare system.

€Don't provide things like vaccinations, because someone else can do those things better. Just manage patients' medication and do it well.€