Professional pharmaceutical care - what it is in practice and what benefits it brings to patients
Pharmacists have been lobbying for a long time to have a law adopted that would cover their vocational group. It was successful and the Pharmacist Profession Bill entered into force over two years ago. Did that law really foster change in this profession?
The Pharmacist Profession Bill is an essential and significant law, codifying fundamental matters for the functioning of the profession. Firstly, the bill clearly classifies the profession of pharmacist among medical professions, which has numerous consequences, including privileges as well as obligations. A pharmacist is given full professional autonomy and integrity. They are becoming more of an expert in pharmacotherapy. The legal changes have finally enabled pharmacists to put the knowledge learned during their studies into practice. What matters is that due to that bill, a new career path opens before pharmacists, leading towards medical services. Summing up: there has never been such great change at such a rapid pace before.
Other than the law, what other factors contributed to these changes?
The pandemic was also a factor. The time of the pandemic enforced certain changes that used to seem unfeasible for years. The draft Pharmacist Profession Bill stipulated that a pharmacist will be able to administer all kinds of vaccines – this claim was powerfully resisted, after all a pharmacist was not even allowed to touch a patient, not to mention to affect skin tissue. This resistance was overcome soon afterwards – with the pandemic, trained pharmacists were permitted to administer COVID-19 vaccines. They are authorized to give pro auctore and pro familiae prescriptions and they have extended options to issue pharmacist prescriptions, not only in life threatening situations but also in cases of threats to health.
The law stipulates that the performance of a pharmacist’s job involves, among other things, providing pharmaceutical care. Does this refer to vaccines and to prescribing drugs?
No, absolutely not. The Pharmacist Profession Bill stipulates that pharmaceutical care comprises a broad range of pharmacist advice, medication reviews, building an individual pharmaceutical care plan, selected diagnostic tests for evaluation of treatment and analysis of drug-related issues, as well as prescribing medications as continuation of a doctor’s order.
It should be emphasized that pharmaceutical care is based on collaboration. A pharmacist has to collaborate with the patient and the doctor. A pharmacist supports the patient in following the doctor’s orders, observes certain issues the patient may have with taking their medication, identifies drug interactions or doubled products prescribed by different specializations as a consequence of the patient not informing their new doctors about the drugs they are taking already. Furthermore, pharmaceutical care consists of monitoring the patient’s treatment objectives and suggesting the right time to see a doctor. Preventative care also has a huge role to play here.
Work is currently pending at the Polish Chamber of Pharmacists on the standards for various pharmaceutical care services, whereas the Polish Pharmaceutical Society published its guidelines on handling drug reviews. It demonstrates the fundamental importance of collaboration between the vocational self-government and the academic circles.
A postgraduate course in “Professional Pharmaceutical Care” has been opened at the WUM Medical University of Warsaw. Why the “professional” part?
Pharmacists used to provide pharmaceutical services involving pharmaceutical interviews or consulting patients based on intuition. This intuition is good, but pharmacists often lack proficiency in the tools and procedural algorithms necessary for providing the extensive range of care as defined in the law. Through our postgraduate studies, we intend to strengthen pharmacists’ competences by expanding their toolset so that their work is systematic, based on evidence and repeatable procedures.
Is the increasing involvement of pharmacists in pharmaceutical care a response to medical staff shortages and problems with accessibility of medical doctors?
I do not think this is the right perspective. First of all, taking responsibility for catering to the patient’s drug-related needs and overseeing pharmacotherapy is what pharmacists should be doing, it is our unique role in the system and not an attempt at replacing other members of the patient care system. Hence, a pharmacist is not the doctor’s competitor or replacement. A pharmacist is the doctor’s partner, and both doctors and pharmacists need to learn how to pursue this partnership so that the pharmacist’s involvement is ultimately most beneficial for the patient.
What are the advantages of such care for the patient?
On one hand, measures undertaken as pharmaceutical care serve to improve the quality of life, to avoid hospital stays, to prolong the lives of the persons coming to a pharmacy. On the other hand, they have their educational role, and a well educated patient is informed and committed to their treatment. Finally, a patient receiving good care will be satisfied with their treatment.
What are your role models in pharmaceutical care development?
We want to participate in building our proprietary Polish model, tailored to the local environment. We learn from the experiences of other countries, we have a pharmacist in our team who has the experience of working in the United Kingdom. However, the British model is not the only one. Pharmaceutical care is growing rapidly in all English-speaking countries as well as elsewhere in Europe and globally. Intensive work is pending at the moment on the standards of pharmaceutical care at the Council of Europe. We follow the activity of the European Directorate for the Quality of Medicines (EDQM) relating to the implementation of pharmaceutical care in Europe and we intend to take what’s best from these. However, it is not our intention to copy off-the-shelf solutions; rather, we intend to adapt the existing projects. Even though theoretical models and assumptions are very important, we focus mainly on practical experience.
What will pharmaceutical care look like in practice?
In practice, pharmaceutical care is highly diversified, just like the range of services it encompasses. A lot depends on where it is offered. Even though a pharmacy is the main point of care, we should emphasize that it is pharmacist-specific and not pharmacy-specific, so that pharmacists will be authorized to open their individual pharmaceutical care centers in the future. But regardless of the location, it is always good to start with the services for which standards and procedures have already been developed, such as Nowy Lek (New Drug) or drug reviews; as new competences and self-confidence appears, this range should be extended with further interactions according to local needs. My proposal is to proceed in small steps, as it works both for patients and for pharmacists.
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Interviewed by Iwona Kołakowska
Photo by Michał Teperek
University Communication and Promotion Office