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Editorial International Journal of
Pharmacy Practice International Journal of Pharmacy Practice 2014, 22, pp. 373–374
Integrating pharmacy services in primary care Marcel L. Bouvy Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands. ([email protected])
doi: 10.1111/ijpp.12160
The economic crises of 2008 alerted governments worldwide that healthcare reforms cannot be postponed any longer. In many countries, the ageing of the society, the rise in noncommunicable diseases and the concurrent advancement in medical possibilities has led to significant increases in health expenditure to the extent that for the past decade they have exceeded growth in the gross domestic product. Recently policymakers in The Netherlands predicted that within the next few decades, a Dutch family with an average income will spend half of its income on health care. It is clear that this is not sustainable. Concurrently, there is a shortage of qualified healthcare personnel in many countries. The UK National Health System recruits doctors from a range of overseas countries to fill vacancies. It is disappointing that under these circumstances the potential of pharmacists remains underutilized. Policymakers have proposed several ideas to stop this‘overgrowth’ of healthcare expenditures. Cost containment by increasing co-payments or impeding the accessibility of health care may have some effect in the short term but does not give sustainable improvements. It is increasingly apparent that healthcare systems have to be organized in a different way. Costs incurred initially as a result of decisions made in secondary care can lead to long-term increases in primary care costs once patients are discharged. Patients with uncomplicated type II diabetes or hypertension, e.g. do not have to be treated by hospital physicians, but could be treated in primary care by general practitioners. Unfortunately, there is already concern about how GPs can manage their current workload, and shifting more care from secondary to primary care setting may not be an option with current workforce configurations. This is where pharmacists have ample opportunity. Studies have repeatedly shown that drug-related problems are major causes of unnecessary patient harm, often resulting in hospital admissions with resultant increased direct and indirect health costs. Pharmacists in all settings should in the opinion of Dutch policymakers increasingly work as healthcare providers in close cooperation with physicians and nurses. This policy fits in a worldwide trend in healthcare reform that is often referred to as integrated care
© 2014 Royal Pharmaceutical Society
but also has been described in different terms such as comprehensive care, seamless care or transmural care. Integrated care should solve many of the problems caused by the fragmented delivery of healthcare services. Pharmacists can play an important role both in horizontal integration (close cooperation with GPs in primary care and with consultants in the hospital setting) and in vertical integration (facilitating the safe transfer of patients between primary and secondary care). The latter process is known to cause a plethora of drug-related problems and associated unnecessary healthcare utilization. Better cooperation and communication between physicians and pharmacists is expected to improve patient outcomes.[1] Especially in primary care, integration between GPs and pharmacists has many barriers. In several countries small steps are taken to stimulate the cooperation between pharmacists and GPs, such as recommending the use of one community pharmacist to be responsible for the pharmaceutical care of the patient. Pharmacists’ access to medical information is very important to improve their role as healthcare provider. In The Netherlands, legislation has been adapted to grant pharmacists access to important medical information such as the reason for prescribing and laboratory values that are needed to interpret safe use of medication (e.g. renal function and electrolytes).[2] This is also happening in the UK. The ultimate goal would be to have all healthcare providers working from the same patient record, with possibly different levels of read and write access according to provider type, e.g. doctor, nurse or pharmacist. What are the implications of these developments for practice research? First, we should give high priority to research focused on improving collaboration between pharmacists and physicians. Observational studies can provide insights into areas for targeting. Robust intervention studies can show the added value of pharmacists. Furthermore, it is important that the specific expertise of the pharmaceutical profession is defined, and pharmacists are not seen as second best. Pharmacists have a specialized knowledge about the pharmacological and pharmaceutical properties of medicinal products. We have to promote this knowledge in order to become a recognized member of the integrated healthcare team.
International Journal of Pharmacy Practice 2014, 22, pp. 373–374
374
References 1. Kwint HF et al. The relationship between the extent of collaboration of general practitioners and pharmacists and the implementation of recommendations
© 2014 Royal Pharmaceutical Society
Editorial
arising from medication review: a systematic review. Drugs Aging 2013; 30: 91–102. 2. Holsappel IG et al. Prescribing with indication: uptake of regulations in current practice and patients opinions in
the Netherlands. Int J Clin Pharm 2014; 36: 282–286.
International Journal of Pharmacy Practice 2014, 22, pp. 373–374
Editorial International Journal of
Pharmacy Practice International Journal of Pharmacy Practice 2014, 22, pp. 373–374
Integrating pharmacy services in primary care Marcel L. Bouvy Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands. ([email protected])
doi: 10.1111/ijpp.12160
The economic crises of 2008 alerted governments worldwide that healthcare reforms cannot be postponed any longer. In many countries, the ageing of the society, the rise in noncommunicable diseases and the concurrent advancement in medical possibilities has led to significant increases in health expenditure to the extent that for the past decade they have exceeded growth in the gross domestic product. Recently policymakers in The Netherlands predicted that within the next few decades, a Dutch family with an average income will spend half of its income on health care. It is clear that this is not sustainable. Concurrently, there is a shortage of qualified healthcare personnel in many countries. The UK National Health System recruits doctors from a range of overseas countries to fill vacancies. It is disappointing that under these circumstances the potential of pharmacists remains underutilized. Policymakers have proposed several ideas to stop this‘overgrowth’ of healthcare expenditures. Cost containment by increasing co-payments or impeding the accessibility of health care may have some effect in the short term but does not give sustainable improvements. It is increasingly apparent that healthcare systems have to be organized in a different way. Costs incurred initially as a result of decisions made in secondary care can lead to long-term increases in primary care costs once patients are discharged. Patients with uncomplicated type II diabetes or hypertension, e.g. do not have to be treated by hospital physicians, but could be treated in primary care by general practitioners. Unfortunately, there is already concern about how GPs can manage their current workload, and shifting more care from secondary to primary care setting may not be an option with current workforce configurations. This is where pharmacists have ample opportunity. Studies have repeatedly shown that drug-related problems are major causes of unnecessary patient harm, often resulting in hospital admissions with resultant increased direct and indirect health costs. Pharmacists in all settings should in the opinion of Dutch policymakers increasingly work as healthcare providers in close cooperation with physicians and nurses. This policy fits in a worldwide trend in healthcare reform that is often referred to as integrated care
© 2014 Royal Pharmaceutical Society
but also has been described in different terms such as comprehensive care, seamless care or transmural care. Integrated care should solve many of the problems caused by the fragmented delivery of healthcare services. Pharmacists can play an important role both in horizontal integration (close cooperation with GPs in primary care and with consultants in the hospital setting) and in vertical integration (facilitating the safe transfer of patients between primary and secondary care). The latter process is known to cause a plethora of drug-related problems and associated unnecessary healthcare utilization. Better cooperation and communication between physicians and pharmacists is expected to improve patient outcomes.[1] Especially in primary care, integration between GPs and pharmacists has many barriers. In several countries small steps are taken to stimulate the cooperation between pharmacists and GPs, such as recommending the use of one community pharmacist to be responsible for the pharmaceutical care of the patient. Pharmacists’ access to medical information is very important to improve their role as healthcare provider. In The Netherlands, legislation has been adapted to grant pharmacists access to important medical information such as the reason for prescribing and laboratory values that are needed to interpret safe use of medication (e.g. renal function and electrolytes).[2] This is also happening in the UK. The ultimate goal would be to have all healthcare providers working from the same patient record, with possibly different levels of read and write access according to provider type, e.g. doctor, nurse or pharmacist. What are the implications of these developments for practice research? First, we should give high priority to research focused on improving collaboration between pharmacists and physicians. Observational studies can provide insights into areas for targeting. Robust intervention studies can show the added value of pharmacists. Furthermore, it is important that the specific expertise of the pharmaceutical profession is defined, and pharmacists are not seen as second best. Pharmacists have a specialized knowledge about the pharmacological and pharmaceutical properties of medicinal products. We have to promote this knowledge in order to become a recognized member of the integrated healthcare team.
International Journal of Pharmacy Practice 2014, 22, pp. 373–374
374
References 1. Kwint HF et al. The relationship between the extent of collaboration of general practitioners and pharmacists and the implementation of recommendations
© 2014 Royal Pharmaceutical Society
Editorial
arising from medication review: a systematic review. Drugs Aging 2013; 30: 91–102. 2. Holsappel IG et al. Prescribing with indication: uptake of regulations in current practice and patients opinions in
the Netherlands. Int J Clin Pharm 2014; 36: 282–286.
International Journal of Pharmacy Practice 2014, 22, pp. 373–374
