Research in Social and Administrative Pharmacy 11 (2015) 590–591
Letter to the Editor
Legal cognitive requirements impact on pharmacy practice and patient outcomes Karin Svensberg, M.Sc.Pharm.a,*, Ingunn Bjo¨rnsdottir, M.Sc.Pharm., Ph.D.a, Sofia Ka¨lvemark Sporrong, Ph.D.b a
School of Pharmacy, Section of Social Pharmacy, Research Group Pharma-Safe, University of Oslo, P.O. 1068, Blindern, 0316 Oslo, Norway b Department of Pharmacy, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen, Denmark
To the Editor: Dispensing medications is among the core and most time consuming tasks of community pharmacists. Dispensing can be defined as the distribution of medications according to a prescription.1 Some aspects of the dispensing process, such as finding the right product to dispense or label, can be done by a robot. Nevertheless, the dispensing can also include important clinical and cognitive elements, i.e. identifying clinical errors and undertaking interventions to optimize patient outcomes. In those situations a pharmacist’s professional competence and judgment is needed to ensure optimal outcome and patient safety. We also know that pharmacists’ individual dispensing practice varies regarding i.e. kinds and amount of prescription interventions undertaken.2,3 Irrespectively of pharmacy system, the legislation constitutes a basis for the pharmacy professional’s work and autonomy. This subsequently impacts the comprehensiveness, content and the quality of the dispensing process. Exploring the regulatory frameworks’ requirements increases our understanding of policymakers’ intentions with regard to the clinical role of the community pharmacists and their autonomy during dispensing. Various countries throughout the world differ in their requirements of the prescription review
process for pharmacy staff during dispensing. We conducted a comparison of the Nordic countries’ (Denmark, Finland, Iceland, Norway and Sweden) legal demands of the dispensing process (except for counseling, which is described elsewhere4). The results showed that the countries legal cognitive requirements of the prescription review process and handling of interventions are diffuse and few. At least when compared to requirements regarding control of prescriptions for completeness; i.e. technical issues such as standard information on the prescriber and patient, and verification of the authenticity. Some cognitive areas mentioned for control are dosage accuracy and checking for interactions. Otherwise the pharmacist should judge and approve each prescription professionally, with no further definitions or guidelines. As a general rule in these countries, all identified clinical and technical problems should be discussed with the prescriber before a change takes place. Whereas for example Canadian pharmacists, in some situations, can independently change the dose or regime of a suboptimal prescribed medication to improve patient outcomes.5 The Nordic dispensing legislations, on the other hand, appear to limit the benefits the patients enjoy from the pharmacists’ medication expertise.
* Corresponding author. Tel.: þ47 22845549. E-mail address: [email protected] (K. Svensberg). 1551-7411/$ - see front matter Ó 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.sapharm.2015.01.003
Letter to the Editor / Research in Social and Administrative Pharmacy 11 (2015) 590–591
Questions can be raised regarding the cognitive role of the pharmacist during dispensing and who (should) decide pharmacists’ freedom of action therein. Which legislative framework is preferable for guaranteeing best possible patient outcomes, how detailed should regulations be, and what consequences does this have for the profession? Hence, more attention ought to be given in future discussions and research to the role of the legislation and its impact on the development of community pharmacist’s practice during dispensing. This could be a research field of great importance for the pharmacist profession’s future development. References 1. Online Oxford Dictionaries. Search Word: Dispense. Oxford University Press. Available at: http://www. oxforddictionaries.com/definition/english/dispense? q¼dispensing. Accessed January 2015.
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2. Mandt I, Horn AM, Ekedahl A, Granas AG. Community pharmacists’ prescription intervention practices-exploring variations in practice in Norwegian pharmacies. Res Social Adm Pharm 2010;6:6–17. 3. Benrimoj SI, Langford JH, Ward PR, et al. Clinical intervention rates in community pharmacy: a randomised trial of the effect of education and a professional allowance. Int J Pharm Pract 2003; 11:71–80. 4. Svensberg K, Sporrong Ka¨lvemark S, Bjo¨rnsdottir I. A review of countries’ pharmacist-patient communication legal requirements on prescription medications and alignment with practice: comparison of Nordic countries. Res Social Adm Pharm, 2015. http://dx. doi.org/10.1016/j.sapharm.2015.01.002. [Accepted manuscript]. 5. Canadian Pharmacists Association. Cross-jurisdictional Scan of Legislative and Policy Framework. Ottawa, Canada: Canadian Pharmacists Association, 2013. Available at: http://blueprintforpharmacy. ca/docs/kt-tools/blueprint_policy-framework_finald january-2013.pdf. Accessed January 2015.
Letter to the Editor
Legal cognitive requirements impact on pharmacy practice and patient outcomes Karin Svensberg, M.Sc.Pharm.a,*, Ingunn Bjo¨rnsdottir, M.Sc.Pharm., Ph.D.a, Sofia Ka¨lvemark Sporrong, Ph.D.b a
School of Pharmacy, Section of Social Pharmacy, Research Group Pharma-Safe, University of Oslo, P.O. 1068, Blindern, 0316 Oslo, Norway b Department of Pharmacy, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen, Denmark
To the Editor: Dispensing medications is among the core and most time consuming tasks of community pharmacists. Dispensing can be defined as the distribution of medications according to a prescription.1 Some aspects of the dispensing process, such as finding the right product to dispense or label, can be done by a robot. Nevertheless, the dispensing can also include important clinical and cognitive elements, i.e. identifying clinical errors and undertaking interventions to optimize patient outcomes. In those situations a pharmacist’s professional competence and judgment is needed to ensure optimal outcome and patient safety. We also know that pharmacists’ individual dispensing practice varies regarding i.e. kinds and amount of prescription interventions undertaken.2,3 Irrespectively of pharmacy system, the legislation constitutes a basis for the pharmacy professional’s work and autonomy. This subsequently impacts the comprehensiveness, content and the quality of the dispensing process. Exploring the regulatory frameworks’ requirements increases our understanding of policymakers’ intentions with regard to the clinical role of the community pharmacists and their autonomy during dispensing. Various countries throughout the world differ in their requirements of the prescription review
process for pharmacy staff during dispensing. We conducted a comparison of the Nordic countries’ (Denmark, Finland, Iceland, Norway and Sweden) legal demands of the dispensing process (except for counseling, which is described elsewhere4). The results showed that the countries legal cognitive requirements of the prescription review process and handling of interventions are diffuse and few. At least when compared to requirements regarding control of prescriptions for completeness; i.e. technical issues such as standard information on the prescriber and patient, and verification of the authenticity. Some cognitive areas mentioned for control are dosage accuracy and checking for interactions. Otherwise the pharmacist should judge and approve each prescription professionally, with no further definitions or guidelines. As a general rule in these countries, all identified clinical and technical problems should be discussed with the prescriber before a change takes place. Whereas for example Canadian pharmacists, in some situations, can independently change the dose or regime of a suboptimal prescribed medication to improve patient outcomes.5 The Nordic dispensing legislations, on the other hand, appear to limit the benefits the patients enjoy from the pharmacists’ medication expertise.
* Corresponding author. Tel.: þ47 22845549. E-mail address: [email protected] (K. Svensberg). 1551-7411/$ - see front matter Ó 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.sapharm.2015.01.003
Letter to the Editor / Research in Social and Administrative Pharmacy 11 (2015) 590–591
Questions can be raised regarding the cognitive role of the pharmacist during dispensing and who (should) decide pharmacists’ freedom of action therein. Which legislative framework is preferable for guaranteeing best possible patient outcomes, how detailed should regulations be, and what consequences does this have for the profession? Hence, more attention ought to be given in future discussions and research to the role of the legislation and its impact on the development of community pharmacist’s practice during dispensing. This could be a research field of great importance for the pharmacist profession’s future development. References 1. Online Oxford Dictionaries. Search Word: Dispense. Oxford University Press. Available at: http://www. oxforddictionaries.com/definition/english/dispense? q¼dispensing. Accessed January 2015.
591
2. Mandt I, Horn AM, Ekedahl A, Granas AG. Community pharmacists’ prescription intervention practices-exploring variations in practice in Norwegian pharmacies. Res Social Adm Pharm 2010;6:6–17. 3. Benrimoj SI, Langford JH, Ward PR, et al. Clinical intervention rates in community pharmacy: a randomised trial of the effect of education and a professional allowance. Int J Pharm Pract 2003; 11:71–80. 4. Svensberg K, Sporrong Ka¨lvemark S, Bjo¨rnsdottir I. A review of countries’ pharmacist-patient communication legal requirements on prescription medications and alignment with practice: comparison of Nordic countries. Res Social Adm Pharm, 2015. http://dx. doi.org/10.1016/j.sapharm.2015.01.002. [Accepted manuscript]. 5. Canadian Pharmacists Association. Cross-jurisdictional Scan of Legislative and Policy Framework. Ottawa, Canada: Canadian Pharmacists Association, 2013. Available at: http://blueprintforpharmacy. ca/docs/kt-tools/blueprint_policy-framework_finald january-2013.pdf. Accessed January 2015.
