Elizabeth Plant: Pharmacists step up as drug therapies get more complex

Medication is an increasingly complex area and is growing all the time. In the lifetime of a 50-year-old, the number of medication choices able to be prescribed and dispensed has risen from about 250 to more than 4000. Every year there are new and increasingly complex medications being developed.

People are on a number of medicines not just for the treatment of diseases but also to prevent them from developing likely conditions. Medication will not have their most beneficial effect for patients unless they are optimally prescribed and patients take them as prescribed.

Services which improve the appropriate use of medication have the potential to benefit patients directly, by improving their health status, and indirectly, by freeing up health system resources for more productive uses.

Health Minister Tony Ryall believes pharmacists are underutilised and the pharmacy sector agrees with him. New Zealand research has found that 13 per cent of all hospital admissions are related to adverse medical events. A total of 50 per cent of people don't take their medication properly, 19 per cent either skip their repeats or do not get their prescriptions filled, and about 1.5 per cent of all hospital admissions are related to drug therapy problems originating in the community.

These are very real and significant problems and they are not able to be best addressed with the way health and pharmacy services are currently structured and delivered in New Zealand.

District Health Boards (DHBs) identified this in 2005 and invested in developing a national framework of pharmacist services with the aim of changing the current focus of pharmacists providing mainly dispensing services to using them much more for the clinical skills they have been trained to have and should be using.

The framework was launched in 2007 and identified a number of new pharmacist services and provides the DHBs with the opportunity to address the challenges of poor management of public medication.

United Future leader Peter Dunne was also aware of this when he undertook the work and consultation through the medicines strategy. One of the key recommendations, as outlined in the Government's accompanying "Actioning Medicines NZ", is to use the clinical skills of pharmacists more appropriately. The national framework of pharmacist services provides specifications for five new services incorporating the existing dispensing with each new service having three levels. The new services include:

Medicines use review and adherence support. The pharmacist works with the patient to review the patient's understanding of their medication and checks whether they are taking it properly. This is a four-part review and occurs over a year.

Medicines therapy assessment. Pharmacists review the medication a patient has been prescribed and looks to make recommendations as to any changes or alterations that can be made to optimise therapy for that patient. A good area for this type of review is a rest home setting. The information from the review is passed to the prescriber. This review is also a four-part one over a 12-month period and is done in partnership with the GP or prescriber.

Comprehensive medicines management. This involves a more comprehensive type of assessment and may involve pharmacist prescribing. This type of review would probably be used in specialised types of areas such as anticoagulation clinics or in a clinic as part of a wider team.

Health education services for the public, where pharmacists would be involved in health education campaigns, such as a stop smoking campaign.

Medicines clinical information support for doctors/prescribers. People have experienced the benefits of a patient-focused medicine use review with DHBs around the country (Waikato, Waitemata, Counties Manukau, Canterbury, Nelson/Marlborough and Capital and Coast) implementing this first level service since the DHB launched the framework.

The Pharmaceutical Society and the New Zealand College of Pharmacists (the training organisation) have been working closely with the DHBs and Ministry of Health officials to implement the better use of pharmacists' skills to achieve better patient health outcomes. The college, with DHBs, has run training seminars to standardise delivery and quality for pharmacists intending to provide a patient review service in their area. This year the society will produce the competency standards for pharmacists intending to provide medication therapy assessment services, the next level in the framework of pharmacist services.

The increasing and differing health needs of New Zealand population groups - such as those with acute medication needs, long-term conditions, specific disease and public health programmes - can be better met with new the service structure.

The public of New Zealand can be reassured the Pharmaceutical Society will make sure that the pharmacy profession does this properly.

* Elizabeth Plant is president of the Pharmaceutical Society of New Zealand.