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On the interface of physician and pharmacist: safety and proper use

Jean-Baptiste Rey, recorded at TAO (Transatlantic Oncology meeting), Nov 21-22, 2013

B07 - Saturday 14h45

Dr. Jean-Baptiste Rey will share experiences from his own professional life. The pharmacist should not just be the buyer and distributor of drugs. Dr. Rey will provide some practical examples to illustrate the work of a clinical pharmacist.

Clinical pharmacy is not a discipline as such, making it hard to find a definition. Google turned up with the definition that it is the drug professional, providing drugs for hospitals and patients. He also provides information and guidance, to – together with the other professionals – come to a safe use of drugs with as little adverse effects as possible. Pharmacy has evolved over the past 30 years, and nowadays very few centers will share this vision.

The clinical pharmacist will want to share his specific knowledge with other practitioners. Why do we not share this knowledge also with the patients? This will help to ensure proper use of medication, and limit the number of adverse effects. It is not about treating patients for the lowest price, but about providing better treatment. More expensive medication can be used, as long as it is used in a smart fashion. Inappropriate use of cheap drugs will not improve the patient.

Dr. Rey shows the triangle of professionals around the patient, with focus on diagnosis (phycisian), therapy (pharmacist) and health (care providers). These will all interact with the patient and with each other. This is the basis for good patient management onto which other specialists can be added.

During the morning rounds, drug use by the patients is checked and adjusted as needed. The pharmacist will eliminate (currently) useless prescriptions, avoid ineffective or dangerous drug combinations, ensure an economically sensible combination of drugs, etc. Such adjustments should be discussed with the patient.

Dr. Rey shares that when he started to join the rounds of the doctors and nurses, he did not understand what they were talking about. Similarly, they did not understand what he was talking about. So, all parties learned from each other, sharing culture and knowledge, enriching one another. The main task of the pharmacist on these rounds is to validate the prescriptions. This is very easy once you, as pharmacist, have seen all the data the doctor used to come to this prescription. Also, your presence on the floor helps to optimize the use of the medication by the nurses (as they can easily ask you any simple question), and to optimize stock logistics.

IT is very important and it can be a starting point for the interaction. E.g. as pharmacist you can invite yourself to explain to the doctor how he should properly enter a prescription in the system. This is how the collaboration can be initiated, and allows you to also communicate with the other staff. The IT prescription information is much more complete, allowing proper validation of prescriptions. Through the system also messages can be linked to prescriptions, but personal communication is sometimes more effective.

Dr. Rey then switches the topic to the patient that leaves the hospital. The pharmacist is providing counseling to the patient. The main role is to help obtain patient compliance with the prescription once he leaves the hospital. Explaining (the necessity for) the treatment, making sure he understands, explain what the doctor has said, go over the schedule(s), connect them with the chemists, and more. This includes clear schematics showing when a drug needs to be taken, and why. This meeting takes place face to face, not e.g. over the phone. You check if the patient completely understands, and explain again when needed. A report should appear in the patient’s record. This is also of use to the other caregivers, as they can learn for instance what was still unclear to the patient and may require extra attention in a next meeting. The patient will be asked if the prescription can be forwarded to a local chemist, and the latter will receive the prescription in time to e.g. order the specific drugs, possibly not on stock. This also allows the chemist to prepare for this patient to come in and provide the necessary support.

The topic of onco-geriatrics is addressed. Elderly patients often take many drugs. During a first meeting with an elderly patient, a pharmacist is always present. The pharmacist will analyze the prescriptions and suggest (to the doctors) adjustments to optimize treatment. An example based on an actual case is provided. At the consultation, it is checked if the patient understands the application of the drugs, or experiences any problems/difficulties. Also, a suggestion is done in light of foreseen future treatment of the cancer.

Dr. Rey summarizes his conclusions and a brief discussion with the audience follows.