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7/10/2015 - Medicines Optimisation and Monitoring

Drug Related Problems lead to problems
“Pharmacists should stop talking about Drug Related Problems”. Laurence Brown, Professor and Associate Dean at the School of Pharmacy of the Chapman University (CA) started his keynote at the recent FIP congress with this controversial advice.


The yearly FIP Congress (Fédération Internationale Pharmaceutique) brings together the ‘fine fleur’ of pharmacy from all over the world. The core of this event is talking about pharmaceutical care and more specifically about resolving Drug Relate Problems (DRP’s). The most recent edition, last week in Düsseldorf (Germany) was no exception, with over 2.000 pharmacists attending.

This blog is a little sample of the congress, more specifically the “Medicines Optimisation around the World” session, organized by the “Community Pharmacy” section.


Is Laurence Brown going mad, imploring the profession to stop talking about what is most crucial today? Not at all. He just understands how we think and percieve.

“When pharmacists call doctors to resolve drug relate problems, the latter only hear the word ‘problems’. In the US they immediately fear prosecution for malpractice, if a patient file or a mail that would be sent in this matter would refer to a ‘problem’ that would arise from a doctor’s prescription”. Talking about problems with prescribers or patients – when they don’t take their medication appropriately – is counter productive. People are humans and they get defensive when they get the impression they are the source of the problem.

“Drug Related Problems lead to communication problems”, quipped a participant and he was right.

Brown pointed the way to understand why it is so difficult for some pharmacists in certain cases to call doctors and be accepted as a valuable partner in the health team.

Medicines Optimisation (”Geneesmiddelen optimalisatie”)
“Let’s start talking about ‘Medicines Optimalisation’ instead”, suggested Brown. That way a doctor or a patient thinks he is already doing all right and the pharmacist only tries to make it even better.

It seems only to be a semantic sleight of hand and from a rational point of view it makes very little difference. But ‘between our ears’ – what we emotionally perceive – it is a completely different message we receive.

Most caretakers have trouble thinking along those lines. Our mind, the way we perceive things, think about them, act to them and get motivated, is not rational at all. But if your training only teaches you pharmaceutical science and evidence based medicine, after a couple of years it gets very difficult to understand that ‘solving drug related problems’ is something fundamentally different from “medicines optimisation’.

Flipping the mental switch
Over the last week, ever since I heard Laurence Brown in Düsseldorf and had the epiphany that explained why DRP’s lead to problems, I have tried to throw some mental switches and consciously and systematically use the words “medicines optimisation” (“geneesmiddelen optimalisatie”).

Nurses probably don’t talk to doctors about the care related problems they see. Over the years they have developed a more ancillary and complementary approach. It has put them in pole position to take over a number of tasks, when doctors will be more and more swamped by the rising needs of an ageing population with a lot of chronic disorders.

If we, pharmacists, want to be accepted in that ‘care team of the future’, we also need to be perceived as qualified partners, helping to optimise medicines and medication use.

Monitoring
Brown also stated that we don’t monitor enough. “In healthcare today, we are used to think in terms of seeing patients, prescribing and delivering medicines. Afterwards the patient walks out and we don’t see or hear from him/her anymore. Is the patient doing better ? Is he dead, sick or alive and well ? We don’t know”

Modern healthcare should be about monitoring what the outcomes are of what we do. Measuring health production might not be easy, certainly not if you would try to express that production in QALY’s or DALY’s (Quality Adjusted Life Years / Disease Adjusted Life Years).

But we should start thinking about getting, registering and analysing data from patients after they walk out of our practices or pharmacies. How is their blood pressure (hypertension), cholesterol (hyperlipidemia), peak flow (asthma, COPD), mental status (depression), etc.

Investing in a platform, standards, filters and handy interfaces to give patients “personal health records” they can store their own data in (and make them available to their care team) should become one of the most urgent issues if we want to ‘disruptively change’ healthcare provision.

Dirk Broeckx – 7 October 2015

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