Wednesday, 22. May 2019
For information about risks and side effects, read the package insert and ask your physician or pharmacist.
How nice this sentence reads1 – after all, it contains what we want to see in a multi-drug therapy today: The informed patient reads (and maybe understands?) the package insert, physician and pharmacist provide coordinated information and all three parties contribute to ensuring the safety of the therapy. This approach, known as safe medical treatment (AMTS), is important for the patients' safety and can only be optimally achieved through interprofessional cooperation.
The World Health Organisation (WHO) speaks of interprofessional cooperation when different healthcare professionals work together with patients, families and caregiving relatives as well as communities with the common goal of achieving the best quality of care for patients. The WHO calls these people "health workers" whether they are physicians, pharmacists, nurses, psychologists, physiotherapists, geriatric nurses or any other professionals.
It is important that professionals succeed in working together to improve the patient's condition. How far are we from achieving this goal today? Experts already count on interprofessional programmes during student education in order to sustainably support the cooperation of different professions. There are already some expert societies, also in Germany, which institutionalise interprofessional cooperation and which have come together globally in the "All Together Better Health" campaign.
Some of the facts that demonstrate the need for inter-professional cooperation:
According to the WHO, about half of all patients who suffer from a chronic disease do not take their medication or do not take it properly. Harmful side effects can only be minimised if drugs are correctly prescribed and taken. Additional support is therefore necessary.
Two professional groups are particularly crucial for the improvement of AMTS, both of which care for the patient and should understand him or her even better: physicians, who initiate the therapy and pharmacists, who support patients in the implementation. Preventive measures as well as prescription of drugs in accordance with guidelines and taking into account patient preference are core elements of the physicians' activities, while medication management of all prescribed and self-medication drugs as well as adherence-supporting measures are among the pharmacists' core tasks.
The figures above show that there is a great need for improvement. Optimal AMTS can only be achieved if physicians, pharmacists and patients work together towards achieving this goal in a structured way. One thing is clear: no cooperation is possible without communication! Recent studies have shown that although both professional groups - physicians and pharmacists - want qualified colleagues with whom they can communicate at eye level in order to be able to design patient-centred therapy in an interprofessional manner, they still know little about each other's work and it seems necessary to develop a structured concept for interprofessional communication.
Adherence promotion means that communication is consistent and that it is made as easy as possible for patients to carry out their drug therapy. Particular attention should be paid to the three phases of adherence, namely the correct start of therapy, full implementation in everyday life and a possible premature termination of therapy. This also includes the sustainability of support throughout the patient's life.
In a three-month pilot project with 15 German pharmacists, the participants were asked about their pharmaceutical advice at the beginning and end of the project. How they deal with adherence in their daily pharmaceutical routine and how they communicate with patients and physicians as well as a self-assessment of the pharmacists were evaluated. After the initial questioning, adherence training was carried out for the pharmacists to train them to become adherence coaches. Subsequently, the pharmacists were asked to apply their new competence to at least five chronically ill patients. They were also asked to record the time needed for patient consultation and communication with physicians.
Overall, the pharmacists made the following experiences during this pilot project: On average, a patient consultation took 37 minutes, and in a fifth of the cases the inclusion of the attending physician was necessary. The most frequent reasons for non-adherence that were found in this study were incomplete information about the prescribed medication and lack of motivation to take it. The pharmacists enjoyed the consultations, which were well received by both patients and physicians.
The main findings of this study are as follows:
A further project is now to investigate which clinical results are associated with improved adherence and how the cooperation between physicians and pharmacists can be further developed, taking patient preferences into account.