Letters

Integrating pharmacy into the primary care team

EDITOR,--We agree with Steven Ford and Kevin Jones that the policy of integrating pharmacy into the primary care team has much to recommend it.¹ Genitourinary medicine clinics have pioneered the concept of "one stop care," with on site medical, nursing, laboratory, pharmacy, counselling, psychology, and social work facilities. With the ever increasing numbers of patients with HIV infection attending, these in house services have increased to include dietetic, dental, and ophthalmic care.

Integrated pharmacies have had a key role in the provision of services in genitourinary medicine clinics from the beginning. There is a satellite dispensary in many larger clinics, staffed by a full time pharmacist, who is responsible for all prescriptions. In other smaller units prepacked drugs are dispensed direct by medical or nursing staff from an in house pharmacy, although this system is not ideal.

Integrated pharmacy has many advantages for patients, as shown by a study carried out in an HIV outpatient clinic to assess clients' experience of outpatient dispensaries versus distribution of drugs in clinics (D G Webb et al, scientific meeting of Medical Society for the Study of Venereal Diseases, Dublin, June 1992). Distribution based in clinics was perceived to be superior in terms of waiting time, quality of advice, availability of information leaflets, and confidentiality, and the overall satisfaction ratings for the service were high. These factors are especially important for frail, sick patients such as those with HIV infection, but they would also be appreciated by people with busy work schedules, mothers with babies, and many other groups of clients. The benefits to medical staff should not be forgotten and include help with difficult management problems, drug interactions, and drug resistance and the provision of other specialised drug information. There are some disadvantages with this system, in that small clinics and primary care surgeries may not be able to afford the service of a full time pharmacist, but this could be overcome by having a pooled pharmacist covering several small units. Integrated pharmacies have served a useful purpose in genitourinary medicine clinics for many years, and their incorporation into primary care settings should be seriously considered.

Senior registrar senior pharmacist Consultant in genitourinary medicine Consultant physician Infection and Immunity Clinical Group, Ambrose King Centre, Royal London Hospital, London E1 1BB

G Crowe, C J Harris, G E Forster, B T Goh 

1. Ford S, Jones K. Integrating pharmacy fully into the primary care team. BMJ 1995;310:1620-1. (24 June.) [Free Full Text]