Letters

Clinical medication review by pharmacists would improve care

EDITORUnsurprisingly, Zermansky et al found that the involvement of pharmacists improves the quality of medication management for older people.¹ Repeat prescribing was poorly monitored in older people, but the authors miss an opportunity for a more rigorous analysis of this problem.

In the United Kingdom incrementally dispensed drugs require a doctor's signature to validate each increment-an expedient adopted for administrative convenience and the probity of pharmacists. This results in general practitioners having to sign many pieces of paper each day. Such a practice undervalues their time, and the sheer number of individual items inevitably affects quality control.

The challenge of adequately reviewing complex drug regimens cannot be accommodated in the 7-10 minute intervals that define general practitioners' clinical practice in the United Kingdom. The role of the pharmacist is also degraded, being reduced to that of a passive dispenser, who might occasionally issue warnings in the case of overlooked interactions.

Zermansky et al show how different things could be. With a structured, shared approach, the respective talents of doctor and pharmacist could be better harnessed, to the benefit of both patient care and the professional satisfaction of both parties.² It would be interesting to see the results of longer term follow up of these cohorts of patients to see if differences in outcome emerged. The true long term impact on the workload and job satisfaction of doctors and pharmacists could also be assessed.

Joe Neary, chair of clinical network. 
Royal College of General Practitioners, London SW7 1PU

joeneary{at}dial.pipex.com