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Rapid Responses: Rapid Responses published:
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The pharmacist in the community. A Cuban experience.
- Siria Teope-Romero Lic, Santos-Peña Moises MD, Filgueira-Ramos Benigno MD, Justafré-Couto Leticia MD, Hernández-Fernández Juana Isabel MsC (29 May 2007)
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Health professionals need to work as a team with latest information on drug safety in pregnancy
- Adam P Morton (30 May 2007)
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A golden opportunity for pharmacists to exchange mercury thermometers.
- Phillip J. Colquitt (30 May 2007)
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clinical indications aids pharmacist and clinician communication
- Nigel J Masters (1 June 2007)
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Twelve years later...
- Steven Ford (2 June 2007)
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Siria Teope-Romero Lic, Pharmacy and Epidemiology Departments. Gustavo Aldereguía Lima University Hospital. Cienfuegos, Cuba, Santos-Peña Moises MD, Filgueira-Ramos Benigno MD, Justafré-Couto Leticia MD, Hernández-Fernández Juana Isabel MsC
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After a staff discussion of the Editoral in the BMJ entitled The role of pharmacists in primary care, we have felt the need to share the Cuban experience.
In order to achieve optimal results in implementing pharmaceutical health programs adequate dispersal and structure of community pharmaceutical services is required. This requires among other aspects those related to the cooperative and integral work of the health staff, the minimal documents related to it, the number of patients linked to each drug store and the establishment of risk groups in order to offer the appropriate follow up to the patients’ pharmacological tratments. 1 In Cuba, community pharmacological services are presented by means of the community drug stores which are aimed at making optimal use of medications by means of good dispensary practices as well as of actions oriented to modify the habits of the individual, the family and the community , all of them within the essential concept of rational use of medications. These services should be included within the National Program of Medications of the country and directed by an able professional staff.2 It is a policy of the Cuban Ministry of Public Health to continue improving and strengthening Primary health Attention as a priority for a greater social impact. To reach this goal all the efforts have been led to strengthen the local entities and to improve human resources. The decisions about a greater descentralization in some services and the establishment of an emergency system of oblige us to develop a program for constantly requalifying and keeping up to date public health professionals in Cuba. 2, 3 It has been stated that in a national policy of medications, programs of Pharmacological Attention should be implemented at a hospital level and in community drug stores for outpatients as a way to guarantee an appropriate, safe and sure pharmacotherapy for all the patients as a solution to any failure which is mainly caused by the bad used of medications by patients. 2 References: 1. Peri J Ballantyne. Editorials: The role of pharmacists in primary care. BMJ 2007; 334: 1066-1067. 2. Fernández-Manzano E et al. Indicadores vinculados a las funciones asistenciales de los servicios farmacéuticos comunitarios en las regiones Central y Oriental de Cuba. Rev Cubana Farm 2006; 40(1) 3. Fernández Manzano E, Fernández Monagas SA, González Quesada LI, Henriques Rodríguez RD, Iñiguez Rojas L. Exploración de la disponibilidad de los servicios farmacéuticos comunitarios cubanos. Rev OFIL. 2005;15(1):21-7. Competing interests: None declared |
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Adam P Morton, Physician Mater Hospital South Brisbane Australia 4101
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One of the greatest sources of frustration and distress to patients is when they are presented with conflicting information by health professionals. This is particularly true in pregnancy where women are reluctant to take medications because of concerns for their unborn child. A recent article by Stockigt highlighted the inaccuracy of the commonly used compilation productions regarding thyroid-related medications, particularly advice pertaining to pregnancy (1). My experience is that this is true for the majority of medications regarding their safety in pregnancy. In my practice in obstetric medicine I usually give the mother printed information demonstrating the evidence for safety of the prescribed medication in pregnancy so this can be shown to their pharmacist and General Practitioner. Despite this, I commonly receive telephone calls from distressed mothers who have been given conflicting advice from their pharmacist, based upon the outdated information at their disposal. It is very rare that a pharmacist would contact me before giving this conflicting advice. There is a need for closer collaboration between health professionals and for widespread availability of up-to-date information on the safety of medications in pregnancy. (1) Stockigt JR. Barriers in the quest for quality drug information: salutary lessons from TGA-approved sources for thyroid-related medications. Med J Aust 2007;186:76-9. Competing interests: None declared |
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Phillip J. Colquitt, Technicain/RN Independent Comment
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I recently learned, upon finding in-hospital patients in possession of mercury thermometers, that attempts by government to practice non- mercury thermometry in major teaching hospitals are totally ignored by pharmacists who continue to sell these mercury thermometers - sometimes in retail outlets on hospital campus!! Here in Brisbane, and one suspects the same applies in BMJ’s London and in the author's Canada, retail pharmacies do continue to sell mercury[Hg] fever thermometers, without hazard warning labels. Inevitably, the mercury in glass thermometer will break, usually spilling the mercury. Despite this, these Hg devices are a known cause of domestic fatality[1], a recognized public health and occupational hazard [2], and contribute significant amounts of Hg to global pollution[3]. Hospitals cannot control the import of thermometers when patients acquire these devices from retail pharmacies in the community, and bring them into hospital with their belongings. Pharmacist should show they deserve respect by ceasing to sell Hg thermometers, and by becoming the major point of exchange of Hg thermometers for digital models which are affordable[approx 10-20 AUD]. [1]Jaeger A, et. al. Accidental acute mercury vapour poisoning. Vet Hum Toxicol 1979;21 supp 62-3. [2]Clouse R. Mercury use in health care: an occupational and public health hazard. Am J Nurs. 2005 Sep;105(9):104. [3]Colquitt PJ, The effect of occupational exposure to mercury vapour on the fertility of female dental assistants. Occup Environ Med 1995;52(3):214 Competing interests: None declared |
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Nigel J Masters, General medical practitioner Highfield Surgery Highfield Way Hazlemere High Wycombe HP15 7UW
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Dear Sir I was pleased to see the discussion of the role of pharmacists in primary care. By simply adding a few words to the prescription the clinician and pharmacist can become a powerful team in the delivery of medicines efficiently and safely. Work from Australia in 1998 suggested that prescription based communication on drug purpose was valued highly both by clinicians and pharmacists (1). With the IT infrastructure this is now possible in primary care and has been described in everyday use for over four years. I consider clinical indications the most significant advance in medicines delivery in over 50 years(2). For the pharmacist locally to know the true purpose of a drug strengthens his role in providing information and advice and of course speeds the process of Medicine Use Review. For clinical indications to gain maximum momentum it needs software development that integrates with what is already available in practice- that will be the future . 1. Liddell M, Goldman S. Attitudes to and use of a modified prescription form by general practitioners and pharmacists Med J Aust 1998;168:322-325 2.www.clinicalindications.com Competing interests: None declared |
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Steven Ford, GP Haydon & Allen Valleys Medical Practice
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Sir In 1995 the BMJ was kind enough to publish an editorial that I co- wrote with Dr. Kevin Jones (BMJ, 24th June 1995, Vol. 310, Pages 1620- 1621) in which we proposed the wholesale integration of community pharmacy into primary care. This did not attract any adverse comment at the time and it's message remains as relevant today as it was then. The negative findings that are mentioned in Ballantyne's editorial can be traced back to the semi-detached nature of community pharmacy and its post hoc role in the prescribing/dispensing sequence. The pharmacist's key intervention must come before the prescription is written. That which comes after, dispensing and promoting correct usage, are roles for the technicians and those in normal contact with patients. For so long as community pharmacy remains outside the primary care team - always assuming that the team escapes complete destruction in the present vainglorious maelstrom of 'reform' - it will fail to achieve its optimum performance and the intellectual horsepower lurking in the dispensary will continue to be wasted. Yours sincerely Steven Ford Competing interests: I have quoted my from an article of my own in the BMJ. |
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