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Editorials

A prescription for better prescribing

BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.38946.491829.BE (Published 31 August 2006) Cite this as: BMJ 2006;333:459

Rapid Response:

Pharmacists and Pharmacological Capacity: Behind every good prescriber is a good pharmacist-physician relationship

The editorial by Aronson et al 1 regarding the pharmacological
deficiencies of doctors, their ability to prescribe soundly and the lack
of capacity within the field of clinical pharmacology raises a number of
important points, as well as providing avenues for collaborative
opportunities.

The authors state that “Prescribing is becoming increasing difficult,
and the inherent risks of adverse events and interactions have increased,”
combined with more complex drugs alone and in combination on an ever
increasing ageing population that requires them. The authors also discuss
that the root cause of prescribing error is among final year medical
students. This is perhaps also reflected in first and second year house
officers prescribing practices who are confronted with a depth and breadth
of prescribing based decisions that perhaps they are not prepared for
based on the median number of training hours figure provided by Aronson
and colleagues.

Pharmacists can provide a conduit to help with easing the
‘pharmacological burden’ and augment the pharmacotherapy capacity of
doctors 2. Pharmacists have a unique skill set that moves more than just
being a ‘pharma-cop’3 4. Utilising pharmacists’ expertise and experiences
can be more than just accessing information about medication, but also in
providing medication management and pharmaceutical care4, decreasing
medication related adverse events 5 6 7 and increasing benefits 8 9 10-12
as well as reducing direct and indirect costs to healthcare 13-15.
Pharmacists also encourage a collaborative team approach to decision
making that allows for a seamless approach to patient centred healthcare
and provide a supportive environment for junior doctors, with whom
pharmacists have the most contact with in secondary and tertiary care with
respect to medication related issues.

Pharmacists within the hospital wards can provide support towards
building and increasing pharmacological and pharmacotherapy capacity for
physicians with the outcome being better prescribing decisions for the
patient that result in less pharmacokinetic, pharmacodynamic and
iatrogenic adverse events2. Pharmacist’s core business is medication
management and can support the physician in helping with respect to
weighing up the risks and benefits, providing information that help with
drug response variability and can tailor medication to match the
patient10.

Collaboration between these two health professions has short and long
term benefits16 17 18, especially in the secondary and tertiary health
sectors by helping ‘train’ junior doctors for the primary sector and to
enable a continuation of that support with their local pharmacist in the
primary health care communities that they serve19. Doctors are not
expected to work in isolation from other professions nor are they no
longer in a health sector environment that expects them to work alone
(professionally and medico-legally). Although a good relationship takes
time, a good pharmacist-doctor relationship has a number of benefits that
move beyond the pharmacological, pharmacotherapy boundaries.

References

1. Aronson JK, Henderson G, Webb DJ, Rawlins MD. A prescription for
better prescribing. Bmj 2006;333(7566):459-60.

2. Leape LL, Cullen DJ, Clapp MD, Burdick E, Demonaco HJ, Erickson JI, et
al. Pharmacist participation on physician rounds and adverse drug events
in the intensive care unit. Jama 1999;282(3):267-70.

3. Hanlon JT, Landsman PB, Cowan K, Schmader KE, Weinberger M, Uttech KM,
et al. Physician agreement with pharmacist-suggested drug therapy changes
for elderly outpatients. Am J Health Syst Pharm 1996;53(22):2735-7.

4. Krska J, Cromarty JA, Arris F, Jamieson D, Hansford D, Duffus PR, et
al. Pharmacist-led medication review in patients over 65: a randomized,
controlled trial in primary care. Age Ageing 2001;30(3):205-11.

5. Advice from the pharmacy. As a team, physician, pharmacist and patient
can prevent potentially problematic drug interactions. Health News
2004;10(9):14.

6. Brown CA, Bailey JH, Lee J, Garrett PK, Rudman WJ. The pharmacist-
physician relationship in the detection of ambulatory medication errors.
Am J Med Sci 2006;331(1):22-4.

7. Levenson D. Pharmacist-physician partnership reduces unwanted drug
consequences. Rep Med Guidel Outcomes Res 2003;14(17):9-10, 12.

8. Ali F, Laurin MY, Lariviere C, Tremblay D, Cloutier D. The effect of
pharmacist intervention and patient education on lipid-lowering medication
compliance and plasma cholesterol levels. Can J Clin Pharmacol
2003;10(3):101-6.

9. Bogden PE, Koontz LM, Williamson P, Abbott RD. The physician and
pharmacist team. An effective approach to cholesterol reduction. J Gen
Intern Med 1997;12(3):158-64.

10. Borenstein JE, Graber G, Saltiel E, Wallace J, Ryu S, Archi J, et al.
Physician-pharmacist comanagement of hypertension: a randomized,
comparative trial. Pharmacotherapy 2003;23(2):209-16.

11. Erhun WO, Agbani EO, Bolaji EE. Positive benefits of a pharmacist-
managed hypertension clinic in Nigeria. Public Health 2005;119(9):792-8.

12. Lee SS, Cheung PY, Chow MS. Benefits of individualized counseling by
the pharmacist on the treatment outcomes of hyperlipidemia in Hong Kong. J
Clin Pharmacol 2004;44(6):632-9.

13. Ariano RE, Demianczuk RH, Danzinger RG, Richard A, Milan H, Jamieson
B. Economic impact and clinical benefits of pharmacist involvement on
surgical wards. Can J Hosp Pharm 1995;48(5):284-9.

14. Bailey RA, Ashcraft NA. Pharmacist-physician drug fair for educating
physicians in cost-effective prescribing. Am J Hosp Pharm 1993;50(10):2088
-9.

15. Chisholm MA, Vollenweider LJ, Mulloy LL, Wynn JJ, Wade WE, DiPiro JT.
Cost-benefit analysis of a clinical pharmacist-managed medication
assistance program in a renal transplant clinic. Clin Transplant 2000;14(4
Pt 1):304-7.

16. Zillich AJ, McDonough RP, Carter BL, Doucette WR. Influential
characteristics of physician/pharmacist collaborative relationships. Ann
Pharmacother 2004;38(5):764-70.

17. Muller BA, McDanel DL. Enhancing quality and safety through physician-
pharmacist collaboration. Am J Health Syst Pharm 2006;63(11):996-7.

18. Zillich AJ, Milchak JL, Carter BL, Doucette WR. Utility of a
questionnaire to measure physician-pharmacist collaborative relationships.
J Am Pharm Assoc (Wash DC) 2006;46(4):453-8.

19. Muijrers PE, Knottnerus JA, Sijbrandij J, Janknegt R, Grol RP.
Changing relationships: attitudes and opinions of general practitioners
and pharmacists regarding the role of the community pharmacist. Pharm
World Sci 2003;25(5):235-41.

Competing interests:
No competing interests

Competing interests: No competing interests

07 September 2006
Bevan J Clayton-Smith
Research Fellow
Research Centre for Mãori Health and Development