Pharmaceutical care in community pharmacies: practice and research in Germany

OBJECTIVE: To discuss the provision of pharmaceutical care in community pharmacies in Germany including community pharmacy, organization and delivery of health services, pharmacy education, community pharmacy services, research in community pharmacy, and future plans for community pharmacy services. FINDINGS: In Germany, cognitive pharmaceutical services have been developed for more than 12 years. Several studies and programs have shown that pharmaceutical care and other pharmaceutical services are feasible in community pharmacy practice and that patients benefit from these services. In 2003, a nationwide contract was established between representatives of the community pharmacy owners and the largest German health insurance fund. In this so-called family pharmacy contract, remuneration of pharmacists for provision of pharmaceutical care services was successfully negotiated for the first time. In 2004, a trilateral integrated care contract was signed that additionally included general practitioners, combining the family pharmacy with the family physician. Within a few months, the vast majority (>17 000) of community pharmacies have registered to participate in this program. CONCLUSIONS: German community pharmacies are moving from the image of mainly supplying drugs toward the provision of cognitive pharmaceutical services.     

Pharmaceutical care in community pharmacies: practice and research in Switzerland

OBJECTIVE: To describe the current situation and prospects for community pharmacy practice in Switzerland, a confederation of 26 cantons with a population of approximately 7 million, located in the center of Europe. FINDINGS: For the past 10 years, the Swiss Association of Pharmacists has directed an in-depth reform of the profession, with measures such as a system of remuneration based on pharmaceutical cognitive services, a quality care program named QMS-Pharmacy, a postgraduate education program (including specific titles and certificates) and obligatory continuous education, programs of public relations and health promotion, innovative services of managed care, generics substitution, and others. DISCUSSION: The implemented changes in management represent a pharmaceutical care solution for Swiss community pharmacies, which face intense competition and a very liberal policy regarding healthcare organization, relating in particular to the important cantonal autonomy, free establishment of ownership of pharmacies, pharmacy chains, dispensing physicians, chemist shops, mail order, and others. CONCLUSIONS: Community pharmacy in Switzerland is making modernization of its role in public health policy a clear orientation. Priorities for the future include reinforcement of education and academic research in pharmacy practice, demonstration of the added value of pharmacists, integration of new information technologies with pharmacies, and development of new pharmaceutical services for managed care network in collaboration with physicians and other healthcare professionals.     

Pharmaceutical care in community pharmacies: practice and research in Canada

OBJECTIVE: To discuss the provision of pharmaceutical care in community pharmacies in Canada including the following topics: organization and delivery of health services, health service policy, methods of payment, types of pharmacy services provided, types of cognitive pharmacy services, research in community pharmacy, and future plans for community pharmacy services. DATA SYNTHESIS: The implementation of pharmaceutical care in Canadian community pharmacies continues to become more widespread. However, barriers to the provision of pharmaceutical care still exist, including the current shortage of pharmacists and lack of reimbursement systems for cognitive services. Evidence of the value of pharmaceutical care in Canadian community pharmacies has been supported by several pharmacy practice research projects. The pharmacist's role in patient care is expected to continue to expand. CONCLUSIONS: Although Canadian pharmacists' capabilities are not yet universally recognized and applied to their full potential, there is reason to be optimistic about the future of pharmaceutical care in the community setting in Canada.     

Pharmaceutical care in community pharmacies: practice and research from around the world

Pharmaceutical care models and practices differ in various countries. Reimbursement for cognitive services, for example, varies across countries in Europe, Asia, and the Americas. Practice-based research has blossomed in many countries, with different emphases and challenges. This international series will describe the organization of community pharmacy within the healthcare system and report the status of practice-based research. Each paper will focus on one country. The series will conclude with a summary by the series editors describing the key themes across the papers, outlining milestones yet to be achieved, and proposing a research agenda for community pharmacy practice.     

Pharmaceutical care in community pharmacy: practice and research in the Netherlands

OBJECTIVE: To describe the pharmaceutical care activities and research in community pharmacy in the Netherlands. FINDINGS: Pharmaceutical care is well advanced in Dutch pharmacy practice. This is largely due to the fact that clinical pharmacy was already an integrated part of community pharmacy practice by the end of the 1980s. Activities of the International Pharmaceutical Federation (FIP), some wholesale companies, and influential individuals in the Netherlands stimulated universities and the Royal Society for the Advancement of Pharmacy to advance the implementation of pharmaceutical care. DISCUSSION: Not all pharmacies in the Netherlands provide pharmaceutical care at the same level, although medication surveillance (concurrent and prospective medication analysis) is part of everyday practice. Implementation of quality assurance systems in community pharmacy practice could be helpful in assuring high levels of care. Similar to those in other countries, Dutch pharmacists are torn between the wish to provide pharmaceutical care and economic considerations, although the financial status of most pharmacies is still (very) healthy. New entrants into the market, such as supermarket and pharmacy chains, seem to put little emphasis on care provision. CONCLUSIONS: Pharmaceutical care has been implemented in many Dutch community pharmacies, but not everywhere to the same extent. Due to excellent automated medication surveillance; structured, high-quality medication counseling; and the fact that patients usually visit the same pharmacy, Dutch patients are well protected against many drug-related problems.     

Providing patient care in community pharmacies in Spain

OBJECTIVE: To review the current status of Spanish community pharmacy, both in practice and research terms, and analyze its future trends. FINDINGS: Spain has a social security system where all citizens receive health care, social services, and pensions. All medical care and surgery are free for citizens; however, community pharmacies in Spain are privately owned. There are geographic and population standards for the establishment of new pharmacies, resulting in an average of 1 pharmacy per 2000 residents. Almost all pharmacies offer the same services: compounding, weight and blood pressure measurement, and cholesterol and glucose testing. There are also other, less-implemented services, such as methadone supply or directed observed treatments. Most of these services are freely provided, except compounding (fee for service), methadone, and directed observed treatments. University pharmacy practice departments do not exist in Spain, which leads to scarce research in this area. DISCUSSION: Efforts have been made to describe and measure the prevalence of negative clinical outcomes produced by pharmacotherapy and create an operational procedure to provide pharmacotherapy follow-up. CONCLUSIONS: Spain has many community pharmacies, but there is little pharmacy practice research. Some advanced cognitive services exist, but few are being remunerated.     

Pharmaceutical care for patients with skin diseases: a campaign year at Swedish pharmacies

A pharmaceutical care programme for pharmacy customers/patients with skin disorders was carried out at all Swedish pharmacies in 1993 (Skin Year). The objective of the campaign was to increase awareness, compliance and appropriateness of the treatment of skin diseases in patients attending pharmacies. The campaign was carried out primarily at pharmacies and in close contact with other health–care professionals. A variety of promotional material was produced and made available to the pharmacies. The activities were primarily directed towards pharmacy customers but also towards the staff of local health–care centres. To avoid large–scale and costly population surveys in the national evaluation of the Skin Year campaign, evaluation was carried out indirectly by following four disease groups and monitoring the influence that the campaign may have had on the use of medicines by patients with those disorders. The groups chosen were dry skin, eczema, athlete's foot and acne. There was a substantial increase in the use of medication for skin disorders in the campaign year 1993 and in 1994. If it is assumed that the level of drug use is a reflection of the level of treatment it can be concluded that treatment of the four diseases increased substantially, indirectly demonstrating ‘increased awareness, compliance and appropriateness of treatment’ as stated in the objectives. It is estimated that the campaign may have reduced the number of physician consultations for skin problems and that this has led to a cost reduction of at least SK100 million (equivalent to $15 million) or 5–10% of the health–care costs for skin disorders. Comparable data on patient outcome as a result of the campaign are not available.     

Developing palliative care practice in the community

The inadequacy of some areas of palliative care provision was acknowledged in the NHS Cancer Plan (DoH 2000). Many patients would prefer to die at home, but only one quarter are able to do so because of the lack of community or specialist palliative care teams in some parts of the country. The Lancashire and South Cumbria Cancer Services Network developed an initiative to meet the educational and training needs of practitioners delivering palliative care in the community.     

Participatory action research: integrating community occupational therapy practice and research

Participatory action research (PAR) is a form of collaborative research particularly concerned with power inequities of marginalized communities. With this approach, occupational therapists can work with clients and communities to address issues of access, inclusion, equity and collaboration in practice and research. This paper begins with a summary of key concepts and controversies related to participatory action research. Two examples from occupational therapy experience are used to demonstrate the initial steps and key principles of PAR projects and to highlight the conceptual links between PAR and community-based, client-centred occupational therapy. One project involved a group of mental health consumers, the other a community group of older adults. Several challenges and potential outcomes in PAR projects are highlighted in this examination of the complexity of PAR processes. The paper concludes by identifying possibilities and obstacles to the further use of PAR in occupational therapy.