Pharmacist-patient interface

The patient is the last individual in the medication use process. The pharmacist-patient interface can play a significant role in capturing medication errors before they occur. Unfortunately, many health care organizations do not take advantage of this key interaction. Three important factors play a role in any patient interface and often determine the outcome of error-prevention efforts. These include direct patient education, health care literacy, and patient compliance. 

Essential aspects of compendial standards are intrinsic in the history and composition of the Convention. USP standards are meant to describe an acceptable article from the point of view of the physician-pharmacist-patient interfaces and they are inherently time-of-use (that is, shelf life) requirements. Another outcome of this focus is that practical, medically significant aspects are dominant in assigning requirements and the limits therein. Compendial standards are always established from the viewpoints of the medical and pharmaceutical professions, which in the United States are represented by the USPC. 

Although the concepts of documentation are consistent irrespective of practice settings, the process by which data are collected and the tools for documentation can be quite different. Thus the training associated with documentation must be specific to the respective practice environments of pharmacists. For example, access to health care providers, medical records, laboratory data, and patients is more common in hospital pharmacy practice than in community pharmacy practice, where direct access to patients is often the only source of information. As a result, data collection, documentation, and communication with other health care providers and patients will vary based on the practice setting. However, as the use of EMRs and digital documentation becomes more common, the ability of pharmacists to interface with these systems will become less of a logistical barrier. 

Pharmacists are uniquely positioned to become involved in DM activities for several reasons. First, within the community, pharmacists practice at the interface of care and therefore have the ability to interact directly with patients. In addition, public opinion polls reveal that pharmacists are consistently ranked among the most trusted professionals. Figure 17.1 illustrates how the drug prescribing process places pharmacists at the interface of patient care. Because pharmacists, like physicians, have the ability to directly deliver DM services, they can serve as conduits for implementing DM programs developed by health insurance providers, PBMs, pharmaceutical companies, wholesalers and distributors, and employers. 

Lewis, S.M. Kroner, B.A. Patient survey of a pharmacist-managed anticoagulation clinic. Managed Care Interface 1997, 70 (11), 66-70. 

The sale of a pharmaceutical product may be by retail (community pharmacy), wholesale, health centre, hospital, dental, health care centres, special homes, home trade or export, etc. These may be further broken down into ethical and over the counter (OTC) sales. Ethical products are normally available only through or via the profession, i.e. pharmacist, doctor, dentist, nurse, veterinarian, etc. They may be supplied either as a bulk pack which is then broken down into a smaller quantity at the patient-dispenser interface or as an original pack whereby a course of treatment is supplied in the pack as produced by the pharmaceutical manufacturer (also called patient pack or unit of use pack). 

Medicines are available for patients as authorised medicines or as pharmacy preparations (unlicensed medicines). Market logic ensures that only medicines with sufficient return on investment will be marketed. However, health care logic requires pharmacists to provide their patients with necessary medicines. There are regulations that cover medicines for clinical research, marketing authorisation and import, as well as traffic between European countries (parallel imports). If medicines are not available as authorised medicines, various options such as compassionate use or parallel trial programme can be considered. The authorisation of medicines for orphan diseases is promoted by the orphan dmg regulations. The system of reimbursement will be discussed briefly due to its special situation at the interface of both public health and social insurances. 

Many leaders fail to address exposures in the known working interface, and the professional caregivers—nurses, doctors, pharmacists, and others—are often not actively engaged in patient safety. How does leadership change this How do you create a culture in which safety really is a driving value ... 

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