'Improved doctor-pharmacist collaboration needed': study

March 8, 2010

The use of a physician-pharmacist collaborative care plan to manage lipid control in patients with high cholesterol does not have significant clinical impact, found an article in CMAJ (Canadian Medical Association Journal).

A research team from the Laval Centre de santé et de services sociaux, Université de Montréal and McGill University Health Centre has examined the benefits of greater collaboration between family physicians and community pharmacists for select patients. Published in the March 8 edition of the Canadian Medical Association Journal, the research project focused on patients with high levels of cholesterol who are at risk of cardiovascular disease. In all, 77 family physicians, 108 community pharmacists and 225 patients were recruited for the study.

As part of the investigation, pharmacists counseled patients about their medications, requested laboratory tests, monitored the effectiveness and safety of treatments, verified patient adherence to therapy and adjusted dosages. The collaborative care involving physicians and pharmacists had no significant impact on cholesterol control, yet the study showed an improvement in the care offered to patients. In fact, more patients receiving collaborative care reported having discussed lifestyle changes with their pharmacist and implementing such changes. What's more, their medication was adjusted more frequently according to their specific needs.

According to principal researcher, Dr. Lyne Lalonde of the professor at the Université de Montréal Faculty of Pharmacy and the Laval Centre de santé et de services sociaux, results clearly demonstrate that the quality of pharmaceutical monitoring provided to patients was exemplary. "Many patients say they received VIP treatment from their pharmacist."

"Attending pharmacists didn't only adjust medication dosages - they discussed patient lifestyle and offered professional advice," says Julie Villeneuve, project coordinator and a Université de Montréal PhD graduate. "For the patient, collaborative care implies regular monitoring. For the pharmacist, it's a golden opportunity to offer expertise in pharmacotherapy. The healthcare system is suffering from widespread shortages, hence the importance of exploiting the potential of all players."

Essential collaboration:

According to co-author Dr. Eveline Hudon, a clinical professor at the Université de Montréal Faculty of Medicine, Quebec will eventually have no other option than to rely on inter-professional collaboration in order to compensate for the lack of medical personnel. "We knew that collaboration between physicians and nurses was successful, and now we know that the same potential exists for physicians and pharmacists," says Hudon. "Pharmacists are open to taking on new responsibilities."

"While this study focused on patients with a disrupted amount of lipids in their blood," says Dr. Hudon, "pharmacists also have the required knowledge to undertake the pharmaceutical monitoring of other conditions such as hypertension, tobacco addiction, certain forms of dementia such as Alzheimer's and chronic conditions like asthma for which medication is often misused by patients. Other studies could explore these possibilities."

Expertise:

Cardiologist Jacques Genest, of the McGill University Health Centre and author of the Canadian cholesterol guidelines, was a consultant on the study and noted that collaborative care bolstered respect for treatment guidelines. He says pharmacists should play a larger role in healthcare: "Pharmacists can adjust the dosage of anticoagulation medication, for instance, and they have the necessary knowledge to take on more. Doctors simply can't monitor all their patients and other competent players are able to perform certain parts of the job."

The Ordre des pharmaciens du Québec (Order of Pharmacists of Quebec or OPQ) emphasizes the majority of their members would like to take on more responsibility. "Many avant-garde countries adopted such practices a long time ago," says Diane Lamarre, president of the OPQ. "Even the World Health Organization supports a larger role for pharmacists throughout the world."

"What's important is that physicians keep their pivotal role," says Lamarre who is also a professor at the Université de Montréal Faculty of Pharmacy. "We believe it's essential that they remain informed of all developments in a patient's file. The healthcare system can capitalize on the availability of pharmacists so they can make certain adjustments in the dosage of medication."

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