SEPTEMBER 25 was this year’s World Pharmacists Day with the theme: ‘Safe and effective medicines for all’. The theme aims to promote pharmacists’ crucial role in safeguarding patient safety through improving medicines use and reducing medication errors.
“Pharmacists use their broad knowledge and unique expertise to ensure that people get the best from their medicines. We ensure access to medicines and their appropriate use, improve adherence, coordinate care transitions and so much more.
Today, more than ever, pharmacists are charged with the responsibility to ensure that when a patient uses a medicine, it will not cause harm,” says FIP President Dominique Jordan. Nigerian pharmacists are better placed to safeguard patient safety through medicines optimisation and patient centred care. I have observed that this service tends to be lacking in our primary and secondary care facilities because there is lack of multidisciplinary team approach in some settings. We need to start having these conversations and changing the status quo. A lot of patients using clinical facilities do not come in contact with a pharmacist. hey do not get their medicines reconciled or reviewed, which could result to exposure to adverse drug-drug interactions and lack of concordance.
As long as we still have some clinicians in Nigeria diagnosing, prescribing, dispensing medication and ‘hiding’ the name of the medicine from the patient, duplication of therapy, adverse drug reactions and drug-drug interactions are inevitable. Patients have the right to know the medicines they are taking to help achieve concordance and prevent medication errors and overdose. Medicines reconciliation is a process whereby patient’s medicines are reconciled as they move between different stages of healthcare, from primary-secondary care interface. Pharmacist-led medication review tends to be more in-depth, capturing all the essence of patient-centred care as it offers more time for the patient to ask medicines-related questions which enhances concordance. Medication reviews are needed to highlight issues of blood monitoring, therapeutic drug monitoring for medicines that require special monitoring like methotrexate, diuretics, digoxin etc.
According to the Royal Pharmaceutical Society, “Medicines optimisation represents that step change. It is a patient-focused approach to getting the best from investment in and use of medicines that requires a holistic approach, an enhanced level of patient-centred professionalism, and partnership between clinical professionals and a patient.”
Evidence has shown that a good number of medicines prescribed end up not being taken due to lack of concordance and compliance. My experience with patient-returned medication has shown that patients who do not understand the rationale for prescribed medication are more likely not to use the medication. Also medication used for preventative measures are at a higher risk of non-compliance as patients do not appreciate the benefits of taking such medication.
The gains of patient centred care cannot be overemphasised. All medical needs have to be tailored to the individual patient, considering their personal circumstances and other co-morbidities. Sometimes, frailty comes into consideration for some elderly patients as well.
In some clinical settings, a lot of patients do not know what regular medicines they are taking or the reason why it has been prescribed, their indication or side effects to expect and they have never had their medication reviewed by a pharmacist since their long-term condition was diagnosed. Part of the role of the pharmacist in a clinical setting is to complete medicines reconciliation and medication reviews especially for patients taking regular medication for long-term condition like hypertension, diabetes, arthritis, asthma etc. We need to create the enabling environment for this to be achieved.
For instance, a patent living in Kaduna with a history of hypertension, takes antihypertensive–Calcium channel blocker (CCB)-amlodipine tablets prescribed by his local doctor.
Adaku Efuribe
Lagos.