At last with the introduction of the New Medicines Service (NMS) the Department of Health have shown confidence ion pharmacist’s ability to add value for patients prescribed a new medicine in 4 important therapeutic areas. It is to be hoped that most community pharmacists will grab this opportunity to prove the benefit they can bring to patients and to the wider healthcare community, as well of course as earning a welcome service oriented modest additional income stream.The NMS is well described elsewhere, but in this short piece I hope to encourage pharma companies and related others to think further about developing well thought out and well structured concordance activities of their own with interested pharmacists, for the vast majority of therapy areas that will NOT be covered by the NMS.
In terms of preparation for concordance developing activities, I suggest that further research is required into the psychological motivations of both target patients (and pharmacists!). In relation to any particular condition and related prescribed therapy, it is important first to find out the patients motivations are to get well. Whilst on the surface the answers to such lines of enquiry may seem predictable, the predictions should not be taken for granted. Previous such research has suggested that there are 3 key areas to understand in order to optimise patient concordance to a prescribed therapy after a medical consultation
*exploration of patient understanding
*patient memory
* patient satisfaction with the consultations
Whilst the background research needs to be done in some detail, practical experience has shown that the concordance interventions developed for pharmacists to deliver to patients need to be structured and straightforward. Any associated administration pharmacists must complete to assess intervention effectiveness, needs to be as automated as possible. If these pointers are ignored, ultimate success is very unlikely.
To design an effective concordance enhancing intervention, I would like to credit a proposal recently made by Nina Barnett with the suggestion that all concordance interventions be developed to cover 4 essential and progressive steps with patients: 1. exploration, 2. education, 3. empowerment and 4. enablement.
Pharmacists are perhaps best trained to educate, and increasingly to explore. Epowerment and enablement are however somewhat newer concepts which will require more support to be given to pharmacists in order that they can effectively deliver them.
I can’t remember the source of the following quote but “If you always do what you always did, you will always get what you always got” . It is, I suggest, time for Pharma to begin to more actively engage with community pharmacists in developing work in this area, the time could never be better.