As HSE managers scramble to find solutions to reach record levels of overcrowding in hospital emergency departments and GPs face busy clinics, the role of pharmacists in helping to deal with large numbers of patients sick with viral illness has received little attention. got.
Dermot Twomey, the president of the Irish Pharmacy Union, says pharmacies can provide a solution to the current health crisis. “Ireland’s 1,900 pharmacies are located in virtually every municipality. They are easily accessible and should be our health system’s first line of defense,” says Twomey, owner of a busy pharmacy in Cloyne, Co Cork.
Dr. Chris Luke, former emergency medicine consultant at Cork University Hospital, also sees a role for pharmacists in this healthcare emergency. He believes that pharmacists should be enabled to provide much more primary care. “Let them prescribe or provide alternatives to a doctor’s prescription if there is a shortage of a drug,” he wrote in a recent column in the Irish Examiner. And recent research at University College Dublin has shown how many community pharmacists feel their competences and skills are under-recognised and under-utilised.
At the moment, pharmacists can give advice on self-care medicines and deliver prescriptions from general practitioners and hospitals, but they cannot prescribe medicines independently. They can only give patients alternative medicines if there is a shortage of the prescribed medicine or if a patient is happy to take a cheaper generic medicine with the same formulation. During the Covid-19 pandemic, pharmacists were temporarily given additional powers to dispense repeat prescriptions and emergency medicines for extended periods of time, which are still in effect today. Many pharmacists are now offering flu and covid vaccination, blood pressure monitoring and emergency contraceptive consultations.
Twomey says that in order to play a bigger role in easing the workload of GPs – and emergency departments too – pharmacists need to establish a minor ailment scheme. “This would allow pharmacists to prescribe drugs to patients on medical cards and be paid by the state for the drugs and the consultation. If pharmacists could treat patients with minor ailments such as indigestion/heartburn, athlete’s foot, coughs and colds, it would put pressure on GPs,” he says.
Currently, patients with a medical card must go to their doctor for a prescription so that they can get free medicine from their local pharmacy.
Aware of the potential conflict of interest as a drug seller and prescriber, Twomey says protocols could be developed with safety nets so pharmacists could only sell one or a maximum of two products under certain conditions. “This would ultimately free up GPs so they can handle more complex cases and similarly, hospitals could in turn handle cases with even more complexity,” says Twomey.
Such an approach would see pharmacists as the first stage in a triage system that would then refer patients to their GP if their condition did not improve. The Royal College of General Practitioners and the College of Emergency Medicine in the United Kingdom have estimated that one in seven GP consultations and one in 13 emergency room visits could have been handled by a trip to the pharmacy.
Many people first approach their pharmacist with minor ailments such as rashes, coughs and minor injuries. But the attention they get often depends on whether they have a friendly relationship with their local pharmacist or not. And some people feel that pharmacists’ propensity to sell products can sometimes override their desire to provide advice that would lead individuals to self-care options with simpler home remedies.
Twomey says pharmacists give a lot of advice informally. He suggests that such advice should be formalized into paid consultations without the need to always sell products. “We could take these consultations to a much higher level if we had access to the patient’s record,” says Twomey.
Dr. Brian Higgins, a GP in Galway City, believes there is a major role for community pharmacists in health education, but if pharmacists are to expand their role in patient care, it should be as a practice pharmacist who is part of the clinical team in town. primary care or general practice.
Referring to an evening shift he recently worked at a GP practice, he says about 80 percent of patients (13 out of 16) had self-limiting viral illnesses and the other 20 percent needed treatment and follow-up. plan.
“Health literacy is a very big issue and pharmacists can play a key role in educating patients about the use of over-the-counter medications such as acetaminophen, ibuprofen, cough syrups, the importance of rest and when a medical assessment is needed.” says Higgins. He adds that if patients were more knowledgeable about how to manage self-limiting viral infections, it would give GPs more time to see patients who would benefit from medical interventions, such as those with ankle sprains, pneumonia, severe tonsillitis or eye infections.
Higgins also praises the HSE’s website, undertheweather.ie, which provides clear information and advice on how to manage colds, coughs, sore throats, flu, earaches, diarrhea and vomiting, rashes, high temperature (fever) in children and adults, dehydration and sinusitis. “I text it to all my patients and ask them to read it and come back to me if they have any questions,” he says.
In the UK there are a number of clinical pharmacists who work as part of GP teams. Their duties include medication reviews for patients, helping manage long-term conditions and advising people on multiple medications. They also play a vital role in ensuring patient safety with regard to medicines.
The Galway Primary Care practice on Tuam Road, Galway, where Higgins works, is one of the few practices in Ireland to have a pharmacist as part of the shared care team. “Our pharmacist, Grainne McCormack, is amazing at providing safe, quality care to our patients. She reviews all requests for repeat prescriptions and advises patients whether the repeat is appropriate or whether a medical assessment and other investigations are needed,” explains the doctor.
According to Higgins, having a practice pharmacist not only improves safe prescribing and follow-up, but also reduces the administrative workload of the medical team. “This increases our ability to treat as many sick patients as possible,” he adds.
Dr. Brendan O’Shea, GP in Newbridge, Co Kildare, and assistant adjuvant professor of primary care and public health at Trinity College Dublin also sees the value in having pharmacists in GP surgeries. However, the VGM currently does not provide financial support to GP practices with patient card patients who employ a pharmacist as part of their team.
“Many community pharmacists already do a huge amount of work supporting people with medicines beyond dispensing pills and labeling bottles, but most Irish GP practices are not big enough to make it commercially viable to have a pharmacist or even a pharmacist assistant in their department. plow,” he says.
However, O’Shea believes that at a time when primary care physicians are “overwhelmed and underpowered,” there is a need for all evidence-based solutions. “In other countries, pharmacists have a greater role and with our aging population of frail elderly people there is a greater need for pharmacists’ expertise to safely treat patients who are taking a number of different medications that require regular review.”