There is limited literature available on the effect of pharmaceutical care on patient outcomes, or is based upon small patient numbers or ill-defined endpoints^1-4. This study aims to develop a pharmaceutical care plan through evidence of current practice that improves the system of information transmission from secondary to primary care, using a randomised-controlled trial design. Both process and outcome measures will be used to assess the effects of the intervention: reduced re-admissions to hospital and patient-initiated visits to primary health care providers. We are taking an evidence-based approach to developing such a model and this paper describes the initial processes involved in the development of such a plan. Four methods were used to describe the current delivery of pharmaceutical in hospital and the ideal model of pharmaceutical care. This will provide evidence behind the design of the intervention to be tested in the randomised controlled trial.

The first stage was a literature review to explore national and international concepts of pharmaceutical care, where these concepts differ and the grounds upon which they are based, to provide insight into the theoretical concept of pharmaceutical care. The second stage was a content analysis of the protocols and written procedures describing the delivery of pharmaceutical care on wards within the study trust. This provided insight into the managerial application of pharmaceutical care. The third stage was a description of the various types of pharmaceutical care delivered throughout the trust using observational methods. This provided insight into the application of pharmaceutical care in practice in various settings. The fourth stage was an exploration of the ideals model of pharmaceutical care as perceived by the pharmacists observed during the third phase. The findings from the first three stages informed the development of an interview schedule, which explored perceptions of current practice, protocols and guidelines, potential involvement in the development of guidelines for best practice, the ideal model of pharmaceutical care, effect on professional esteem and measurable outcomes.

The findings of all four stages are being used to propose and develop a replicable model of pharmaceutical care that reduces re-admissions to hospital and patient-initiated visits to primary health care providers, whilst improving professional esteem and developing models for clinical governance within pharmacy. In this way, we utilise best current practice to further develop pharmaceutical care and to set standards of excellence to be replicated throughout the profession.

References

1. Lobas, N., Lepinski, P. and Abramowitz, P. (1992) Effects of pharmaceutical care on medication costs and quality of patient care in an ambulatory-care setting. American Journal of Hospital Pharmacy 49, 1681-1688.
2. Bjornson, D., Hiner, W., Potyk, R., Nelson, B., Lombardo, F., Morton, T., Larson, L., Martin, B., Sikora, R. and Cammarata, F. (1993) Effect of pharmacists on health care outcomes in hospitalized patients. American Journal of Hospital Pharmacy 50, 1875-1884.
3. Shalansky, S., Nakagawa, R. and Wee, A. (1996) Drug-related problems identified and resolved using pharmaceutical care versus traditional clinical monitoring. Canadian Journal of Hospital Pharmacy 49, 282-288.
4. Smythe, M., Shah, P., Spiteri, T., Lucarotti, R. and Begle, R. (1998) Pharmaceutical care in medical progressive patients. The Annals of Pharmacotherapy 32, 294-299.