Introduction

International studies have indicated substantial discontinuation and non-adherence rates among patients prescribed statins for the treatment of hyperlipidaemia. 'Pharmacy in the Future- implementing the NHS plan' states a commitment to the development of schemes for pharmacists to support patients in their use of medicines. As part of a study into patient and community pharmacist perspectives on statins, the relationship between patient and pharmacist was explored in relation to the dispensing of statins.

Method

Purposive sampling methods were used to identify patients from a single general medical practice who were classed as new, long-term or previous statin takers. Semi-structured interviews were conducted with 25 patients, exploring their beliefs and experiences in relation to taking statins. A sample of 20 community pharmacists was purposively drawn and interviews conducted which covered a number of issues including activities currently undertaken when dispensing statins for patients.

Results

Patients in the study reported little or no interaction with pharmacists when receiving first time or repeat prescriptions for statins, with any dealings amounting to little more than a transaction between the two. In-depth dialogue was entered into only in response to patient query. In contrast whilst stating that invariably there was no interaction with patients receiving repeat prescriptions, in the case of first time prescriptions pharmacists reported undertaking a number of activities including providing technical information, lifestyle advice and highlighting the necessity of treatment.

Pharmacists identified cholesterol monitoring, repeat dispensing, supplementary prescribing, lifestyle advice and support, and medication review as areas for role development. Patients' views on extended roles varied, with support for those viewed as convenient to them, such as repeat dispensing and cholesterol monitoring, and less support for roles that involved the pharmacist making a clinical intervention by altering statin doses. Pharmacists saw lack of access to patient medical records as a barrier to service development, however patients expressed concerns over pharmacist access, particularly with regard to other pharmacy staff maintaining confidentiality of information.

Discussion and Conclusion: Patients in this study came from a single medical practice, and consequently were not necessarily using the pharmacies of those community pharmacists interviewed. However, the results indicate a significant gap between patient and pharmacist accounts of their interactions when a first time prescription for a statin is dispensed, and in their perceptions of how the pharmacist's role could be developed in the future.

From the patient's viewpoint, pharmacists appear to play a minor role in the statin-taking experience. In contrast, pharmacists represent themselves as playing a more active part in providing advice and information to patients, at least when they are starting to take statins. Pharmacist and patient views on extending the roles of pharmacists in this area also differ. These issues need to be addressed if the delivery of medicines management services is to improve and develop in the future.