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Pharmacists could play bigger role in healthcare

November 23, 2016

  • Recommendations include more involvement in public health and wellbeing programmes
  • More assistance for patients in managing chronic diseases (e.g. asthma, diabetes)
  • Anticipates pharmacists’ locations may change, with changing healthcare delivery patterns and patient need e.g. providing medicines expertise in GP surgeries, in nursing homes and in tandem with domiciliary care.

The Pharmaceutical Society of Ireland (PSI), the regulator of pharmacists and pharmacies, has published a major report on how pharmacists can best meet the needs of patients and the public into the future, which contains significant recommendations for the planning and delivery of patient care and pharmacy services in Ireland.  “Future Pharmacy Practice in Ireland - Meeting Patient Needs” is the result of a research project, commenced in late 2015, that included an extensive consultation process involving patients, healthcare professionals, including pharmacists, other regulatory bodies, and engagement with policy-makers including the Department of Health, HSE, and wider stakeholders.

Anticipating patients’ healthcare and medicines needs in the future, the project examined the role pharmacists might play in public health and patient care improvements and healthcare system efficiencies that would benefit the public.  The report also informs the role the PSI will play in supporting pharmacists’ education and practice standards to meet these changes.  

Irish healthcare is facing a number of significant challenges including a rapidly ageing population and escalating demands. The number of people aged over 65 is expected to grow by circa 3% per year over the next 10-15 years, while 40% of the population is forecast to have at least one chronic illness by 2020.  Medicines are the most common healthcare intervention within the health system. However the ever increasing choice of medication treatments brings added complexity and potential risks to the safe and effective use of medicines.  National health policies, and the Programme for Government, meanwhile continue to focus on enhancing preventative healthcare, promoting wellbeing, and prioritising patient care needs as close to home as possible.

Dr Ann Frankish, PSI President, speaking at the launch of the report said “As the regulator we have a role in furthering quality public healthcare provision and facilitating an evolving pharmacist role where there is clear patient care value. Having examined the evidence available, this report presents the opportunities that would make the best use of pharmacists’ knowledge and expertise, both in community and hospital settings, as well as their extensive network. We have also highlighted the greater role that pharmacists can play as part of multidisciplinary teams, which ultimately contributes to patient safety and also provides cost savings to the health service.”

The recommendations outline how pharmacists could provide greater assistance for patients in managing their chronic diseases (such as diabetes, asthma), as part of structured medicine management initiatives in hospitals and also in the community for patients taking multiple or complex medicines.   The report anticipates that physical settings for services and patient care, delivered by pharmacists are also likely to evolve with changing healthcare delivery patterns and patient need. International experience has shown an increase in pharmacists successfully working and providing medicines expertise in GP surgeries, in nursing homes and in tandem with domiciliary care.

Dr Frankish added: “With an estimated 2 million visits to a pharmacy by the public per month pharmacists are the most accessed healthcare professional. We believe that maximising this regular contact would assist the implementation of the national health and wellbeing strategy by enabling pharmacists to support patients, protect and improve their health.”

Dr Norman Morrow, former Chief Pharmaceutical Officer at the Department of Health, Social Services and Public Safety in Northern Ireland chaired the special steering group appointed by the PSI to oversee the project.  Speaking at the launch he said “This report is not designed to be self-serving or to present a ‘wish list’ of services. Instead it puts patient in the centre, to see how their needs can be best met and recognises that pharmacy is part of the solution to the formidable healthcare challenges facing the country. “Future Pharmacy Practice in Ireland - Meeting Patient Needs” offers a direction of travel for the profession within the context of Government strategy and reform that will provide for multidisciplinary teams and a more integrated approach to managing the care of patients and the public.”

The extensive consultation process undertaken as part of the project was supplemented with national and international research on healthcare trends and best practice. Submissions were also received from 141 pharmacists or pharmacies about innovations already being undertaken in community and hospital practices to help improve patients’ medicine management and provide health promotion services. The consultation process also highlighted where policy-makers believe pharmacists could contribute most valuably to the healthcare system to ensure that the needs of patients are met in the most cost-effective way.

Significant changes have occurred in recent years in pharmacy practice including the availability of emergency hormonal contraception from pharmacists without prescription, the expanded role of community pharmacists vaccinating against seasonal influenza, and hospital pharmacists being more closely involved in the prescribing process as part of multidisciplinary teams.

The new roles for pharmacists that are recommended in the latest report would see pharmacists:

  • Contributing to health and wellbeing initiatives through structured population health information and awareness campaigns and providing reliable and informed information to the public on preventative medicine to support the maintenance and improvement of the health of the public;
  • Providing expertise in assisting patients to manage their chronic diseases and improve adherence to prescribed medicines by structured medicines initiatives, availing of ongoing disease monitoring and where appropriate, patients accessing medicines through supplementary prescribing by pharmacists, which allows therapy or medicines continuation in collaboration with a patient’s GP;
  • Managing what are complex medicines regimes throughout the patient care pathway via structured initiatives such as medication reviews for at-risk and vulnerable patients in the community and local settings e.g. nursing homes; and the greater use and sharing of pharmacists’ medicines expertise through education of both patients and other healthcare professionals in acute settings, to increase safety, reduce medication errors, ease transfer of care and optimise the use and impact of medicines for patients.

The report acknowledges that some key enablers are needed to support the development of future pharmacy practice, including on-going research, regulation and governance, education, continuing professional development and continued investment in IT. The report also identifies that leadership by the profession and collaboration between healthcare professionals is a critical element in securing progress in the best interests of patients, the public and the wider health service.

The full report is available at

View photographs from the launch of the Future Pharmacy Practice Report

Overview of the pharmacy sector

  • Over 1,900 registered pharmacies in Ireland; 1800 community pharmacies;
  • Over 5,700 registered pharmacists in Ireland; circa 10% work in hospitals;
  • Three out of four (76%) pharmacists in Ireland are under 45 years of age;
  • 2 million people visit a community pharmacy every month;
  • 20 million prescriptions are filled annually;
  • 62% of people over 65 years of age have one or more chronic illnesses;
  • More than 8% of all emergency admissions to hospital are medicine related;
  • More than eight out of ten (85%) older people are taking five or more medicines (polypharmacy) on admission to hospital;
  • Nearly a quarter (23%) of pre-admission medicines are omitted or incorrectly notified on admission;
  • Hospital discharge prescription errors have been reported for up to half (50%) of all patients.

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