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The Pharmacist's Role in Patient Care

1991; Wiley; Volume: 21; Issue: 1 Linguagem: Inglês

10.2307/3563340

1552-146X

Richard Schulz, David B. Brushwood,

Pharmaceutical Practices and Patient Outcomes

Richard M. Schultz, associate Professor of pharmacy practice, College of pharmacy, University of South Carolina, Columbia; David B. Brushwood is professor of pharmacy health care administration College of Pharmacy, University of Florida, Gainesville. The role of the pharmacist is frequently omitted from discussions of patient care issues, where the focus is on the physician and other health care providers within the physician's immediate sphere of influence. When attention does turn briefly to pharmacists, confusion often arises about the scope of their responsibilities to the patient and the expectations patients should have of them. Similarly confused views of pharmacy are frequently seen in newspaper articles and judicial opinions.[1] A factor that may contribute to confusion about the role of pharmacists is that observers of health care trends tend to be autonomous decisionmakers, who in their personal lives have little need for the information and counseling that are valued highly by less sophisticated pharmaceutical consumers. Well-educated, high-income policy makers can be their own advocates. They are not likely to leave a doctor's office without a thorough explanation of a drug's beneficial and detrimental effects. Less fortunate and less assertive individuals may have greater need for a pharmacist's assistance with drug-related medical decisions. Class differences between patients and physicians may stifle interaction if physicians withhold information that they consider too technical and detailed for certain levels of understanding or if patients remain silent for fear of appearing ignorant or being a nuisance. Pharmacists frequently live and work in the same community as the people they serve, and are often closer in socioeconomic status to patients than are physicians. Patients, therefore, may view pharmacists as more approachable about health issues. We suggest that the public would be well served if pharmacy practice expanded into new areas, including patient advocacy. Legal scholars, ethicists, and health care analysts must consider whether such expansion should be encouraged. Critical questions shaping this consideration should be: (1) Do physicians currently provide patients with sufficient risk-related information about drugs? (2) Do pharmacists possess sufficient knowledge of drugs and diseases to counsel patients competently in the physician's absence? (3) Is the pharmacist an appropriate person to serve as a patient advocate with respect to drugs? (4) Does pharmacists' providing patients with accurate information about drugs necessarily interfere with the Physician-patient relationship? (5) Is a risk assessment/risk management conceptualization sufficiently rich and flexible to accommodate emerging health care roles? (6) When, if ever, is a pharmacist justified in withholding information from a patient? and (7) Can pharmacists work legally and ethically with a patient to develop an optimal medication practice for that patient if the medication practice might differ from the directions for medication use given by the physician? Stages of Assessment: During the past several decades, there has been a trend in drug therapy toward centralized decisionmaking, with fewer and fewer options being left to the person whose body is to be affected by the drug. New drugs must be approved by the Food and Drug Administration (FDA) before they are marketed, and most effective drugs must be prescribed by a physician. A patient does not have the freedom to decide to use a chemical substance as a medication unless the FDA has first approved it and a physician has prescribed it. The drug distribution system, although rigid in some respects, is sufficiently flexible to accommodate risk evaluation at three stages. The first stage is the negotiation between a new drug's industrial sponsor and the FDA. In deciding whether to approve a new drug, a scientific assessment of risk is made, based on known characteristics of a general population. …