Hi Michael
Yopu have raised an interesting point regarding the incorporation of
pharmaceutical care into smoking cessation programmes. I would like
to comment on what I consider to be the 2 principles which underpin
the philosophy of pharmaceutical care, namely accepting
responsibility for patient outcomes and developing a relationship of
trust based on competence and commitment to patient's drug-related
needs. In the following I have given a few examples linked to
smoking cessation. However, I hope that it is clear from
what I say that these are only marginally linked to the provision of
medication.
1. Responsibility for outcomes is based on the
generation of evidence of progress towards outcomes and the
maintenance of standards. Progress should be recorded by both patient
and pharmacist over a wide range of activities (depending on the
nature of the programme - three patient examples: 1. diary to record
time of craving and the perceived effectiveness of nicotine patch; 2.
diary to record amount of money saved on cigarette purchases on a
daily basis; 3. requiring the patient to carry a container (jar)
into which the cigarette ends are placed every day, counted at the
end of the day and recorded on a chart, plotted on a graph; .
Pharmacist examples 1. record and monitor patient information; 2.
calculate cost effectiveness of treatment over time; 3. record
patient positive experiences - eg. taste sensation, progress with
decline in early morning cough, improved exercise performance etc.
etc). Standards could be providing evidence of good pharmacy
practice standards - eg. accessibility, affordability (cost
effective/ cost benefit etc), reduce risk of drug related problems.
2. Trusting Relationships . These are built through first,
establishing a therapeutic alliance with each patient based on trust
and second, through networking with others. The first requires
evidence of competence (show the patient that you are up-to-date,
knowledgable in the field of smoking cessation (pamphlets, CE course
certificate) and credibility (evidence provided by other patients who
have successfully completed your smoking cessation course) and
commitment to the best interests of the patient (empathy,
confidentiality, continuity of care - all-hours telephone number to
contact in case of craving crisis; follow-up phone calls and
appointments to show commitment etc). The second requires linking
with significant others in the community involved in smoking
cessation - education and promotion of smoking cessation will
raise status of opinion leadership and personal influence,
reinforcing credibility and commitment.
Cheers
Billy
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Billy Futter
Associate Professor: Pharmacy Administration and Practice
School of Pharmaceutical Sciences
Rhodes University, Grahamstown, South Africa 6140
Voice +27 46-603-8494
fax +27 46-603-8205
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