Abstract
We read with interest the article by Buxton et al., which proposes a simple pharmacist intervention to improve use of evidence-based therapies. 1 The authors concluded that an intervention such as this is quick, and improves medication management and collaboration with physicians. While we agree that more needs to be done in improving collaboration and use of clinical guidelines, the suggestions made by the authors must be pushed further before meaningful change is possible.
It seems that the authors' primary suggestion is that the model they propose will “[help] encourage a collaborative relationship” between physicians and pharmacists; however, we question the authors' definition of collaboration. To begin with, the example provided in the paper to improve use of ASA in certain patients is, in the current practice environment, something that pharmacists could suggest directly to the patient without any physician involvement. Notwithstanding that issue, we also question whether a collaborative relationship is really being created between health care professionals when one sends a fax seeking permission and acceptance from another in an authoritative model? There is no mention within the paper of a formal discussion or consensus building between the physician and the pharmacist.
The term collaboration has been examined and defined by a number of organizations, 2,,–5 and a unifying quality of these is that communication and decision-making is undertaken in a setting where both parties have the opportunity to discuss patients' health as equals. That is, both parties have the chance to speak and listen to the rationale of the other. To make collaboration work, health professionals must be skilled in active listening and effective conversation, whether they are interacting with patients/clients or with colleagues. 6 Collaboration implies that knowledge is shared between the parties — sending a fax and waiting for an acceptance of the recommendation is not sharing of knowledge or consensus building. It is plugging holes.
We would also argue that in addition to establishing a meaningful collaboration with physicians, patient involvement is paramount. If there is no buy-in from the patient, there is no collaboration, let alone adherence or concordance. The most effective therapeutic plans will only work if the patient agrees with the choices made and subsequently takes the medication. The patient's role in collaboration is central to it functioning effectively and ultimately improving patient health.
Patient-centred care, as defined by the Blueprint for Pharmacy, is understood as communication with patients, partnership with patients, health promotion and delivery of care. 7 Similarly, pharmaceutical care is “achieved through a collaborative and iterative process of reviewing medication according to the dynamic status of the person's health, [which] relies on communication between the pharmacist, the patient and the GP.” 8 As such, it is important to “tailor [one's] approach to the patient based on knowledge of the patient”; this means actively listening and considering the patient's point of view in addition to that of various other members of the health care team. 8
Neither collaboration nor patient-centred care are “simple” or “quick” processes — they take time, dedication and perseverance. The question then becomes, are pharmacists ready?