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BMJ. 2007 June 9; 334(7605): 1180.
PMCID: PMC1889953
Pharmacists in Primary Care

Study shows wrong people, wrong skills, wrong tools . . .

Duncan R Petty, lecturer practitioner and Arnold Zermansky

Salter et al identify some deficiencies in a small sample of pharmacist consultations.1 Their results say more about the need for consultation skills training and the context of the pharmacists and patients involved in this study than they do about the concept of pharmacist medication review.

The pharmacists involved in this study were the wrong people because they had no connection with the patient, the general practitioner, the local pharmacy or the hospital department and therefore lacked credibility. They had the wrong skills because they scrupulously avoided exploring patients' ideas and beliefs and persisted in a predetermined agenda that patients did not identify with. They had the wrong tools because they did not have the medical records or any indication for the medicines. They were doing the wrong job because people who have just had their medicines reviewed are not likely to benefit from a further review. And the timing was wrong because older people just discharged from the turmoil of hospital need some time to settle and reflect before someone intervenes again.

This study says little about pharmacists' ability to conduct medication reviews. The HOMER study was not a realistic model for pharmacist medication review.2 The discharge note must be reviewed in context of the clinical record and in discussion with the general practitioner. Only then should the patient be visited. Their paper is therefore a lesson in the need to construct a useful intervention before setting out to test it. It is also reminds us of the need to learn Osler's century old lesson “Listen to the patient, he's telling you the diagnosis.”

Notes

Competing interests: None declared.

References

1. Salter C, Holland R, Harvey R, Henwood K. “I haven't even phoned my doctor yet.” The advice giving role of the pharmacist during consultations for medication review with patients aged 80 or more: qualitative discourse analysis. BMJ 2007;334:1101-4. (26 May.) [PMC free article] [PubMed]
2. Holland R, Lenaghan E, Harvey I, Smith R, Shepstone L, Lipp A, et al. Does home based medication review keep older people out of hospital? The HOMER randomised controlled trial. BMJ 2005;330:293. [PMC free article] [PubMed]

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