Toward a Unified Model for Contemporary Institutional Pharmacy Practice

Abstract

When a patient sees a physician anywhere in Canada or the United States, chances are high that the approach the physician takes to assessing and diagnosing actual or potential medical problems will be virtually the same as that of other physicians, regardless of geographic location or practice setting. Although different physicians may arrive at different diagnoses or different treatment plans for the same diagnosis, the process that they use to reach those decisions is consistent and essentially universal. This congruence reflects the fact that physicians have an established, consistent, widely accepted practice model. The same is true for dentists, as well as for the vast majority of other health care professionals. On the other hand, when a patient is under the care of a hospital pharmacist in Canada or the United States, it is likely that the pharmacist’s approach to assessing and diagnosing drug therapy problems will not be the same as and, in many cases, will not be remotely similar to that of other hospital pharmacists. The approaches of institutional pharmacists to the assessment and diagnosis of drug therapy problems and to the development of treatment plans vary widely from practitioner to practitioner, from institution to institution, and even from patient care unit to patient care unit within the same institution. Furthermore, chances are that the specific role of the pharmacist on the health care team will vary from institution to institution and from unit to unit. More broadly, specific drug distribution models, and the overall process of ensuring that the right patient receives the right drug at the right time, also vary widely from institution to institution, as do the roles assigned to pharmacy technicians. Even the technologies that we use in our drug distribution systems vary substantially from institution to institution. In brief, the profession of pharmacy, including pharmacy as practised in institutional settings, does not have an established, consistent, widely accepted practice model. Why is this so? Why don’t pharmacists have an established, consistent, widely accepted practice model? Part of the reason may be that the role of pharmacists within the health care system has not been precisely defined. I would propose that the role of the pharmacist, as an integral and indispensable member of collaborative multidisciplinary health care teams, is to identify, diagnose, and manage (or prevent) actual and potential drug therapy problems and to be responsible for patients’ outcomes related to drug therapy. With respect to the drug distribution system, I see the role of the pharmacist as primarily that of an overseer, with technicians, using appropriate technology, being primarily responsible for functions within the system. However, my sense is that many pharmacists and other health care professionals would not necessarily agree with me, and they might well propose a different definition of the pharmacist’s role within the health care system. If we cannot define and agree upon our role, how can we delineate the appropriate practice model through which to fulfill that role? Why is it important for medicine, dentistry, and, I would suggest, pharmacy, to have their own established, consistent, widely accepted practice models? Provided that each patient’s drug therapy problems are adequately addressed, does it matter how the pharmacist achieved this? I would suggest that, without an established, consistently effective practice model, it is impos sible to consistently and accurately identify, diagnose, and manage (or prevent) actual and potential drug therapy problems and thereby to improve patients’ outcomes related to drug therapy. In pharmacy, we currently do not know which model of practice is most effective for improving patient outcomes, and this is a fertile area for pharmacy practice and comparative effectiveness research. An effective, consistent practice model would likely also help to establish and affirm the importance of pharmacists to patients and to the other health care professionals with whom we collaborate to deliver care, as it would more consistently demonstrate who we are, what we do, and why our work is important for patient care. Pharmacy practice models, applicable to all pharmacists regardless of practice setting, have been proposed in the past. Most notably, the pharmaceutical care practice model was