Rogalski David, Barnett Nina, Bueno de Mesquita Amanda, Jubraj Barry
Camden and Islington NHS Foundation Trust, London RG24 9NA, UK.
London North West University Healthcare NHS Trust, London HA1 3UJ, UK.
Pharmacy (Basel). 2023 Mar 22;11(2):62. doi: 10.3390/pharmacy11020062.
Pharmacists have traditionally supported the prescribing process, arguably in reactive or corrective roles. The advent of pharmacist prescribing in 2004 represented a major shift in practice, leading to greater responsibility for making clinical decisions with and for patients. Prescribing rights require pharmacists to take a more prescriptive role that will allow them to contribute to long-standing prescribing challenges such as poor medication adherence, overprescribing, and the need for shared decision-making and person-centered care. Central to these endeavors are the development and possession of effective consultation skills. University schools of pharmacists in the UK now routinely include consultation skills training, which is also provided by national education bodies. These challenges remain difficult to overcome, even though it is understood, for example, that increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments. More recently, a concerted effort has been made to tackle overprescribing and the harm that may occur through the inappropriate use of medication. In routine pharmacy work, these priorities may linger at the bottom of the list due to the busy and complex nature of the work. Solutions to these problems of adherence, optimizing benefits of medication, and overprescribing have typically been pragmatic and structured. However, an arguably reductionist approach to implementation fails to address the complex patient interactions around prescribing and taking medication, and the heterogeneity of the patient's experience, leaving the answers elusive. We suggest that it is essential to explore how person-centered care is perceived and to emphasize the relational aspects of clinical consultations. The development of routine pharmacist prescribing demands building on the core values of person-centered care and shared decision making by introducing the concepts of "relational prescribing" and "open dialogue" to cultivate an essential pharmacotherapeutic alliance to deliver concrete positive patient outcomes. We provide a vignette of how a clinical case can be approached using principles of relational prescribing and open dialogue. We believe these are solutions that are not additional tasks but must be embedded into pharmacy practice. This will improve professional satisfaction and resilience, and encourage curiosity and creativity, particularly with the advent of all pharmacists in Great Britain becoming prescribers at graduation from 2026.
传统上,药剂师一直支持处方开具过程,可以说他们扮演的是反应性或纠正性角色。2004年药剂师获得处方权代表了实践中的重大转变,这使得药剂师在与患者共同并为患者做出临床决策方面承担了更大的责任。处方权要求药剂师发挥更具指导性的作用,从而使他们能够应对长期存在的处方开具难题,如用药依从性差、过度开药以及共同决策和以患者为中心的护理需求。这些努力的核心是有效咨询技能的发展与掌握。英国的药学院校现在通常会开展咨询技能培训,国家教育机构也会提供此类培训。尽管人们明白,例如提高依从性干预措施的有效性对人群健康的影响可能远大于特定医疗治疗的任何改善,但这些挑战仍然难以克服。最近,人们齐心协力应对过度开药以及不当用药可能造成的危害。在日常药房工作中,由于工作繁忙且复杂,这些优先事项可能会被搁置在清单底部。解决这些依从性问题、优化药物疗效以及过度开药问题的方法通常是务实且有条理的。然而,一种可以说是还原论的实施方法未能解决围绕处方开具和用药的复杂患者互动以及患者体验的异质性问题,导致答案难以捉摸。我们认为,探索如何理解以患者为中心的护理并强调临床咨询的关系层面至关重要。常规药剂师处方开具的发展需要在以患者为中心的护理和共同决策的核心价值观基础上,引入“关系处方”和“开放对话”的概念,以培养至关重要的药物治疗联盟,从而实现切实积极的患者治疗效果。我们提供了一个如何运用关系处方和开放对话原则处理临床病例的示例。我们认为这些解决方案并非额外的任务,而是必须融入药房实践。这将提高职业满意度和适应能力,并激发好奇心和创造力,尤其是随着从2026年起英国所有药剂师在毕业时都将成为开处方者。