Pharmacists' interventions: A few moments to save a life?

摘要

Imagine for a moment that you've just completed a cardiopulmonary resuscitation training course and the last session ran late. You are barely going to have enough time to stop and pick up your dry cleaning and buy milk before you need to be home to take your kids to soccer practice. On the way to your car, you see a woman on the sidewalk standing over her collapsed husband, screaming that he has no pulse. Is it conceivable that, with your list of errands, you might consider yourself too busy to help? Of course not. You would help because you have the expertise to perhaps save the man's life and because you know that the other tasks making you so busy are less important and could be performed by someone else.Imagine now that within every pharmacist's practice there are also simple evidence-based interventions that could save lives if they were being performed. But for the most part they are not being done and lives are not being saved. If you knew how to incorporate these interventions into your practice and you acknowledged that the other tasks that currently keep you busy are less important and could be performed by someone else, would you be willing to change your practice? Of course you would.This article is the first in a series that will aim to facilitate practice change by highlighting simple interventions, proven to improve outcomes, which pharmacists could implement with little or no change to the environment within which they practise.The intervention: Targeted telephone follow-up The idea of pharmacist telephone follow-up calls has been well-documented as an intervention that is effective, yet simple and quick to implement.1'2 Although there are pharmacies in Canada that currently perform regular telephone follow-up calls, it is certainly not utilized everywhere.Until recently it was unclear which patients should be targeted by pharmacist telephone follow-ups and the degree to which these patients would benefit from the service. In 2006, Wu and colleagues published a study that found that pharmacist telephone follow-up improved adherence and reduced all-cause mortality by 41% when targeting elderly patients (average age 71 years) taking 5 or more daily medications who had a previous history of nonadherence.3 The study was a 2-year, prospective, non-blinded, randomized controlled trial conducted in a hospital-based outpatient medical clinic in Hong Kong. Patients with chronic diseases were seen for routine follow-up by their physician every 2-4 months (for 10-15 minutes), which is similar to care provided in the Canadian health system. Stable patients were enrolled in the study if they were receiving 5 or more medications and if they had a history of nonadherence. Patients randomized to the intervention group received a 10-15 minute telephone call from the pharmacist (who worked in the clinic) every 3-4 months (at the midpoint between clinic visits).