prescription drugs

It may be hard to believe but a pharmacy talk can actually be entertaining. Prof Derek Stewart made sure of that whilst conveying some important key insights of his group’s research.

Stewart runs a pharmacy practice research group with international reach at Robert Gordon University, Aberdeen. He has established a key partnership in Qatar and participates in a big EU project amongst many other activities. He even co-organised the first Collaborative Pharmacy Conference in Doha, Qatar.

His group has been rather prolific in recent years. Their publishing output went up significantly from 2014. Stewart’s attitude towards publishing is that is must have impact. There is no point in publishing when nobody reads your paper and nothing changes as a consequence of it.

In his talk on 16th Feb 2017 Stewart explained his current research interests:

  • Complementary and alternative medicine
  • Medicines for older people
  • Prescribing by pharmacists
  • The future of pharmacy practice

Complementary and alternative medicine

One of Stewart’s PhD students investigated the use of complementary and alternative medicine (CAM) by pregnant women. He reported that 56-88% of women in the UK use CAM. The worry here is that regulations for herbal medicines etc. are much less stringent than for regular drugs. This means that there is less evidence for their safety and effectiveness. Pregnant women are a high-risk group who not only put their own health on the line, but also the baby’s well-being.

The team found that family and friends are an important influence in a pregnant woman’s decision to use CAM, even though these women are often unsure whether the substance does any good. Interestingly, one-third of surveyed health practitioners said they have recommended or prescribed CAM despite not being too sure about the safety of the medicines. Health practitioners were 8x more likely to recommend CAM if they had used some themselves before.

A rather controversial finding was that some women are unaware that the medicines they are taking are classed as alternative medicines. This is a worry because regular questionnaires from midwives only ask a sort of top-level question along the lines, “Are you taking any CAM?” Obviously, a pregnant woman will answer that wrongly when she doesn’t realise what she is taking.

Medicines for older people

The older you are, the more drugs you take. The problem is that not all medicines should be taken together, and patients end up in hospital because of side effects. On average an elderly person has 6 to 7 different medicines in their pill box. Shockingly, about two-thirds of patients receive wrong medicines.

Stewart participates in SIMPATHY, a polypharmacy innovation EU project. Polypharmacy is the administration of several drugs at once. SIMPATHY includes 10 European organisations and is led by the Scottish government, which already boasts with excellent pharmacy guidance. The central question of this project is whether we can identify best practice across Europe and cause real change in the management of pharmacy practice.

Prescribing by pharmacists

Non-medical prescribing means that a professional who is not a medical doctor prescribes medicines. Prescribing drugs is a complex task. Stewart says, sometimes the best decision you can make is not to prescribe anything. You should only prescribe if you are clear about the reasons, you have considered the patient’s history and expectations, you are ready to monitor beneficial and adverse effects and you stay within your knowledge by making the decision. Studies have shown that wrong prescriptions in hospitals are not a rarity. One study on junior doctors found that pretty much every second prescription was wrong. The good news is that in such cases other staff, such as nurses, might notice the mistake before the patient gets the wrong drug.

The aim of pushing for non-medical prescribing is to make better use of specialist professionals like pharmacists. After all, drugs are their business. To become a non-medical prescriber, a professional would have to pass specialist training and register. Stewart presented results from a large meta-study, a Chochrane report, that found no difference in the outcomes between medical and non-medical prescribers.

Stewart then spoke about ‘Prescription for Excellence‘, a vision and action plan for pharmaceutical care by the Scottish government. It lays the foundation for a variety of ideas without being clear yet on how everything will work in detail. NHS pharmacists will be able to prescribe medicines by 2023. Robotic dispensing aids can be used to free up pharmacists from preparing pill boxes so that they can spend time on the tasks they are trained to do instead. Patients will be able to register with a pharmacy to receive actual continuity of care. This is especially beneficial for patients on long-term treatments because it means that their pharmacist will know their history and can advise much better.

Finally, Stewart mentioned that RGU is about to establish a memorandum of understanding with Hamad Medical Corporation in Qatar saying that RGU will be the place to go to for pharmacy support and joint working.

The future of pharmacy practice

Stewart thinks there are two key areas around non-medical prescribing that need tackled: (1) evaluation and (2) theory.

  • We need to monitor and evaluate whether non-medical prescribing works and analyse the reasons.
  • Non-medical prescribing means change. We need to understand the psychological theory of how to change behaviour of all involved stakeholders like practitioners, academics or patients. Furthermore, organisational and management theory need to be evaluated in that context

Stewart finished with the following words on integrity and respect:

These are quite literally lecture notes. As such, they may not be free from errors. You are advised to verify all presented statements.