The Drugs and Prescribing Section held a very successful parallel session at Derry, addressing areas of prescribing for older people, where pharmacists and geriatricians working together have the potential to improve management.

Fran Cassidy from the Northern Ireland Centre for Postgraduate Pharmaceutical Education and Training, updated us on the roles and responsibilities of independent prescribers (doctors and dentists) and supplementary prescribers (pharmacists or nurses). She informed us that a written clinical management plan is a legal requirement for supplementary prescribing and that patients have to endorse the prescribing arrangements. She gave some helpful examples of written clinical management plans and prescribing areas, where supplementary prescribing is being developed.

Compliance vs Concordance
Briegeen Girvin, Prescribing Information Pharmacist at the Department of Therapeutics and Pharmacology, Queen’s University, Belfast, clarified the difference between concordance and compliance and reviewed the research on interventions aimed at improving compliance. Her own research has confirmed that improvements in compliance are achieved with once daily medications compared with twice daily. There is however, very little evidence to support many of the interventions used in day to day clinical practice to improve compliance. The best evidence is still probably for interventions that include patient counselling.

OBRA
Finally, Dr Carmel Hughes, Senior Lecturer in Primary Care Pharmacy at the School of Pharmacy, Queen’s University, Belfast, spoke of the need for medication review and improved prescribing in Nursing Homes and the roles of regulation and collaboration in achieving improvements. As a Harkness Fellow in Healthcare Policy, Carmel spent a year in the Centre for Gerontology and Healthcare Research at Brown University, investigating the impact of administrative initiatives such as OBRA (Omnibus Budget Reconciliation Act) on prescribing in Nursing Homes. She outlined the positive achievements of such initiatives, particularly notable improvements in the non-prescribing of ‘bad drugs’. She also addressed the subject of the limitations of a regulatory approach only, in particular the lack of emphasis on the prescribing of ‘good drugs’. She informed us of current research initiatives in the USA (Fleetwood Project), investigating new models of pharmaceutical care which emphasise communication between prescriber and pharmacist, and formalised care planning in a more collaborative fashion. This research is also due to start in Northern Ireland shortly.

The richness of the discussions generated at the DPS session in Derry indicated how important these areas are in day to day clinical practice, particularly as medical science progresses and ever more complex drug regimens become prevalent in older people.

The DPS is very keen therefore to involve more pharmacists, particularly in the research activities of the Section. Enquiries concerning membership of the Section may be addressed to greens3@cf.ac.uk

Sinead O’ Mahony
BGS D&P Section Secretary