Joint Statement: Approaches to Enhancing the Quality Of Drug Therapy

This joint statement was developed by the Canadian Pharmaceutical Association and the Canadian Medical Association and includes the goal of drug therapy, strategies for collaboration to optimize drug therapy and physicians' and pharmacists' responsibilities in drug therapy. The statement recognizes the importance of patients, pharmacists and physicians working in close collaboration and partner-ship to achieve optimal outcomes from drug therapy.

The goal of this joint statement is to promote optimal drug therapy by enhancing communication and working relationships among patients. physicians and pharmacists. It is also meant to serve as an educational resource for pharmacists and physicians so that they will have a clearer understanding of each other's responsibilities in drug therapy. In the context of this statement, a 'patient' may include a designated patient representative, such as a parent, spouse, other family member, patient advocate or health care provider.

Physicians and pharmacists have a responsibility to work with their patients to achieve optimal outcomes by providing high-quality drug therapy. The important contribution of all members of the health care team and the need for cooperative working relationships are recognized: however, this statement focuses on the specific relationships among pharmacists, physicians and patients with respect to drug therapy.

This statement is a general guide and is not intended to describe all aspects of physicians- or pharmacists' activities. It is not intended to be restrictive, nor should it inhibit positive developments in pharmacist-physician relationships or in their respective practices that contribute to optimal drug therapy. Furthermore, this statement should be used and interpreted in accordance with applicable legislation and other legal requirements.

This statement will be reviewed and assessed regularly to ensure its continuing applicability to medical and pharmacy practices.

The goal of drug therapy is to improve patients' health and quality of life by preventing, eliminating or controlling diseases or symptoms. Optimal drug therapy is safe, effective, appropriate, affordable, cost-effective and tailored to meet the needs of patients, who participate, to the best of their ability, in making informed decisions about their therapy. Patients require access to necessary drug therapy and specific, unbiased drug information to meet their individual needs. Providing optimal drug therapy also requires a valid and accessible information base generated by basic, clinical, pharmaceutical and other scientific research.

Working Together for Optimal Drug Therapy

Physicians and pharmacists have complementary and supportive responsibilities in providing optimal drug therapy. To achieve this goal, and to ensure that patients receive consistent information, patients, pharmacists and physicians must work cooperatively and in partnership. This requires effective communication, respect, trust, and mutual recognition and understanding, of each other's complementary responsibilities. The role of each profession in drug therapy depends on numerous factors including the specific patient and his or her drug therapy, the prescription status of the drug concerned, the setting and the patient-physician-pharmacist relationship. However, it is recognized that. in general, each profession may focus on certain areas more than others.

For example, when counselling patients on their drug therapy. a physician may focus on disease-specific counselling, goals of therapy, risks and benefits and rare side effects, whereas a pharmacist may focus on correct usage, treatment adherence dosage precautions dietary restrictions and storage. Areas of overlap may include purpose, common side effect-, and their management and warnings regarding drug, interactions and lifestyle concerns. Similarly, when monitoring drug therapy. a physician would focus on clinical progress toward treatment goals, whereas a pharmacist may focus on drug effects, interactions and treatment adherence: both would monitor adverse effects.

Both professions should tailor drug therapy, including education, to meet the needs of individual patients. To provide continuity of care and to promote consistency in the information being provided. It is important that both pharmacists and physicians assess the patients' knowledge and identify and reinforce the educational component provided by the other.

Strategies for Collaborating to Optimize Drug Therapy

Patients, physicians and pharmacists need to work in close collaboration and partnership to achieve optimal drug therapy. Strategies to facilitate such teamwork include the following.

• Respecting and supporting patients' rights to make informed decisions regarding their drug therapy.
• Promoting knowledge, understanding and acceptance by physicians and pharmacists of their responsibilities in drug therapy and fostering widespread communication of these responsibilities so they are clearly understood by all.
• Supporting both professions' relationship with patients, and promoting a collaborative approach to drug therapy within the health care team. Care must be taken to maintain patients' trust and their relationship with other caregivers.
• Sharing relevant patient information for the enhancement of patient care, in accordance and compliance with all of the following: ethical standards to protect patient privacy, accepted medical and pharmacy practice, and the law. Patients should inform their physician and pharmacist of any information that may assist in providing optimal drug therapy.
• Increasing physicians' and pharmacists' awareness that it is important to make themselves readily available to each other to communicate about a patient for whom they are both providing care.
• Enhancing documentation (e.g., clearly written prescriptions and communication forms) and optimizing the use of technology (e.g., e-mail, voice mail and fax) in individual practices to enhance communication, improve efficiency and support consistency in information provided to patients.
• Developing effective communication and administrative procedures between health care institutions and community-based pharmacists and physicians to support continuity of care.
• Developing local communication channels and encouraging dialogue between the professions (e.g.. through joint continuing education programs and local meetings) to promote a peer- review-based approach to local prescribing and drug use issues.
• Teaching a collaborative approach to patient care as early as possible in the training of pharmacists and physicians.
• Developing effective communication channels and encouraging dialogue among patients, physicians and pharmacists at the regional, provincial, territorial and national levels to address issues such as drug-use policy prescribing guidelines and continuing professional education.
• Collaborating in the development of technology to enhance communication in practices (e.g.. shared patient databases relevant to drug therapy).
• Working jointly on committees and projects concerned with issues in drug therapy such as patient education, treatment adherence, formularies and practice guidelines, hospital-to…

CMA-CPhA Joint Statement, September 1996 C Copyright 1996, Canadian Pharmaceutical Association and Canadian Medical Association. All rights reserved. This joint statement may not be reproduced stored in a retrieval system or transmitted in any form or by any means, electronic. mechanical, photocopying. recording, otherwise, without prior written permission of the Canadian Medical Association or the Canadian Pharmaceutical Association

To comment or to obtain further information, please contact CPhA or CMA. Additional copies are available upon request.

Canadian Pharmaceutical Association (CPhA), 1785 Alta Vista Drive, Ottawa, ON KlG 3Y6, tel (613) 523-7877. 1-800-917-9489 ' fax (613) 523-C445. Canadian Medical Association (CNIA), 1867 Alta Vista Drive. Ottawa. ON KlG 3Y6, tel (613) 731-9331. 1-800-267-9703, fax (613) 731-1779.

CNIA-CPhA Joint Statement, September 1996