Development of Pharmacy Services in a Family Medicine Residency Program

Abstract

INTRODUCTION

Reports of pharmacists working in family medicine settings appeared in the literature as early as 19741 and have continued to the present day.2-28 The role of the pharmacist in this setting has evolved over the past 30 years. In the 1970s most sites had dispensaries, and pharmacists were involved in traditional dispensing functions.1-3,6,7 Pharmacists were also involved in patient care activities (e.g., counselling and taking medication histories), liaising with pharmaceutical company representatives, and providing drug information and education to physicians.1-10 The 1980s saw the expansion of patient care services (i.e., consultations, monitoring, home visits, and liaising with community pharmacists) and the enhancement of services to health care professionals (i.e., education for physicians, residents, and nurses; formulary product selection; and newsletters).11,12,14,15,17-19,21,22 This growth continued into the 1990s, with pharmacists becoming more involved in committee and administrative work as well as research and scholarly activities.23-27,29-33 These changes were especially evident in sites that served as training facilities for family physicians.23,25,27,28,30-33 The first study of pharmacists’ contributions in this setting was reported in 1975. It showed that pharmacists’ consultations with patients regarding their medications and health care needs improved consumers’ attitudes toward pharmacy.3 In a 1979 study, a peer review panel concluded that drug therapy recommendations made by pharmacists and implemented by physicians were appropriate and had favourable effects on patient care.10 Studies published since then have shown that patient-specific consultations and both formal and informal drug-related education provided by the clinical pharmacist improve physicians’ prescribing practices.34,35 Other studies have reported that recommendations made by clinical pharmacists contribute positively to patient care by resolving drugrelated problems or improving the clinical status of the patient.30,36,37 Several studies have described patients’, physicians’, and family medicine residents’ positive perception of clinical pharmacy services.9,12,33,37,38 Other research has demonstrated the positive cost–benefit ratio of clinical pharmacy services in family practice.39-42 Most of the research appears to have been conducted at sites with residency training programs in family medicine.9,10,12,30,33-38 There is, however, a paucity of information on the role or impact of clinical pharmacists in family medicine settings in Canada. The purpose of this paper is to describe the implementation and growth of pharmacy services in a family medicine residency training program in Halifax, Nova Scotia.