'Strong medicine': an analysis of pharmacist consultations in primary care

Background. Patients often find it difficult to discuss their medications f ully with their prescribing doctor. Little is known about what might be sai d about medications to another professional within the primary health care team (PHCT). Pharmacists are seeking to extend their role within primary ca re and are ideally placed to provide independent medication advice. Objective. Our aim was to test the feasibility of using primary care pharma cists as medication counsellors, and to analyse the content of their consul tations using qualitative methods. Method. Some patients were referred by their doctors, some self-referred an d others were invited by the pharmacists for medication reviews. Pharmacist -patient consultations took place within GP surgeries and in patients' home s, and were audiotaped, transcribed and analysed qualitatively. The study s ample consisted of 25 consultations with th ree primary care pharmacists co nducted over a 3-month period. Results. Referrals from the doctors were slow and there were no referrals f rom nurses. The pharmacists, who all had clinical backgrounds and were not dispensing pharmacists, experienced few problems with the consultations. Pa tients were willing to discuss their medications in detail with the pharmac ists. A theme emerged regarding the perceived potency of medications, and t his seemed to have an effect on the experience of side effects and the perc eived efficacy of the medications. Conclusions. From this small study, it would seem that pharmacist consultat ions within primary care are a feasible extension of their current role as prescribing budget advisors. The richness of the consultations reflects the acceptability to patients. Feedback of information to other members of the PHCT, given patient consent, would be very useful for a better understandi ng of the patient's perspective, which in turn would facilitate concordance in the negotiation of the patient's management.