The role of community pharmacists as advisors on prescription medication

This thesis describes the historical and functional evolution of British community pharmacists showing the succession of a compounding role by a supply function with incumbent bureaucracy. Development of a role as advisors on prescription medication is reviewed and the potential benefit explored by reviewing patients' lack of understanding about their medication following advice from general medical practitioners. Although ethical directives and specific guidance could be identified for the application and use of additional labels, little was found for provision of verbal advice. No comprehensive research was found to describe the prescription medication advisory role of community pharmacists. The present thesis primarily addresses this lack of knowledge. For a total of 651/2 days between June 1988 and February 1989 the discussions of twenty of twenty four randomly selected community pharmacists which involved prescription medication were tape recorded, transcribed and the circumstances observed. For half this time a poster advertising community pharmacists' advisory service was displayed. Verbal advice was provided by the community pharmacist to 473 of 3519 individuals involved with prescription medication. Two types of community pharmacists were identified, proactive and reactive. Irrespective of type, a constant level of requests for advice was noted. Overall, display of the poster was not associated with any significant effect on the quantity of advice; however, it was associated with changes in the nature of advice with greater emphasis on 'Specific problem' and 'Side effects' over 'What is prescribed' and 'What to do with it'. Although reiteration of the prescribers' directions and verbalising additional label warnings accounted for the majority of verbal advice, qualitative analysis revealed an element of independent judgement. The sociological literature on the professions provides an understanding for the observations. It is argued that guidance for verbal advice provided in the British National Formulary may facilitate community pharmacists' prescription medication advisory role.