COLLABORATIVE DRUG THERAPY MANAGEMENT (CDTM) BY PHARMACISTS: A SOLUTION TO THE NIGERIAN POOR HEALTH INDICES

The traditional system of providing drug therapy to patients, in which only certain health care professional are authorized to initiate drug therapy is under attack at many levels. The process of drug prescribing, dispensing, administration, monitoring and dosage adjustment as practiced in this traditional fashion occurs in disjointed fashion that frequently result in avoidable drug-related problems that contributes significantly to poor patient outcomes and increased medical cost. CDTM, characterized by an interdisciplinary approach to patient care, is emerging as a solution that can maximize the patient health related quality of life, reduce the frequency of avoidable drug related problems, and impose suitable benefits from pharmaceuticals. In this approach to care, drug therapy decision making and management are coordinated collaboratively by pharmacist, physicians, other health care professionals and the patients. When pharmacist share in CDTM, they share responsibility for patient outcomes, not just by providing basic dispensing function and drug information services, but by solving patient and indication-related problems and making decision regarding drug prescribing, monitoring and adjustments. The American college of clinical pharmacists advocates the role of qualified pharmacist as capable collaborative drug therapy managers to improve patient outcome and increase efficiencies in the health care system. Until 1938 pharmacists had been able to prescribe medications legally. The Durham-Humphrey Amendment of 1951 hence made it impossible for pharmacists to refill legend drugs without authorization from the physician. Thus the practice of physician prescribing and pharmacist dispensing became law. The paradigm shift came in the 1960, when pharmacists began to assume roles as direct patient care providers in rural settings within the Indian Health Services. Some of them were trained to diagnose and treat acute self limiting disease and chronic disease in ambulatory patients. A one year review of this management showed that 70% of the patients in this group were solely cared for by pharmacists and the quality of care was satisfactory and patient acceptance was excellent. In a similar fashion Erickson described a program in the Indian health service system that demonstrates that pharmacists were able to provide patient monitoring between physician visits and were also able to extend the interval between physician visit. The estimated health care savings due to clinical pharmacists prescribing in a skilled nursing facility were $70,000 annually (in 1984) for every 100 beds. Legislation allowing pharmacists to prescribe under protocol was first passed in the state of Washington in 1979. Currently 14 states in the US and its federal government have enacted legislation allowing some form of collaborative prescribing for pharmacists. Impact of pharmacist performing collaborative drug therapy management Since the late 1970s, many studies have been published that documented the success of pharmacist’s management of specific types of patients, drugs, disease states and specific patient problems issues. Outcomes measured have included increased patient safety and satisfaction, reduced healthcare cost, Improved efficiency. A study recently shows that for every dollar invested in clinical pharmacy services, on average, $16.70 of benefit was realized. Evolving view of health care Health care is now undergoing a paradigm shift from the failed government-driven health care reform to the emergent market-driven health care reform which has three principal values: 1) holding or lowering costs, 2) increasing patient satisfaction; 3) improving the quality of patient outcomes. This shift to create this new system will be accomplished by more integration and collaboration, as opposed to fragmentation. This reregulation of health professions has direct bearing on the need for collaborative drug therapy management and prescriptive authority for pharmacists, which is nurtured with a bid to protect consumers from misbranded and dangerous medications. Pharmacy is not also left out in this paradigm shift as it has embraced the philosophy that the provision of pharmaceutical care represents the principal mission of the profession. Core activities of pharmacists who provide pharmaceutical care include participating in drug therapy decisions, selecting drug products, determining doses and dosage schedules, preparing and providing drug products, providing drug information and education and monitoring and assessing of drug therapy. A collaborative practice maximizes physician training and expertise in diagnosis, and pharmacists training and expertise in drug therapy and disease management. In most successful example, the pharmacist and the physician have entered into a collaborative practice agreement or protocol under which the physician diagnoses and may make an initial treatment decision, and then authorize the pharmacist to select, monitor, modify, and discontinue medications as necessary to achieve favorable patient outcomes. The physician and pharmacist share the risk and responsibility for patient outcomes. A collaborative environment is the nature of current and future health care delivery system. Collaborative drug therapy managements; a solution to the Nigerian health sector The mortality indices and average life expectancy of Nigerians is presently below acceptable standard. This is largely due to the shortage of health care facilities and healthcare professionals which has a negative toll on the nation’s health indices. The various form of disease presentation is also lending a hand to these poor indices and is massively complicated by drug therapy problems which can only be detected by the pharmacists by virtue of his training. The drug therapy problems include wrong drug selection, indication not treated, drug for no indication, drug over dosage and toxicity, sub therapeutic dosing of drug, adverse drug reaction, drug interactions and failure to administer drug. All these significantly affect the mortality indices of the nation, with ADRs been the most pronounced of them all. In the United States, the cost of such response has been estimated at $ 100 billion and to be the cause of over 100,000 deaths annually. It is a truism that physicians by virtue of their training, specialization (diagnosis) and workload cannot keep pace with the growing pace of drug information and hence may lack the technical know-how to detect ADRs in record time to forestall its hazardous effect, thus heightening the need for collaborative drug therapy management by pharmacist. In the word of a physician during the last, “HIV SUMMIT”, organized by the National Association Of Hospital and Administrative Pharmacists (NAHAP) FMC Asaba chapter he said, “it’s time for health professionals to connect, collaborate and then compete not with themselves but with the diseases that challenge the human race”. This actually sells a solution to improve our health indices, because when collaborative agreements are reached the various community pharmacies which are scattered all around the federation can actually help reduce the number of patient that visit the hospital with uncomplicated/self-limiting condition leaving only complicated cases to the physician to handle. The number of patients that crowd our healthcare facility and overstretch the facility just for refills would also be reduced. If collaborative drug therapy management is adopted and practiced in our health sector the countries mortality rate would drop drastically and more persons would have access to health care because all members of the health team would be actively utilized bringing to the table their wealth of experience. References ACCP, Collaborative Drug Therapy Management by pharmacists, in Encyclopedia of clinical pharmacy, Joseph .T .D, Marcel Dekker Inc., USA, 2003 Pharm kanu, Ekenedilichukwu Azubuike (B.Pharm, Cert in Epidemiology, Dip Health Studies, MPSN, MGHN)