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Homepage Pharmaceutical
Opinion and the pharmacistQuestions from the pharmacist |
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 1. Is it possible to establish a Pharmaceutical Opinion in the absence of a prescription ? If so, do I have the « right » or the « possibility » of transmitting it to the physician ?
2. When an Opinion has been established and a solution adopted in cooperation with the prescribing physician and recorded in the follow-up dossier, is it necessary to send it to the physician ?
3. Can the opinion be given to the patient ? Sometimes, never, in all cases ?
4. Does the use of a Pharmaceutical Opinion presuppose a modification of the French Public Health Code or can it be developed as a professional practice unto itself ?
5. When the Pharmaceutical Opinion is implemented, is there a provision to explain its purpose to physicians ?
6. Patient follow-up by the pharmacist requires considerable time. Is this compatible with the current work load of a community pharmacy ?
7. Is the entry of patient file information included in the activities of a pharmacist ?
8. Is the community pharmacy the right place to practice the Pharmaceutical Opinion ?
9. Does the introduction of the Sesam Vitale 2 smart card (inclusion of administrative data with other relevant data such as past history of deliveries, pathologies, biometric data, hypersensitivity, certain laboratory results, etc.), or of an equivalent system risk making the pharmacotherapeutic follow-up dossier inoperant ?
10. Does therapeutic follow-up conducted by the pharmacist risk to compete with practical surveillance by the physician, causing conflicts of competence ?
11. Are all pharmacists equally trained to use a Pharmaceutical Opinion ?
12. Could the Pharmaceutical Opinion affect medical practices ?
13. Does that take time ?
14. For how long should Pharmaceutical Opinion's be archived ?
15. Can all pharmacists prepare a Pharmaceutical Opinion ?
16. Is it possible that supervisory authorities will be tempted to use Pharmaceutical Opinion for their benefit to control physicians concerning the merits of their prescriptions (or pharmacists on their vigilance) ?
17. Does the Pharmaceutical Opinion involve laboratory workers, hospital staff, etc. ?
18. Is it necessary to belong to a topic-oriented network ?
19. For patients going to several community pharmacies, should the others be informed if a prescription problem is discovered by one of them ?
1. Is it possible to establish a Pharmaceutical Opinion in the absence of a prescription ? If so, do I have the « right » or the « possibility » of transmitting it to the physician ?
Whether or not a demand for a medicine is backed up by a prescription, the pharmacist is required to verify « the interest of the patient's health ». He can prepare a Pharmaceutical Opinion if the situation requires it, supported by recommendations to the patient or information for the physician.
For example, in the case of a contraindication or interaction with other treatments whether or not prescribed, presenting a risk of masking a symptom which could delay a diagnosis, etc…
2. When an Opinion has been established and a solution adopted in cooperation with the prescribing physician and recorded in the follow-up dossier, is it necessary to send it to the physician ?
When a Pharmaceutical Opinion is established, it is :
In a standardised format when there is a complex
alert, a doubt whether or not resolved, a need for surveillance, an original
intervention, a known vulnerability, a pathogenic behaviour, specific precautions
for use, a particular substitution, a need for internal information in the
community pharmacy, etc.
and communicated when legally required (in case of refusal
or modification), or if the pharmacist judges it useful to provide precise
information to the prescribing physician which he may need . Silence
by the pharmacist that could adversely affect patient interest, on the other
hand, could be sanctioned .
3. Can the opinion be given to the patient ? Sometimes, never, in all cases ?
Upon demand, the patient has the right to access personal information concerning him or her. There are two possible situations :
if delivery follows the prescription, it does not seem to be a good idea
to immediately remit the Pharmaceutical Opinion to the patient. It could
be a source of worry that is disproportionate with the aim in question.
If there is a modification, the patient has noted the pharmaceutical intervention.
If he asks questions, it may be useful to communicate the Pharmaceutical
Opinion, backed up for example by a recommendation or particular information
4. Does the use of a Pharmaceutical Opinion presuppose a modification of the French Public Health Code or can it be developed as a professional practice unto itself ?
No, it is not necessary to modify the French Public Health Code, since the Pharmaceutical Opinion is the embodiment of the pharmacist's public health mission. On the contrary, the Pharmaceutical Opinion may enable this mission to be developed by actively associating the pharmacist and the specialist of medicines as regards drug use in community practice.
5. When the Pharmaceutical Opinion is implemented, is there a provision to explain its purpose to physicians ?
The Pharmaceutical Opinion is the embodiment of the pharmacist's responsibilities: it is a document of his act that has been made possible by information technology.
The Pharmaceutical Opinion system has been designed by the Quality Assurance Commission of the Ordre des pharmaciens in which physicians have naturally participated. The approach was multi-disciplinary from the outset. The current information campaign reflects the installation of this site, of which a part is intended for physicians.
The implementation of the system and its thorough understanding are above all based on the reciprocal initiatives of health care professionals, physicians and pharmacists around the patient.
6. Patient follow-up by the pharmacist requires considerable time. Is this compatible with the current work load of a community pharmacy ?
Patient follow-up is one of the basic missions that goes beyond the simple security approach of the demand for medicines, whether or not prescription items. The Pharmaceutical Opinion system makes available functions that were heretofore difficult to use. The objective is to be as user-friendly as possible, to facilitate rather than complicate professional exercise. Patient follow-up may ultimately be improved.
7. Is the entry of patient file information included in the activities of a pharmacist ?
Yes, since « the interest of the patient's health » is at the heart of the pharmacist's activity. Until the present time, however, no tool has been available for the use of this relevant information, explaining the lack of data input. Data entered in the follow-up file result from questioning (of the patient, prescribing physician, etc.) and not an examination. It does not try to establish a diagnosis but rather aims at making the medicinal demand safe and assisting patients according to pharmaceutical criteria.
8. Is the community pharmacy the right place to practice the Pharmaceutical Opinion ?
Yes, provided the pharmacist retains the spirit of the two basic aspects of his profession, competence and the obligation of professional secrecy that require a confidential area inside the community pharmacy.
The introduction in France of direct health services payment to pharmacists has already changed the conditions of their profession. Implementation of the Pharmaceutical Opinion is the logical extension of this progress.
9. Does the introduction of the Sesam Vitale 2 smart card (inclusion of administrative data with other relevant data such as past history of deliveries, pathologies, biometric data, hypersensitivity, certain laboratory results, etc.), or of an equivalent system risk making the pharmacotherapeutic follow-up dossier inoperant ?
No, since these systems are complementary and compatible: the data are independent of the systems. This situation is similar to the use of direct health services payment software that uses administrative data, with the import of the same data from the Sesam Vitale 1 smart card. This introduction has not resulted in modifications of software structure.
10. Does therapeutic follow-up conducted by the pharmacist risk to compete with practical surveillance by the physician, causing conflicts of competence
No, since they do not have the same goal: follow-up by the pharmacist originated in the reasons for the demand for a medicine and not in a diagnostic procedure.
11. Are all pharmacists equally trained to use a Pharmaceutical Opinion ?
The aim of training pharmacists is to provide pharmaceutical acts whose Pharmaceutical Opinion is only the formal expression. Every delivery of a medicine is necessarily the result of a conclusive pharmaceutical analysis. A more detailed analysis is made possible by complementary training that the pharmacist is required to follow. He has the general responsibility of extending his knowledge.
12. Could the Pharmaceutical Opinion affect medical practices ?
Yes, once the pharmacist can rapidly communicate precise information affecting the establishment of the therapeutic course to follow. On the other hand, the Pharmaceutical Opinion is not a police tool to monitor prescriptions, since each of the parties is free and responsible for his acts, both protected by professional secrecy.
13. Does that take time?
This depends on the complexity of the patient's situation. Even so, the Pharmaceutical Opinion system was designed to have maximum user friendliness, leading to practical and rapid deployment.
14. For how long should Pharmaceutical Opinion's be archived ?
There is no specific guideline as yet but the follow-up dossier should be kept active for the same time as the medical file.
15. Can all pharmacists prepare a Pharmaceutical Opinion ?
All pharmacists are competent to prepare a Pharmaceutical Opinion. Technicians, on the other hand, do not have the same scientific qualifications and thus not the same legal prerogatives.
In the course of the process, technicians can nevertheless conduct all preparatory measures within the realm of their competence (administrative and accounting aspects, biometrics data, entry of medicines) and can consult the Pharmaceutical Opinions. They are of course subjected to professional secrecy.
16. Is it possible that supervisory authorities will be tempted to use Pharmaceutical Opinion for their benefit to control physicians concerning the merits of their prescriptions (or pharmacists on their vigilance) ?
This is possible, but it must be remembered that supervisory authorities already control medical acts via the simple payment for medicines. Nevertheless, even if the accounting trace of the act is accessible to the insurer or authority, the acts themselves are protected by professional secrecy. They can be accessed only by persons legally empowered.
17. Does the Pharmaceutical Opinion involve laboratory workers, hospital staff, etc. ?
The practical aspects of the Pharmaceutical Opinion are in the context of networked system. The development of the Pharmaceutical Opinion may naturally lead to exchanges between pharmacists and laboratory personnel, hospital staff, etc. This will support and develop the existing community practice-hospital relations and may even initiate new ones.
18. Is it necessary to belong to a topic-oriented network ?
No, this is not an obligation! But networks offer many opportunities for multi-disciplinary follow-up of risk factors, etc. This is a privileged domain for the expression of the Pharmaceutical Opinion, just like at-home care.
19. For patients going to several community pharmacies, should the others be informed if a prescription problem is discovered by one of them ?
If the patient's behaviour presents a risk that places his life in jeopardy, it is important to communicate with the health care professionals involved, but while respecting the personal life of the patient.
The patient is the prime intermediary of the pharmacist and he or she must be advised and supported.
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