1. Aren't you afraid that some overzealous pharmacists exceed their competence ?
 2. What is the place of the pharmacotherapeutic follow-up dossier with respect to the medical file that is used ? Is there redundancy ? Is there a risk of confusion ?
 3. Who does the pharmacotherapeutic follow-up dossier belong to : the pharmacist or the patient ? Can it be transferred ? To whom ? With whose consent ?
 4. In the community pharmacy, who can enter data in the pharmacotherapeutic follow-up dossier ?
 5. How are data in the pharmacotherapeutic follow-up dossier verified ?
 6. Is the system open or limited concerning the inclusion of medical and laboratory data ?
 7. Can the physician access the pharmacotherapeutic follow-up dossier ? If yes, is this access « automatic » or must the pharmacist and/or patient give his approval ?
 8. Do you believe that the medical and pharmaceutical secret have the same rigor, confidentiality and finality ?
 9. How can the pharmacotherapeutic follow-up dossier include these possible differences ?
 10. Is this Pharmaceutical Opinion the forerunner of prescription control according to the requirements of good practice recommended by the ANAES (National Agency for Health Accreditation and Evaluation)?
 11. In practice, what are the deadlines and means of reaction of the physician faced with a Pharmaceutical Opinion ?
 12. Is the Pharmaceutical Opinion a means to « score » the practices of physicians ?
 13. Could the Pharmaceutical Opinion be a simple means for some ill-disposed pharmacists to oppose some physicians ?
 14. What databases does the pharmacist use to support his Pharmaceutical Opinion?
 15. How can we change the mentality of patients who believe that the physician's prescription is inviolable ? Is there a risk of a loss of confidence and how can we protect it ?


1. Aren't you afraid that some overzealous pharmacists exceed their competence ?
The legal mission of the pharmacist is to protect « the interest of the patient's health », but the criteria for his participation are strictly pharmaceutical. The pharmacist can formulate no diagnosis and thus in no case is able to form any critical evaluation of the medical relevance of the treatment.


2. What is the place of the pharmacotherapeutic follow-up dossier with respect to the medical file that is used ? Is there redundancy ? Is there a risk of confusion ?
The follow-up dossier is the support for data acquired in the framwork of dispensing the medicine. It is a specialised aspect of the dossier. It is thus not redundant and so there is no risk of confusion because of the way it is constituted ans its particular scientific purpose.

3. Who does the pharmacotherapeutic follow-up dossier belong to : the pharmacist or the patient ? Can it be transferred ? To whom ? With whose consent ?
The follow-up dossier is maintained under conditions imposed by the law : just as the physician, the pharmacist is responsible for the structure and upkeep of his dossier. Ownership of the dossier, the conditions of transfer and the right of access all comply with the same legal provisions.

4. In the community pharmacy, who can enter data in the pharmacotherapeutic follow-up dossier ?
In light of the nature of the data and of their importance in the process, data cannot be entered by all personnel. Some data can be entered by pharmacists and not one else, in particular data that might have been obtained from the physician.



5. How are data in the pharmacotherapeutic follow-up dossier verified ?
Data cannot be entered without citing their source. The pharmacist is responsible for the quality of all data whose acquisition and verification are within the scope of his competence. He is not allowed to enter any type of judgment on data from a medical source. If there is a doubt, the pharmacist must contact the physician.


6. Is the system open or limited concerning the inclusion of medical and laboratory data ?
The system is not limited as regards data inclusion. The Pharmaceutical Opinion is simply a tool for professional acts that must be adapted to all circumstances, e.g. following chronically ill patients.

7. Can the physician access the pharmacotherapeutic follow-up dossier ? If yes, is this access « automatic » or must the pharmacist and/or patient give his approval ?
The physician can naturally access the pharmacotherapeutic follow-up dossier, since this is the prime objective of the Pharmaceutical Opinion : to contain all available information concerning the dispensing of health care products. Access is not automatic, since by analogy, its legal status is the same as the physician's patient file.


8. Do you believe that the medical and pharmaceutical secret have the same rigor, confidentiality and finality ?
The medical secret and the pharmaceutical secret are sanctioned in the same way by the law.
In addition, the secret is imposed on all personnel working for the pharmacist. Even if a part of the data are of a different nature, the ultimate purpose of the secret remains the same : protect the patient's privacy and dignity.

9. How can the pharmacotherapeutic follow-up dossier include these possible differences ?
The differences are related only to the nature of the data and not the legal regimen of their protection. Maintaining a follow-up dossier is an overall qualitative approach that totally retains the requirement of confidentiality and reciprocal confidence with the physician..


10. Is this Pharmaceutical Opinion the forerunner of prescription control according to the requirements of good practice recommended by the ANAES (National Agency for Health Accreditation and Evaluation)?
The purpose of the Pharmaceutical Opinion is to record the pharmaceutical act provided according to the criteria of the French Public Health Code. It is not allowed to adversely affect the basic principles of freedom of prescription, professional independence and personal prerogatives that characterize
liberal professions.
11. In practice, what are the deadlines and means of reaction of the physician faced with a Pharmaceutical Opinion ?
There is no existing standard: the deadlines and means of communication are and will be left to the full discretion of practitioners, depending on the requirements of each situation. The only absolute requirement is protection of the data exchanged.


12. Is the Pharmaceutical Opinion a means to « score » the practices of physicians ?
The number of Pharmaceutical Opinions concerning a patient is in no way an indicator of prescription quality, but rather the complexity of a situation.

13. Could the Pharmaceutical Opinion be a simple means for some ill-disposed pharmacists to oppose some physicians ?
The standard presentation of a Pharmaceutical Opinion enables both its author and recipient to offer opposition ! This ensures that its use will be well intentioned.
Just as the pharmacist, the physician remains the final person responsible for his decisions in the area of his scientific and legal competence. The physician can thus not be deterred by anything or anyone. He is free to determine and possibly discuss the relevance of the data, and just as the pharmacist, assumes his responsibilities freely and fully.


14. What databases does the pharmacist use to support his Pharmaceutical Opinion?
Databases are freely chosen by health care professionals in the context of their personal exercise from all scientifically recognised databases. The Pharmaceutical Opinion must contain the precise reference to any database used.

15. How can we change the mentality of patients who believe that the physician's prescription is inviolable ? Is there a risk of a loss of confidence and how can we protect it ?
The French law of March 4, 2002 on patient's rights considerably modified the relations of patients with the entire community of health care professionals. Ideally, the latter must show that they have accomplished their respective tasks with regard to the patient. The assurance of this multi-disciplinary process and its pedagogical dialogue with the patient will protect and increase the confidence required for the understanding, compliance and success of health care.