A Comparison of Services Provided by Pharmacists and Nurses

11 Aug



Although overall rates of tuberculosis (TB) in Canada are low, the previous gradual decline in disease rates has reached a plateau. In both the United States and Canada certain groups remain at high risk for TB, most notably foreign-born residents, who represent over 50% of cases. Other groups at high risk include Canadian-born Aboriginal people, high-risk inner-city groups (including injection drug users and homeless people), and those with HIV infection.

Control of TB in Canada includes administering antituberculosis medication to those with active disease and preventive treatment to those with latent TB infection. The most serious problem hindering TB treatment and control is noncompliance with therapy, which delays sputum conversion to smear negativity, increases relapse rates, and increases the emergence of drug-resistant mutant strains.

Adherence to treatment requires the active participation of the patient in self-management of treatment and cooperation between the patient and the health care provider. The reasons for poor adherence are multifaceted and complex, and include lack of knowledge about medications and their side effects. Pharmacists who dispense antituberculosis medications provide counselling to enhance patients’ understanding of why they are taking the medication and the potential side effects of treatment, thereby helping to ensure patient adherence. The pharmacist’s role in advocating patient compliance is important for eradicating disease and for preventing relapse and development of resistant strains.
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The BC Centre for Disease Control (BCCDC) is a provincial organization with a mandate to control and eliminate communicable diseases within British Columbia. The Division of Tuberculosis Control of the BCCDC provides clinic services for the prevention and infirmiers n’etait pas significativement differente. Le degre de satisfaction eleve des patients et leur niveau de connaissances eleve des medicaments, comme le montre cette etude, illustrent l’avantage du soutien additionnel des pharmaciens en matiere de conseils. L’importance de fournir des renseignements ecrits aux patients comme vehicules de conseils a ete objectivee par le degre eleve de satisfaction des patients qui ont regu des conseils d’un pharmacien. Les avenues de recherche futures qui se degagent de cette etude comprennent la participation du pharmacien aux conseils prodigues aux patients atteints de tuberculose evolutive, afin que ceux-ci ameliorent leur observance au traitement antituberculeux.

Mots cles : satisfaction du patient, pharmaciens, questionnaires, tuberculose, conseils
treatment of TB. Nurses in the TB Clinic have traditionally counselled patients about their antituberculosis medications; however, in January 2002 medication counselling was taken over by pharmacists for 3 days each week. The pharmacy is housed within the centre, which allows direct patient consultation and gives the pharmacists access to each patient’s drug profile through Pharmanet, the provincial prescription database.
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Previous studies have focused on the pharmacist’s ability to meet patients’ need for health care services in the community and hospital settings. In these studies, the level of patient satisfaction with counselling has reflected the quality of care. In addition, a satisfaction instrument may be applied to evaluate a pharmacist’s performance. Larson and others developed a 20-item self-administered questionnaire to measure patient satisfaction with medication counselling, which allowed pharmacists to pinpoint with confidence the areas of their practice most urgently requiring improvement. In the study by Pickrell and others the level of pharmacist intervention was correlated with improvements in patients’ knowledge and recall of medicines. In that study, the follow-up period for the patient’s recall was limited to 2 weeks after discharge, and the authors suggested that it might be necessary to counsel the patient each time a supply of drugs was dispensed. The study reported here was initiated to compare patient satisfaction with counselling services provided by pharmacists and nurses.