Invisible Pharmacist, The

American Journal of Pharmaceutical Education, 2009 by Dewulf, Nathalie L S, dos Santos, Vania, Pereira, Leonardo Regis Leira, Troncon, Luiz E A

To the Editor: Patient care at reference hospitals of the national health systems requires the articulated action of various professionals usually organized in teams, which should include physicians, nurses, and pharmacists among others. In particular, the pharmacist should be involved in discussing medication-related issues with other team members, as well as in advising patients about their pharmacological treatment. Central to this role is the practice of pharmaceutical care, defined as the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient's quality of life1. This role is far from trivial, and demands appropriate and specific training of hospital pharmacists and pharmacy undergraduate students.

An effective action of pharmacists in this field implies visibility in the hospital environment and ample recognition of their professional role. In an investigation of compliance with pharmacological treatment2, we were surprised that none of the 110 hospital outpatients included in the study mentioned the pharmacist as the professional who advised them about their pharmacological treatment. The physician was remembered by 103/110 (97.2%), the nurse by 11/110 (10.4%), while 4/110 (3.7%) patients mentioned other professionals (nutritionists and social workers). Importantly, 82/110 (74.5%) patients were included in federal programs supplying medications free of charge. These patients had to come to the hospital or go to another accredited center in order to receive the medication. Our expectation was that many patients would remember the pharmacist as the professional who advised them about medication usage; however, this was not the case. These data indicate that the pharmacist was "invisible" to the patients who received pharmacological treatment even though they were the main target of his/her professional action.

Irrespective of local deficiencies in infrastructure for pharmaceutical care and shortage of pharmacists3, pharmacist "invisibility" relates to educational issues. Although pharmaceutical care in Brazil comprises welldefined public policy supported by the law and formally structured in a specific national program of the federal government,5 there is a scarcity of professionals with adequate training for this field of work. It is therefore necessary to invest in continuing education for working pharmacists who must provide patient-centered pharmaceutical care.4,6 This is not an easy task because hospital pharmacists have long been assigned to more predictable administrative activities. They are not comfortable to carry on activities demanding contact with the patient, which represents a new and more challenging practice.

More important is professional training for new generations of pharmacists. In Brazil, the National Curricular Guidelines for undergraduate programs in pharmacy7 recommend that graduates will become closer to the "seven star" pharmacist, seen as a caregiver, a decision maker, communicator, manager, life-long-learner, teacher, and leader.8 This new training paradigm goes beyond the transmission of technical knowledge: the pharmacist, in addition to learning principles of pharmacotherapy, will relate to the health team and, in particular, will interact with patients. This view agrees with that of various institutions involved in pharmaceutical education, such as theAmericanAssociation of Colleges of Pharmacy,which has worked for more than a decade to guarantee a real change in the training of pharmacy professionals9.

The reorientation of the basic training of pharmacists, however, is a slow process facing various barriers of a conceptual and practical nature so that recent graduates have not yet incorporated these new attributes.10 At the 2 Faculties of Pharmaceutical Sciences at the University of Sao Paulo, training activities involving patient care were first introduced in 1997; however, this training still represents just 5% of the total curriculum hours.

There is still emphasis on training of professionals for the pharmaceutical industry, for work in clinical analysis laboratories, and in administration of hospital pharmacy services, but not for participation in actual patient care.

In conclusion, for pharmacist working in reference hospitals to become recognized members of the health team, the institutions should invest in continuing education for these professionals. It is also extremely important for undergraduate pharmacy courses to emphasize activities involving patient contact and multi-professional health teams so graduates will be able to provide adequate pharmaceutical care. Only in this way will pharmacists become more visible to patients and to other health professionals.

REFERENCES

1. Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47:533-43.

2. Dewulf NLS, Monteiro RA, Passos ADC, et al. Compliance to drug therapy in inflammatory bowel diseases outpatients from a university Hospital. Arch Gastroenterol. 2007;44(4):289-96.