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MEDICATION HISTORIES
BPMHs, the outcomes need
to be more favourable in all
respects to warrant such an
investment.
Patient care from a pharmacy
practice perspective requires the
pharmacist to work with the patient
and other members of the healthcare
team in order to “promote
health, prevent disease, and to
assess, monitor, initiate and modify
medication use to assure that drug
therapy regimens are safe and
effective” 1 . Since the BPMH allows
for an assessment of a patient’s
medication use, it is an important
first step in providing pharmaceutical
care. Dersch-Mills et al. (2011)
found that compared to other
sources of BPMHs – such as a
patient chart, a provincial prescription
database, and a community
pharmacy record – the informed
interview of the patient/family by
a trained professional provided
the most complete description of
a patient’s medication use. Thus,
positive patient outcomes are
hinged on the patient interview
more so than the other sources
of a BPMH 2 . Leung et al. (2009)
trained a pharmacy technician to
obtain BPMHs from haemodialysis
patients, and concluded that the
pharmacist could successfully
identify drug-related therapeutic
problems from that BPMH. In order
to determine the accuracy and
completeness of the BPMH by the
pharmacy technician, however, the
pharmacist conducted a follow-up
With considerable knowledge
of medications and their
usual dosing, the pharmacy
technician may even use
that opportunity to highlight
any potential issues for the
pharmacist to clarify during
the interview
interview with each patient 5 . The
drug-related therapeutic problems
were then identified and classified
by the pharmacist, but since this
occurred after they themselves
spoke to the patient, it is impossible
to conclude that all the information
relevant to the provision of safe and
effective medication therapy was
found solely in the BPMH. When
assessing a patient’s medication
use, particularly with regard to
the patient’s level of cognizance
and compliance, pharmacists
often rely on nuances during the
patient encounter, including the
patient’s recall or storytelling,
pauses or hesitations, and general
approach to their medications.
Since pharmacists are responsible
for the assessment of each patient
and subsequent recommendations
regarding the patient’s drug
therapy, it may be important for
the continued safety and efficacy
of that therapy that the pharmacist
be allowed to experience the
encounter with the patient as a
whole person, not merely a list of
medications.
The question of whether pharmacists
or pharmacy technicians
should perform BPMHs limits a
very practical answer: they both
should. Although pharmacy technicians
can likely produce a
fairly accurate list of medications
in a timely manner
within their scope of practice,
the BPMH generated does
not stand alone. Rather, this
list of medications is retrieved
by pharmacists so that they can
evaluate the patient’s medication
use and determine if there are any
drug-related therapeutic problems
– especially those that may
have contributed to the patient’s
hospital visit. Furthermore, the
pharmacist must incorporate the
patient’s clinical lab values (such as
serum creatinine, hemoglobin, etc.)
when judging the efficacy of the
drug therapy and/or the patient’s
compliance, and when making
recommendations for their care.
The collaboration of pharmacists
and pharmacy technicians is made
possible by the fact that there are
both technical and therapeutic
components to the BPMH process.
By delegating certain tasks to
the pharmacy technicians, the
pharmacists would have more time
to analyze in-depth clinical issues,
without sacrificing any of the tools
necessary for them to make clinical
recommendations. The more technical
BPMH tasks that can safely be
delegated to pharmacy technicians
would include retrieving a medication
list from a provincial database,
a community pharmacy, and/or
an institution chart (hospital or
long-term care facility), as well as
updating the BPMH in the charting
system. With these multiple
PAGE 28 ~ WINTER 2013 ~ PHARMACY CONNECTION