Consultant physicians working with patients - Royal College of ...

Consultant physicians working with patients primary care trust (or equivalent) prescribingadvisers regional adverse drug reaction monitoring centre strategic health authority/health board.The work of clinical pharmacologists in promoting thesafe and effective use of medicines is complemented byclinical pharmacy services. Pharmacists often play animportant role in supporting the work of professionalcommittees, providing information about medicines,preventing and reporting adverse medication incidents,and reporting adverse drug reactions. Some consultantsrequire an efficient laboratory service to support plasmadrug concentration monitoring and the assessment ofpoisoned patients. In some circumstances, the work of aclinical pharmacologist involves close collaborationwith primary healthcare.3 Working with patients: patient-centredcareWhat you do with patientsInvolving patients in decisions about theirtreatmentClinical pharmacologists are not only practitioners ofpatient-centred care in their own clinical area but willalso, as part of their mission to deliver appropriate andrational therapeutics, promote improved understandingof drug therapy issues and support concordance withdiscussion of prescribing decisions between localprescribers and their patients, thus enhancingadherence. These objectives may be achieved throughthe education of doctors (at undergraduate andpostgraduate levels), with emphasis on patientinvolvement in therapeutic choices, informed consentand promotion of self care, and through the educationof patients by disseminating relevant information.Clinical pharmacologists also endeavour to improve theefficacy and safety of medicines through the promotionof evidence-based medicine and the development ofguidelines and shared-care protocols. They will,whenever possible, liaise with patient groups and layrepresentatives when developing prescribing policies.4 Interspecialty and interdisciplinary liaisonClinical pharmacologists often have importantrelationships with other specialist groups and primarycare colleagues. They usually have an interest in medicalsubspecialties, particularly cardiovascular, respiratory,and metabolic medicine, in which liaison with otherclinical groupings, such as cardiology and strokemedicine, is important. It is likely that they will work aspart of a multidisciplinary team (MDT) involvingpharmacists and nurses in the pursuit of medicinesmanagement and when carrying out clinical trials.5 Delivering a high-quality serviceA high-quality service includes: a well-organised and efficiently run drug andtherapeutics committee drawing on relevant localexpertise an agreed local formulary development and regular review of local prescribingpolicies that support safe, evidence-based andcost-effective prescribing regular audit of prescribing quality contributions to clinical risk management throughregular review of adverse medication incidents(adverse drug reactions and medication errors) encouraging adverse drug reaction reporting bylocal prescribers regular high-quality education in appropriate andrational prescribing for undergraduates andpostgraduates early review of and advice concerning poisonedpatients.Maintaining and improving the quality of careQuality and standards in clinical pharmacology arelargely expressed by local prescribers in the primary andsecondary healthcare sectors in relation to the approachto appropriate and rational use of medicines, not byclinical pharmacologists alone. The measurement ofquality and standards in relation to the provision of aclinical pharmacology service is therefore problematic.However, potential means to ensure and measurequality do exist, through adherence to widely applicablenational guidelines, dissemination of relevantprescribing information, and implementation ofcost-effective prescribing patterns and audit ofprescribing practices.This work encompasses duties in clinical governance,professional self-regulation; continuing professionaldevelopment (CPD); and the mentoring, education andtraining of others. For many consultants at varioustimes in their careers it will include research; serving inmanagement; and providing specialist advice at local,regional and national levels.74 C○ Royal College of Physicians 2013