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Complications of compliance

"Your shop-front interaction puts you in a better position to spot, say, the average salbutamol junkie"

Medication defaulters and abusers can slip through the net in the average GP surgery, says Dr Messenger, pointing to an obvious role for pharmacists

Two recent prescribing incidents, two adverse outcomes – and maybe one more possible role for pharmacy?


The first was a patient who had suffered a stroke. We’d started treatment for hypertension two years previously, arranged for review a month later, then nothing. He simply vanished off our radar – until we received the ‘CVA, home with care package’ discharge letter.


And the second was a woman who, we now realise, had been over-using her bronchodilator instead of letting us know that her asthma control was going haywire – to the point that she ended up in ITU with a very serious exacerbation.


Both illustrate opposite polarities of the same problem: medication monitoring. With planned review dates and reasonable vigilance, we can only do so much – people will inevitably slip through the net.


We have no easy way of picking up defaulters like patient one - not without more hours in the day and a serious boost to our waning proactive energies. As for patient two, the repeat prescribing clerk might spot excessive use of salbutamol, but it’s asking a lot of non-medical staff to police prescription abuse. And, yes, the computer system probably could be tweaked to prevent unfettered supply, but that creates a whole other set of problems in prescribing inflexibility.


Perhaps this is where you might come in. I doubt you have any more time than us, but at least you have a commercial imperative to chase up apparent defaulters. And as for medication overusers, maybe your shop-front interaction puts you in a better position to spot, say, the average salbutamol junkie. In which case, maybe you could let them, or us, know.

Dr Messenger is a GP trying to negotiate the impenetrable structures and commissioning quagmires of the reformed NHS. Genuinely good friends with his local pharmacist, he offers a GP take on the primary care issues of the day. Please don't shoot, he comes in peace


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Kevin Western, Community pharmacist

I keep reading Dr Messenger's articles and waiting for the "but..." ,or the punchline which makes all this inter-professional fellow feeling go away. The fact that I havent found one yet is very good. I have to wonder and perhaps the good doctor can help us - does he feel isolated in his views within his profession, and if not, how do we get is fellow thinkers to come out of their closets.

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