THE WITHDRAWAL of services by a significant number of community pharmacists in response to unilateral fee reductions by the Health Service Executive (HSE) places patients at the centre of an unwanted dispute. Those entitled to free medicines under the medical card scheme and subsidised treatments through the Drug Payments Scheme are caught in a crossfire between the Irish Pharmacy Union (IPU) and the HSE and the Government.
As a result, many older people and those with disabilities now face the stress of additional travel and waiting times to obtain a regular supply of medicine. With reports of lengthy delays in filling prescriptions and a shortage of certain medicines in some of the temporary dispensaries set up by the HSE, it is an anxious time for those affected. The temptation may be to “borrow” medication from neighbours or friends; but, in a worst- case scenario, a mix-up of drugs with similar names could occur with potentially catastrophic results. Others may assume that doing without tablets for a few days may not be harmful, but this is not uniformly the case.
Disputed reports of prescriptions being filled incorrectly by certain temporary HSE dispensaries are a source of particular concern. The dispensing of medication is part of a process that begins with a doctor’s prescription and ends with the patient taking the correct dose at the right time. It can be a complex process prone to human error. A number of international studies have shown that about 6.5 per cent of hospital admissions are the direct result of adverse reactions to drugs. There are several sources of prescribing and dispensing error: some drug names look or sound alike; symbols and abbreviations may be misread or misinterpreted; and the wrong formulation or route of administration may be chosen. And while fewer errors appear to occur in the dispensing process than in prescribing and administering medicines, this can be attributed to the safety awareness and standard operating procedures applied by pharmacy professionals.
With over 80 per cent of drugs prescribed on a repeat basis, monitoring drug usage is an important element of a pharmacist’s work. This requires a knowledge of the person’s medical history and past medication use; a pharmacist without access to this information is placed at an immediate disadvantage that could result in error.
Where does this leave patients affected by the dispute? At the very least, they face delays and anxiety. At worst, they could become the unwitting victims of medication error. It is the possibility of this worst-case scenario causing death or disability that means the continuation of the dispute cannot be contemplated.
The pharmacy regulator, the Pharmaceutical Society of Ireland, must write to all pharmacists reminding them of their ethical responsibilities to patients. The HSE must respond to IPU offers to achieve the desired savings in a different way. And with a clear danger to patient safety, it is past time for Minister for Health Mary Harney to request the urgent involvement of an independent mediator.