German Community Pharmacists

19 Pages·2014·0.19 MB·English

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ISBN 978-3-8487-1522-0
Nomos
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Jochen Pfeifer
German Community
Pharmacists
From Product-Oriented Suppliers to
Patient-Oriented Health Care Professionals
Nomos
BUT_Pfeifer_1522-0.indd 3 31.07.14 09:06
http://www.nomos-shop.de/23160
Die Deutsche Nationalbibliothek lists this publication in the
Deutsche Nationalbibliografie; detailed bibliographic data
is available in the Internet at http://dnb.d-nb.de
a.t.: Bremen, Univ., Diss., 2014
Original title: Advancing the professionalization of German community pharmacists
and creating a new mission statement using select international best practice standards
ISBN 978-3-8487-1522-0 (Print)
978-3-8452-5562-0 (ePDF)
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library.
ISBN 978-3-8487-1522-0 (Print)
978-3-8452-5562-0 (ePDF)
Library of Congress Cataloging-in-Publication Data
Pfeifer, Jochen
German Community Pharmacists
From Product-Oriented Suppliers to Patient-Oriented Health Care Professionals
Jochen Pfeifer
148 p.
Includes bibliographic references.
ISBN 978-3-8487-1522-0 (Print)
978-3-8452-5562-0 (ePDF)
1. Edition 2014
© Nomos Verlagsgesellschaft, Baden-Baden, Germany 2014. Printed and bound in Germany.
This work is subject to copyright. All rights reserved. No part of this publication may be
reproduced or transmitted in any form or by any means, electronic or mechanical,
including photocopying, re-cording, or any information storage or retrieval system,
without prior permission in writing from the publishers. Under § 54 of the German
Copyright Law where copies are made for other than private use a fee is payable to
“Verwertungs gesellschaft Wort”, Munich.
No responsibility for loss caused to any individual or organization acting on or refrain-
ing from action as a result of the material in this publication can be accepted by Nomos
or the author.
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The physician thinks, decides and orders; the pharmacist obeys -
obeys; of course, with discretion, intelligence, and skill - yet in
the end obeys and does not originate.

Abraham Flexner, 1915
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Acknowledgements
Firstly, I would like to thank my PhD Advisor, Prof. Dr. Gerd Glaeske, for
his continuous support, encouragement, and confidence in me. I deeply
appreciate his valuable advice, our fruitful discussions, and his generosity
in always finding time to advise me on my thesis as well as for his under-
standing and leadership in occasionally very hectic times. Special thanks
go to Ms. Frieda Hoefel for her support, patience, and her very valuable
advice and to all colleagues at the Zentrum für Sozialpolitik of the Univer-
sity of Bremen for their kind support.
I am also very grateful for Prof. Dr. Georg Hempel for supporting me
both while preparing my thesis, but also for his participation in imple-
menting new forms of international cooperation with pharmacy students
from the U.S. and Germany in cooperation with the University of Min-
nesota.
I would like to thank Prof. Dr. Hartmut Derendorf for his support in
starting my career in international pharmacy after becoming one of the
first German International WPPD students at the University of Florida and
for the projects we did since I graduated from Florida with a PharmD de-
gree in 2006.
My thesis would not have been possible without the continuous support
of Prof. Dr. Linda Strand over many years. In our conversations, discus-
sions, and meetings Dr. Strand predicted the difficulties I would encounter
implementing changes into Germany community pharmacy – and those
obstacles did indeed occur.
I am also extremely grateful to Dean Prof. Dr. Marilyn Speedie and the
entire faculty and staff of the University of Minnesota, College of Pharma-
cy for their support and for allowing me to create the very first Interna-
tional Advance Pharmacy Practice Experience for U.S. students in a Ger-
man community pharmacy. This project, created especially for my thesis,
would not have been possible without their help.
Many thanks to my Australian friends for their support and their friend-
ship, Prof. Dr. S.I. “Charlie” Benrimoj, Sydney and Dr. Tim Chen, Syd-
ney.
A big “Thank you” also to my colleagues Andreas Niclas Förster and
Christian Schulze for their continuous support.
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Acknowledgements
All my friends and colleagues deserve my special gratitude for their
support during the time I spent working on my thesis, especially my col-
leagues in my pharmacy who supported me during the busy times when
writing my thesis.
I would like to dedicate this book to my mother, Gertrud Pfeifer, who
passed away on November 21, 2004 and to my father, Friedhelm Pfeifer
who is now retired.
Both were excellent pharmacists who provided the best possible patient
care and who inspired me to work very hard to achieve my dreams.
My mother died shortly before I was awarded the Doctor of Pharmacy
Degree at the University of Florida – but her inspiration lives on.
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Table of Contents
List of Abbreviations 13
Summary 15
1. Professional Status of German community pharmacists 17
2. Community Pharmacists in Germany: History and Challenges 21
2.1 History 21
2.2 Overview 23
2.3 Differences between “Pharmaceutical Advice“ and
“Pharmaceutical Care“ 25
2.3.1 Introduction 25
2.3.2 Pharmaceutical advice 27
2.3.3 Pharmaceutical care 30
2.3.4 Evidence based approaches 33
2.4 Selective care projects in Germany 34
2.4.1 Geriatric Pharmacy 34
2.4.2 Pharmacist-led intervention to improve inhalation
technique in asthma and chronic obstructive
pulmonary disease patients 35
3. Relevance of Foucault’s work to pharmacy practice 37
3.1 Introduction 37
3.2 Foucault’s “Birth of the Clinic” 38
3.3 Power and knowledge 40
3.4 Pharmacists taking control over patients 43
3.5 Patients exercising power and control 44
3.6 Discussion 47
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Table of Contents
4. German community pharmacists’ social authority and
professionalization 49
4.1 Introduction 49
4.2 Abraham Flexner: “Physician thinks, pharmacist obeys” 50
4.3 The “trait” approach 51
4.4 “Impure Status“ of community pharmacists 52
4.5 “Mystique” of community pharmacists’ role 53
4.6 Talcott Parsons’ concept of the “sick role” 54
4.7 Community pharmacists’ professionalization and the U.S.
Supreme Court 56
4.8 Norman Denzin’s “incomplete professionalization” 57
4.8.1 Introduction 57
4.8.2 Control over social objects by community
pharmacists in 2013 58
4.8.3 ‘Over-qualification’ of pharmacists 59
4.8.4 Full autonomous control over prescription drugs 61
4.8.5 Full autonomous control over OTC medication 62
4.9 Social positioning of community pharmacists 65
4.10Psychological reactance 66
4.11Discussion 67
5. Quality of pharmacy practice 73
5.1 Introduction 73
5.2 Definition 73
5.3 Donabedian’s model of evaluating community pharmacists’
quality 74
5.4 FIP’s and WHO’s Quality standards 75
5.4.1 Distribution 75
5.4.2 Assessment of patient health status and needs 76
5.4.3 Management of medication therapy 76
5.4.4 Educating prescribers 76
5.4.5 Monitoring of patients’ outcomes 77
5.4.6 Providing information on health related issues 77
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Table of Contents
5.5 The Seven-Star-Pharmacist concept of the United Nations 77
6. Implementation of international best practice elements 79
6.1 Definition of “Best practice” 79
6.2 Implementation process 80
6.3 Education 80
6.3.1 Germany 81
6.3.2 U.S.A. 83
6.3.3 Australia 84
6.3.4 France 85
6.3.5 United Kingdom 86
6.3.6 Discussion 86
6.4 Essential community pharmacy services 89
6.5 Advanced services 90
6.5.1 Medication Therapy Management (MTM) 90
6.5.2 Consulting Pharmacists 93
6.5.3 Collaborative pharmacy practice including
prescribing rights for the community pharmacist 95
6.5.4 Patient Centered Medical Home 99
6.5.5 Implementation of advanced services into German
community pharmacies 101
6.5.6 New forms of payment 104
7. The International Advanced Pharmacy Practice Experience of
the University of Minnesota, College of Pharmacy, in a German
community pharmacy 109
8. Implementation of advanced pharmacy services into German
community pharmacy according to the recommendations of the
ADVISORY COUNCIL on the Assessment of Developments in
the Health Care System 113
8.1 Introduction 113
8.2 New forms of direct patient care 114
8.3 Practice Management 116
8.4 Implementation in German community pharmacies using
the concept of “Diffusion of innovation“ 118
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Table of Contents
8.5 Discussion 120
9. Proposal: Mission Statement for German pharmacists 123
9.1 Introduction of a mission statement 123
9.2 Proposition of a new mission statement 124
10 Outlook 127
Bibliography 133
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