Do Our Pharmacy Standards Promote Integrated Care

Health care should be clinically effective, cost-effective and safe. Worldwide, reforms are in progress to cope with the rising costs of health care resulting from demographic changes and medical advances. Two approaches are commonly adopted to address these challenges: utilizing the skills of the wider health care workforce and transferring the balance of care from sec ondary to primary care settings. At the same time, it is accepted that patients should be partners in decision-making about their care, which leads to patient empowerment and better health outcomes. These service reforms have been challenged because of concerns over safety, and continuity of care may have suffered. Patients complain of having to repeatedly tell an increasing number of different professionals the same details of their medical (and social) situations. A relatively recent concept designed to address some of these concerns is integrated care, defined by the World Health Organization as “a concept bringing together inputs, delivery, management and organisations of service related to diagnosis, treatment, care, rehabilitation and health promotion. Integra tion is a means to improve services in relation to access, quality, user satisfaction and efficiency.” 1 Integrated care is not a single entity but a multidimensional philosophy of care, including vertical integration across settings and horizontal integration within teams. Those with the most complex health care needs are most likely to benefit from integrated care. Data from the United Kingdom show that 4 out of 5 people 75 years of age or older take a prescription medicine, and 36% are taking 4 or more. 2