Jeroen van de Pol

48 Chapter 2.2 Introduction Community pharmacy around the world is undergoing a transition. Traditional pharmacist tasks such as the compounding and distribution of medicines gradually become less prominent and are being replaced by cognitive pharmaceutical services (CPS). This transition, like in other countries, is also ongoing in the Netherlands. CPS has been defined as “the use of specialized knowledge by the pharmacist for the patient or health professionals for the purpose of promoting effective and safe drug therapy” [1]. Examples of CPS are clinical medication review (CMR), discharge counseling or Inhaler Technique Assessment Service (ITAS) [2]. The urgency of this transition was already emphasized in the 90’s of the previous century, as it was expected that solely dispensing was not going to be a sustainable basis for pharmacy practice [3]. It has also been stated earlier that the sole dispensing of medicines cannot be seen as pharmaceutical care [4]. However, over two decades later, the transition is still unfinished. In the meantime, policymakers are confronted with an ageing population and the introduction of more complex medication use by patients. In this increasingly demanding healthcare setting policymakers and insurance companies are scrutinizing all healthcare professionals and expecting them to provide effective and efficient healthcare. This increases the need of a more clinical role of pharmacists to support patients with multimorbidity and polypharmacy. It has been found in previous research that community pharmacist have a positive impact on the healthcare system [5] and that pharmacist led interventions can benefit patients with diverse conditions such as high blood pressure, hyperlipidemia and tobacco dependence [6,7]. Also, numerous studies have shown that CMR performed by pharmacists, identifies and solves drug related problems (DRP) and inappropriate prescribing [8,9] and improves adherence to medication [10]. Recent research has shown that community pharmacists in the Netherlands have a diverse set of daily recurring activities that are all competing over the available time of the pharmacist [11]. These daily recurring activities are often essential to manage the pharmacy, but may hamper the community pharmacist in the amount of time he/she can dedicate to CPS [4, 12-18].