The Portuguese Association of Hospital Pharmacists (APFH) is dedicated to the education and training of over 1000 hospital pharmacists; essential members of the multidisciplinary teams needed to tackle serious illnesses in the hospital setting. APFH President Patricia Cavaco outlines how her organisation attempts to elevate the role of hospital pharmacists within the Portuguese healthcare system, embraces new technology while maintaining the human aspect of patient care, and advocates for greater recognition and fair compensation for its members.


Can you give us a brief introduction to APFH, including its history, representation, and objectives?

APFH stands for the Portuguese Association of Hospital Pharmacists, and we take pride in being the first and oldest association of hospital pharmacists in Portugal, with a rich 33-year history. Representing more than 1000 hospital pharmacists, our primary focus is on providing education and training for our members, covering various areas of Hospital Pharmacy, like oncology. We recently held our National Congress in November 2023, bringing together 790 (646 live and 144 online) hospital pharmacists for a significant gathering, with some participating online. Our association plays a crucial role in supporting and advancing the careers of hospital pharmacists, fostering a community of learning and professional development.


Having worked as a hospital pharmacist for almost 20 years, what motivated you to take on this additional role? Can you share your vision for steering the association?

I’ve been a hospital pharmacist since 2004, and my association with APFH has grown over the years. Taking on the role of President last year felt like a natural progression, given my desire to contribute to the association’s continued success. I aim to maintain the excellent work of past boards while infusing a clinical pharmacist’s perspective. In Portugal, there isn’t a formal specialization in clinical pharmacy, but my experience in oncology has shown me the importance of being clinical. Clinical pharmacists need to be an integral part of the multidisciplinary team, collaborating closely with doctors, nurses, and other healthcare professionals. This ensures that decisions are well-informed, patient-centered, and aligned with the evolving landscape of medical knowledge. My focus is on fostering collaboration and elevating the role of clinical pharmacists within the healthcare system.


Could you delve deeper into what being a clinical pharmacist entails?

In the realm of oncology, the dynamic nature of medical knowledge demands continuous collaboration between pharmacists and oncologists. As clinical pharmacists, our role goes beyond traditional pharmacy functions. We actively engage with oncologists, participating in patient discussions to address uncertainties and contribute to informed decision-making. Oncology is a field where knowledge evolves rapidly, requiring us to stay current. The multidisciplinary team, consisting of nurses, doctors, and pharmacists, plays a crucial role in this process. To truly put the patient at the center of our decisions, clinical pharmacists must invest time, often personal time, in ongoing education and seamlessly integrate into collaborative efforts within healthcare settings like the Oncology Day Hospital. This ensures a patient-centric approach and fosters a comprehensive understanding of evolving medical landscapes.


How are hospital pharmacists in Portugal embracing the next generation of technologies, including AI?

As we navigate the complexities of modern medicine, embracing new technologies, including artificial intelligence, is crucial. Rather than fearing job displacement, I see AI as a valuable tool that can enhance our clinical practice. Pharmacogenomics, particularly in oncology, is foundational to treatment decisions, and I am actively investing in understanding and incorporating it into our decision-making processes. The key is not to resist change but to understand, adapt, and integrate these technologies into our practice, ensuring that we leverage the best they have to offer while maintaining the human touch in patient care.


How does the APFH advocate for greater recognition and fair compensation of hospital pharmacists given the crucial role they play within the healthcare system?

The landscape of pharmacy services in Portugal is diverse, with community pharmacists playing a crucial role, particularly in smaller villages where they are often the sole health professionals accessible to patients. The community pharmacists, present along almost every street, are instrumental in ensuring patients have access to essential medicines, becoming a vital point of contact, especially in remote areas.

However, the challenge lies in the recognition and awareness of hospital pharmacists among patients. Unlike community pharmacists who are present along almost every street, and are very important for ensuring patients access to essential medicines, hospital pharmacists, who may operate in separate buildings or basements, are sometimes overlooked by patients. This lack of visibility poses challenges in establishing a direct connection with patients during their hospital stays.

In Portugal, hospital pharmacists, particularly those working in clinical services wards or in Oncology Day Hospitals, have taken steps to bridge this gap by creating relationships and fostering communication. Yet, this practice is not universal across all hospital pharmacies in the country. Recognizing the importance of hospital pharmacists as a crucial link in the healthcare chain, efforts are needed to enhance patient awareness and encourage their engagement.

Patient-centered care is a pivotal concept, especially in the hospital setting, where patients and their caregivers often navigate through stressful and disorienting experiences. Pharmaceutical consultations have already been created in several hospitals across the country, which has allowed us to establish a relationship with the patient, making our activity, as healthcare professionals, more visible to them and/or their caregivers. In addition to pharmaceutical advice on the therapeutic plan, advice is also provided to promote healthy lifestyles. This approach aligns with the broader goal of providing multiple points of contact for patients, facilitating a more comprehensive and supportive healthcare experience.

In certain cases, hospital pharmacies in Portugal provide medicines free of charge, making them the last health professionals many patients encounter before leaving the hospital. This presents a unique opportunity for hospital pharmacists to serve as a central point for patients, offering consultations and summarizing information from various healthcare professionals.

As the role of hospital pharmacists continues to grow, there is potential for them to become key contributors to patient-centered care. Building on the existing strengths and addressing challenges in visibility and recognition will be crucial for hospital pharmacists to maximize their impact and become integral members of the healthcare team.

Our emphasis is on showcasing the indispensable role of hospital pharmacists through our actions. We aim to convey the message that investing in and recognizing hospital pharmacists is crucial. Given that we manage a substantial portion of the hospital budget related to medicines, the need for acknowledgement is evident. Through our training programs and initiatives, we work to demonstrate the value we bring to healthcare, especially in optimizing the use of medicines and ensuring the right treatments for patients. By actively contributing to the efficient management of the second most significant hospital budget, we strive to underscore the importance of sustained investment in our profession to the government.


You’ve highlighted a common concern, likely shared by doctors in Portugal, regarding potential underpayment. Are qualified pharmacists facing a situation where they are relocating to work in another country or leaving the profession altogether for different career paths?

Retaining experienced pharmacists poses a challenge, and we’ve observed some professionals shifting to industries like clinical trials or even relocating abroad. To address this, it’s crucial to emphasize the importance of senior pharmacists for effective training of residents. Ensuring a stable workforce is essential for maintaining the quality of education and mentorship within hospital pharmacies.


If had to pinpoint one or two key changes for improving the Portuguese healthcare system, what would they be to ensure better outcomes for patients?

As for the broader healthcare system, we are currently in a transitional period, anticipating elections in March and potential changes to the structure. The envisioned revolution involves the creation of Local Health Units (ULS in portuguese), integrating primary care and hospital services. If successful, this could significantly improve patient care by fostering better continuity between primary care and hospitals, a much-needed transformation in the healthcare landscape, and also to increase the relevance of the Hospital Pharmacist in the National Health Service.


As the President of the APFH with a mandate until 2026, what specific goals do you aspire to achieve during your tenure?

My vision for the presidency is centered on instilling pride within hospital pharmacists, encouraging a sense of accomplishment in their crucial role. A key goal is to advocate for the widespread incorporation of hospital pharmacies into various healthcare settings, promoting their integral presence in all hospitals. By achieving this, we aim to showcase the significance of our profession to the public. It’s about emphasizing that hospital pharmacists are not only essential but indispensable members of multidisciplinary teams. The plan is to enhance engagement within these teams, ensuring pharmacists are actively contributing to and influencing patient care decisions. Ultimately, success would mean a profession celebrated for its value, presence, and impactful collaboration within the broader healthcare spectrum., always focusing on the patient, for whom we work, and always looking for effectiveness and safety.