Community Pharmacy's Role in Promoting Healthy Behaviours

2012

Background: An increased interest is observed in broadening community pharmacists' role in public health. To date, little information has been gathered in Canada on community pharmacists' perceptions of their role in health promotion and prevention; however, such data are essential to the development of public-health programs in community pharmacy. A cross-sectional study was therefore conducted to explore the perceptions of community pharmacists in urban and semi-urban areas regarding their ideal and actual levels of involvement in providing health-promotion and prevention services and the barriers to such involvement. Methods: Using a five-step modified Dillman's tailored design method, a questionnaire with 28 multiple-choice or open-ended questions (11 pages plus a cover letter) was mailed to a random sample of 1,250 pharmacists out of 1,887 community pharmacists practicing in Montreal (Quebec, Canada) and surrounding areas. It included questions on pharmacists' ideal level of involvement in providing health-promotion and preventive services; which services were actually offered in their pharmacy, the employees involved, the frequency, and duration of the services; the barriers to the provision of these services in community pharmacy; their opinion regarding the most appropriate health professionals to provide them; and the characteristics of pharmacists, pharmacies and their clientele. Results: In all, 571 out of 1,234 (46.3%) eligible community pharmacists completed and returned the questionnaire. Most believed they should be very involved in health promotion and prevention, particularly in smoking cessation (84.3%); screening for hypertension (81.8%), diabetes (76.0%) and dyslipidemia (56.9%); and sexual health (61.7% to 89.1%); however, fewer respondents reported actually being very involved in providing such services (5.7% [lifestyle, including smoking cessation], 44.5%, 34.8%, 6.5% and 19.3%, respectively). The main barriers to the provision of these services in current practice were lack of: time (86.1%), coordination with other health care professionals (61.1%), staff or resources (57.2%), financial compensation (50.8%), and clinical tools (45.5%). Conclusions: Although community pharmacists think they should play a significant role in health promotion and prevention, they recognize a wide gap between their ideal and actual levels of involvement. The efficient integration of primary-care pharmacists and pharmacies into public health cannot be envisioned without addressing important organizational barriers.

Clinical Pharmacist, 2018

In the UK, community pharmacies are more accessible to the general population than general practices. Therefore, government white papers and briefing documents from pharmacy professional bodies have advocated the expansion of the role of community pharmacists, particularly in relation to the provision of services that contribute to disease prevention and health improvement. It is unknown whether the same evidence exists globally for the expansion of these roles. This article attempts to appraise and summarise the global evidence for the public health roles that community pharmacists play. Barriers, as well as strategies that can enhance these roles, are also discussed. Electronic databases were searched to retrieve relevant literature published since 1 January 2000. The selected literature included 2 meta-analyses, 7 literature reviews, 23 interventional studies and 41 descriptive studies. These were assessed according to health topics (i.e. smoking cessation, weight management, health promotion, disease screening and preventive activities, vaccination and immunisation, alcohol dependence advice and drug misuse, emergency hormonal contraception, and sexual health services). The effectiveness of community pharmacy-based public health interventions was shown in smoking cessation, health promotion, disease screening and preventive activities, provision of emergency hormonal contraceptive, and vaccination services. Although there was mixed evidence with respect to weight management and alcohol dependence advice interventions, the available data suggest feasibility and acceptability of these services due to the perceived ease of access and convenience.

Australian and New Zealand Journal of Public Health, 2007

2003

2004

Objective To systematically review feedback from pharmacy users on their perceptions and experiences of health-related advice and services provided from community pharmacies.

2023

BMJ open, 2017

To develop a complex intervention for community pharmacy staff to promote uptake of smoking cessation services and to increase quit rates. Following the Medical Research Council framework, we used a mixed-methods approach to develop, pilot and then refine the intervention. Phase I: We used information from qualitative studies in pharmacies, systematic literature reviews and the Capability, Opportunity, Motivation-Behaviour framework to inform design of the initial version of the intervention. Phase II: We then tested the acceptability of this intervention with smoking cessation advisers and assessed fidelity using actors who visited pharmacies posing as smokers, in a pilot study. Phase III: We reviewed the content and associated theory underpinning our intervention, taking account of the results of the earlier studies and a realist analysis of published literature. We then confirmed a logic model describing the intended operation of the intervention and used this model to refine the...

2007

Objective To report the frequency of 27 enhanced pharmacy services (EPS) provided in Australia's community pharmacies and to analyse barriers and facilitators for providing priority services. Setting A large representative sample of community pharmacies in Australia in 2002. Method Questionnaires were mailed to owners or managers of a stratified, representative sample of Australia's community pharmacies; 1131of 1391 consenting pharmacies responded (81.3%). Specifically trained staff, fees charged, structural and other components and plan to introduce EPS were analysed. The barriers and facilitators for all EPS were rated by a Likert scale. Logistic regression models tested for predictors for providing one or more EPS and those related to Australia's National Health Priorities. Key findings Eighty-eight per cent of Australia's community pharmacies offered ≥1 EPS. More than 40% offered EPS for asthma, diabetes, methadone, herbal medicines, hypertension and wound care. Pharmacies with higher turnover (odds ratio (OR), 1.90; 99% confidence interval (CI) = 1.05-3.42) and younger owners (OR for age, 0.69; 99% CI = 0.48-0.99) were predictors for providing ≥1 EPS. Higher turnover was a predictor for diabetes care. Enclosed counselling area was a predictor for hypertension care. Owners and managers committed to continuing education was a predictor for diabetes and hyperlipidaemia services. Significant barriers perceived were lack of confidence for diabetes care and not being regarded as 'part of the job' for asthma, diabetes, hypertension and weight-management services. Conclusion The percentages of pharmacies in Australia that provided equivalent EPS were similar or higher than the UK, New Zealand and USA. The frequency of existing and planned EPS appeared disproportionately low to satisfy national health priorities. Significant barriers and facilitators and pharmacy characteristics for providing EPS were identified. The results assist national bodies to increase the uptake of EPS by pharmacies.

International Journal of Pharmacy Practice, 2011

Objective To quantify pharmacy intervention rates for non-prescription medications (pharmacist-only and pharmacy medicines), to document the clinical significance of these interventions and to determine the adverse health consequences and subsequent health care avoided as a result of the interventions. Methods Non-prescription medicines interventions undertaken by community pharmacy staff were recorded in two field studies: a study of all Australian pharmacies to determine incidence rates for low-incidence, highly significant interventions, and a study of a sample of pharmacies to collect data on all non-prescription interventions. Recorded interventions were assessed by a clinical panel for clinical significance, potential adverse health consequence avoided, probability and likely duration of the adverse health consequence. Key findings The rate of professional intervention that occurs in Australia for pharmacist-only and pharmacy medicines is 5.66 per 1000 unit sales (95% confidence interval 4.79-6.64). Rates of intervention varied by clinical significance. When considering health care avoided, the main impact of the interventions was avoidance of urgent general practitioner (GP) visits, followed by avoidance of regular GP visits and accident and emergency treatment. The most common adverse health consequences avoided were exacerbations of an existing condition (e.g. hypertension, asthma) and adverse drug effects. Conclusions This study demonstrates the way in which community pharmacy encourages appropriate non-prescription medicine use and prevents harm through intervening at the point of supply. It was estimated that Australian pharmacies perform 485 912 interventions per annum when dealing with non-prescription medicines, with 101 324 per annum being interventions that avert emergency medical attention or serious harm, or which are potentially life saving.

2010

Objectives To determine the views of healthy adults on the importance of activities aimed at improving public health, on the role of community pharmacies in contributing to these and on a range of potential pharmacy-based public health services. Method Three hundred healthy adults completed a questionnaire developed from the literature, using a street survey technique in an English city centre. Key findings More than half of the respondents (57%) were infrequent pharmacy users, but 65% (195) had asked for advice about health and/or medicines from community pharmacy staff and 41.3% (124) had received unsolicited advice on health. Only 23% considered that pharmacies were the best place from which to seek general health advice, irrespective of frequency of pharmacy use. There was a general lack of awareness of pharmacy capacity and role in public health. With the exception of smoking-cessation support, the role of pharmacy in providing activities related to improving public health did not relate to respondents views on the importance of the activity. However, most supported the provision of specific services by pharmacies, especially among frequent pharmacy users. A significant proportion of respondents said they would not use pharmacy as a source of public health advice, due to issues around confidentiality, privacy, space and busyness. Conclusions There is little awareness of pharmacy's involvement in providing services designed to improve public health among the general public and a need exists to market these effectively. More research is required to further explore the public's views on how to facilitate pharmacy's contribution to public health.

Journal of Pharmaceutical Health Services Research, 2013

Objectives To explore consumer awareness, experience and expectations of Australian community pharmacy practice, from the perspectives of consumers with chronic health conditions, carers, or both. Methods Semi-structured in-depth interviews were undertaken in four diverse regions of Australia. The constant comparison method was used for analysis purposes. Key Findings Ninety-seven interviews were conducted. Participants had limited understanding regarding the role of community pharmacy staff and the Pharmaceutical Benefits Scheme (PBS). Pharmacists were viewed primarily as medication suppliers, and the services provided by pharmacy, such as Home Medication Reviews, are predominantly unknown. Confusion still exists with respect to generic medications, medication pricing and how the PBS safety net system works. Conclusions There is public uncertainty about specific aspects of Australian pharmacy practice. This is despite the introduction of newer professional services targeting chronic health conditions and extensive marketing campaigns involving pharmacy. If community pharmacy is to better assist consumers with chronic conditions, there needs to be improved community awareness of the professions current scope of practice and the system it works within.

Journal of Public Health, 2005

Background Community pharmacies are widely used in the UK, but the services they provide are changing, with pharmacists expected to take on wider roles and responsibilities. The impact of such changes will partly depend on who uses pharmacies and their illnesses. Methods This was a cross-sectional survey of a stratified random sample of 10 000 adults aged 35 years plus. Results In the previous month, 59 per cent of respondents had collected a prescription medicine and 40 per cent had purchased an over-the-counter (OTC) medicine from a pharmacy, whereas only 12 per cent had asked for advice. Women were more likely to have obtained medicine or asked for advice (76 per cent), but nearly two-thirds of men had done so (63 per cent). Poor self-rated health was the key factor in obtaining medicine, both on prescription and OTC. Purchasers of OTC medicine were more likely to be younger and from higher socioeconomic classes, whereas those who collected prescription medicine were more likely to be older, feel at risk of vascular health problems and non-smokers. Medicines to treat cold and flu symptoms were the most frequently reported purchase type. Only a small number of respondents who asked for advice had not also obtained medicine. Respondents who asked for advice were more likely to have asked about a specific medicine or illness than to have asked for general health advice. Conclusion Whilst those with poorer health are more likely to visit, a wide range of ages and social classes visit pharmacies each month. This provides an opportunity for public health initiatives to be delivered in pharmacies.

International Journal of Pharmacy Practice, 1997

A telephone survey of 40 pharmacists before and after attendance on a health promotion course in Wiltshire, conducted using semi-structured questionnaires, indicated that training led to changes in knowledge and perceived changes in attitude and practice. The value of the increased knowledge was recognised by participants, in particular when talking to patients and other health professionals. The change in attitude, towards a more holistic view of health, is seen by the authors as a positive benefit of training, as it may be of value to the pharmacists. Changes in practice were evident despite recognised constraints. Recommendations for future health promotion training schemes are: training ~hould be ongoing; joint working with other health care professionals is needed fully to achieve training objectives; the role of the pharmacist should be promoted; and this currently unremunerated role should be recognised by Wdtshire health authority for its potential contribution towards the health care of the population, and receive appropriate funding. ME central theme of the United Kingdom Govxnment's "Health of the nation" initiative, launched in 1992, is to encourage individuals and organisations to work together to improve health,] primarily by providing advice about healthy lifestyles and building on people's natural inclination to look after themselves and those tor whom they care. The ready access of the public to their local pharmacy provides an ideal opportunity to give information and advice in support of Health of the Nation. Pharmacies represent an accessible, non-threatening environment from which to provide health education and advice. Pharmacists can reinforce the messages provided by general practitioners, practice nurses, dietitians and their local health promotion service. In the UK, each health authority has at least one health promotion unit responsible for providing information and support to health professionals, school teachers, local authorities and others engaged in health promotion activities. The pharmacist is one of the few health professionals who regularly sees large numbers of "healthy" people; the pharmacy is, therefore, the ideal point from which to disseminate messages about healthy living, healthy eating, safer sex and smoking cessation. In some areas, pharmacists speak the ethnic language of many of the local population, which can be an advantage. The role of the pharmacist in health promotion was identified in the Barnet family health services authority (FHSA) high street health scheme.2-5 The scheme was used as one of the examples in a health promotion booklet produced by the Department of Health for primary health care teams in 1994.6 The Barnet scheme has been adapted and adopted by over half the health authorities in England.3