Public health and pharmacy interventions

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Public health and pharmacy interventions




Study Points



image Pharmacy and its role in public health


image Accessibility of pharmacy


image Services that can be delivered by pharmacists to support the public health agenda




Access


Community pharmacy has, traditionally, had the reputation as the only healthcare profession which is readily accessible to the general public without an appointment.


Over the past few years, as more pharmacies have opened in the UK, particularly pharmacies which open at least 100 hours each week, this accessibility has increased. For example, in England it is estimated that 1.8 million people visit a pharmacy every day, which means that in England, an average person will visit a pharmacy 14 times a year. Many of these will be people using the pharmacy for non-traditional purposes, i.e. not to have a prescription dispensed or to purchase an OTC medicine. These people will use the pharmacy to seek advice about general health care and to access other services. Because many of the people accessing pharmacies are not ill, pharmacists are ideally placed to offer advice to help people stay healthy. The profession’s unrivalled access to this portion of the population makes it extremely valuable in supporting general well-being and reducing the incidence of long-term health problems in the general population.


Thus, pharmacy is ideally located to be at the heart of the patient-centred health service.



Healthy living pharmacies


This is a concept developed in the UK in 2010. The aim is to increase the public’s awareness of community pharmacy as a centre within a neighbourhood, where anyone could go and access information to improve or maintain their health. These pharmacies do not necessarily offer more services than other local pharmacies but they do have ‘health trainers’. These people are usually identified from the medicines counter assistants and are people who are passionate about well-being. Their role is to proactively approach people in the pharmacy to help them with either current health issues or to help them make positive changes to their lifestyle. Health trainers are a recognized role in the NHS but this is the first time they have played a significant role in pharmacy.


Healthy Living Pharmacies are accredited by local commissioners. In the future, it may be that for a pharmacy to be commissioned for new enhanced services, it will have to meet the standards required to be a Healthy Living Pharmacy.




Smoking cessation


For many years, pharmacists and medicines counter assistants have been selling nicotine replacement therapies (NRT) as an aid to stop smoking. As perceptions of smoking have changed, it has become routine for many healthcare professionals to ask patients whether or not they smoke and this has also become routine for pharmacists. Encouraging a smoker to quit is probably the biggest positive intervention that can be made to their health. Since many smokers will use a pharmacy to buy products to treat minor illnesses (particularly coughs and colds), the pharmacy team is ideally placed to encourage a smoker to quit.


For some pharmacy teams, the intervention will be solely based around motivational conversations and the sale of an appropriate NRT product from the wide range available. In other pharmacies, the patient will be able to access a commissioned smoking cessation service. This may involve an in-depth consultation with a smoking cessation advisor (usually drawn from the medicines counter assistant population), during which there will be agreements about why the patient wants to stop, when they intend to stop, the support available (in some pharmacies this can involve groups of quitters meeting weekly to discuss progress) and decisions about the right NRT product for the patient. The patient will then be supplied with the product free of charge, if they are exempt from prescription charges.


In other pharmacies, the pharmacist may be involved in offering a smoking cessation service if they have been authorized to supply Champix® (a selective nicotine-receptor partial agonist) under a PGD (see Ch. 4).


Another group of pharmacies will process the vouchers issued to patients to obtain a free supply of NRT by smoking cessation advisors, who work elsewhere in the community, e.g. nurses in clinics.



Cardiovascular checks


In the UK, cardiovascular disease (CVD) is one of the main causes of premature morbidity and mortality. It is recognized that when cardiovascular disease has been diagnosed as a result of a cardiovascular event (such a minor stroke or myocardial infarction), effective treatments are available to reduce the risk of a second event. However, we do not have an effective national screening programme to reduce the risk of the first cardiovascular event happening.


Screening would be most effective if carried out for both male and females who are aged between 40 and 74 years of age. Often, this is a group of people who do not routinely access care from their GP, but who will access treatment for minor ailments from a pharmacy.


Some pharmacies have been commissioned to carry out CVD risk assessments, particularly in those areas where the target numbers for patients being screened has not been met by GP surgeries.


The CVD risk screening covers the following:



Using the information obtained from the screening tests, the pharmacist calculates the risk of a cardiovascular event occurring in the next 10 years, for the patient. Depending on the level of risk the pharmacist and patient agree either lifestyle changes to reduce risk or referral to the GP for other preventative measures (e.g. medication).



Alcohol intake screening


It is believed that at least one in three adults in the UK drinks more alcohol each week than is regarded as safe. It is also believed that a large number of these people do not realize that their alcohol consumption is at a level that is anticipated to cause health problems in the future.


Pharmacists are being encouraged to include discussions about alcohol intake as a normal part of the conversation with a patient. Currently, this seems very alien and intrusive to many pharmacists. This matches the feelings experienced in the 1990s when pharmacists were first asked to start including discussions about smoking status as part of most conversations. It would be unusual now not to be questioned about smoking status when asking for medication for a cough or cold in a pharmacy and so pharmacists can now plan to increase their patients’ awareness of the problems caused by drinking alcohol to excess.


In some places, pharmacists have been commissioned to provide services to increase awareness of safe drinking levels. Pharmacists can target ‘at risk’ patients, who may include:


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Jun 24, 2016 | Posted by in PHARMACY | Comments Off on Public health and pharmacy interventions

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