The Pharmaceutical Journal Vol 266 No 7148 p675-678
May 19, 2001

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Health promotion

An integral part of medicines management

From Dr C. Anderson, MRPharmS, and Dr P. Bissell

We write in support of Dr Terry Maguire's broad spectrum article¹ and would like to argue that health promotion should be an integral part of medicines management and pharmaceutical care. The Ottawa Charter defined health promotion as “the process of enabling people to increase control over, and to improve their health.”²

Health promotion is commonly perceived as being solely about lifestyle change and personal choice, and the pharmacist's role tends to be discussed in that restricted context. However, it also reaches beyond this in campaigns, working with other health promoters and so on.

Core health promotion activities in community pharmacy aiming to enable people can comprise a number of elements.³ It may be information about adequate use of medicines in general to prevent abuse and misuse, information about all aspects of a condition-specific medication regimen. It may empower the individual to make informed decisions about drug treatment and to manage and monitor regimens.

Advice to promote and support healthy lifestyles, to ensure the therapeutic goal by lifestyle interventions, and information about self help groups and to identify the “best” health and social care providers also come under the umbrella.

In 1990 Hepler and Strand defined pharmaceutical care as “the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient's quality of life.”⁴ Strand redefined it in 1992: “Pharmaceutical care is that component of practice which entails the direct interaction of the pharmacist with the patient for the purpose of caring for that patient's drug-related needs.”⁵

Much of the literature about pharmaceutical care appears to take a narrow view of health promotion, defining it as focusing at a population level rather than on individuals. Pharmaceutical care concentrates on an individual patient's drug related needs. It has been argued⁶ that services that benefit society, such as health promotion, are separate from services that benefit an individual. However, in developing a pharmaceutical care practice, it is certainly difficult to separate individuals' drug-related needs from the social context in which medicines use takes place. Van Mil and colleagues⁷ acknowledge this, saying that in some countries the concept (pharmaceutical care) covers the way people should obtain information about disease states and lifestyle issues.

If, as we take part in medicines management pilots, we are interested in patient outcomes, improvement in the quality of treatment is an important health promoting measure. Applying health promotion principles to pharmacy practice should mean increasing the impact and effectiveness of drug therapy and increasing the impact of advice about health in its broadest sense. This involves applying expert interventions as well as supporting patients' own health development activities. Patient empowerment means accepting that patients are experts about their own health and have a major part to play in health improvement. Improvement in the quality of treatment, a major goal of medicines management and pharmaceutical care, becomes an important health promoting measure.

References

1. Maguire T. More clarity, less dogma in our approach to pharmacy practice. Pharm J 2001; 266: 651.

2. World Health Organization. Ottawa Charter for Health Promotion. Genf: WHO/ HPR/HEP/95.1. Declaration, 1986.

3. Health Promotion in primary care: general `practice and community pharmacy a European project. Available from: URL: http://www. univie.ac.at/phc (accessed 11/5/2001).

4. Hepler CD. The third wave in pharmaceutical education and the clinical movement. Am J Pharm Ed 1987;51: 369-85.

5. Strand LM, Cipolle RJ, Morley P. Pharmaceutical care: an introduction. Kalamazoo, MI: Upjohn Co; 1992.

6. Cipolle RJ, Strand L, Morley P. Pharmaceutical Care Practice. McGraw Hill, New York; 1998.

7. Van Mil JWF, McElnay J, de Jong-Van Den Berg LW, Tromp TFJ. The challenges of defining pharmaceutical care on an international level. Int J Pharm Pract 1999; 7:202-8.

Claire Anderson
Paul Bissell
The Pharmacy School, University of Nottingham

More work needed

From Mr Lloyd Matowe, BPharm

In his “Broad Spectrum” article (PJ, May 12, p651), Dr Terry Maguire describes an evidence-based health promotion practice model. In today's practice patients increasingly demand justification for treatments offered and medical services rendered. A health promotion/public health practice approach thus offers an attractive platform to involve the general populace in the provision of health care.

In his highly enlightening contribution Dr Maguire gives only minimal attention to potential limitations of such a model. Addressing these, however, is undoubtedly critical for the success of the model. To start with, as health promotion places emphasis on entire populations at risk, naturally the resource implications would be large. The availability or unavailability of resources should therefore be at the forefront of any such models.

Another area that could be crucial for the success of this model derives from the fact that health promotion in its entirety is not a new concept. For this reason pharmacists have to move in with a unique role if they are to be viewed without suspicion by other players in the area. This can achieved by targeting areas in which the pharmaceutical professional is strongest.

In a nutshell, the model described appears useful and important to pharmacy. However, it appears that more work needs to be done, particularly in overcoming barriers. One attractive way of moving this forward is the setting up of groups such as the special interest group reported in the same issue of The Journal (p636).

Lloyd Matowe
Department of Public Health, Aberdeen University

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