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Natalie Lane is production editor for
journals at the Pharmaceutical Press
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IJPP online
The Pharmaceutical Press has now launched a new,
updated journals
website.
The website provides information such as how to submit to the IJPP,
subscription information and access to a sample issue.
The full
text is available online (via
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Print-only subscribers and non-subscribers can purchase papers
on a pay-per-view basis. Abstracts are available free of
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Cardiac rehabilitation (CR) programmes are a “secondary prevention
strategy” for individuals who have exhibited signs of coronary
heart disease (CHD). Such programmes are aimed at modifying the risks
factors for CHD and will involve input from groups such as pharmacists,
nurses, cardiologists, dietitians and social workers. However, a published
review article has noted that studies have shown that there is a large
variation in CR programmes and a significant proportion of eligible patients
fail to receive CR, such as minority groups, women and the elderly. The
publication of standards for the prevention and treatment of CHD attempts
to redress this variation. Pharmacists are commonly involved in CR programmes
but their involvement is also variable.
A literature search was undertaken in order to identify published reports
which include the involvement of pharmacists in CR, and considered the
findings with regards to the future opportunities for pharmacists in
the multidisciplinary provision of CR. Electronic databases were searched
using key words, and e-mail alerts identified new papers. Reports included
were those that made specific reference to a CR programme or CR patients,
and included reference to the involvement of pharmacists or pharmacy
practice research.
The 13 reports identified for review were either descriptive or evaluative.
All reports were evaluated for their evidence and graded accordingly.
The six descriptive reports simply described the pharmacist’s role
in CR programmes, and did not make any evaluation of the pharmacist’s
involvement. The descriptive reports were graded as examples of good
practice. Two of the evaluative reports were each allocated a higher
evidence grade than the descriptive reports. One of these reports assessed
whether medicines education met the needs of patients and providers,
ie, what medication information was important and how complete that information
was for inpatients. The second study assessed the impact of pharmacist
involvement in CR in health economic terms. The remaining five evaluative
reports were more than purely descriptive but were abstracts, instead
of full papers, which had not been published and so evaluation was brief.
In discussion, the authors argue that the limitations of the small quantity
of these reports and the lack of high-quality studies should not be discounted
for future research and developments in CR programmes. Yet, the main
finding of the review is the lack of evidence regarding the effectiveness
of the pharmacist in CR. The authors note a “paucity of high-quality
research among the reports of pharmacist involvement in CR, a lack of
meaningful outcome measures”, and the tendency of authors to be
over-optimistic about the benefit of pharmacists in CR. Further research
is needed, particularly with future opportunities, such as pharmacist
prescribing, that could provide greater involvement in CR.
HIV/AIDS in South Africa
Another published study explores the current and future role of pharmacists
in South Africa and their role in the prevention and management of
the HIV/AIDS epidemic. It is noted that there is a potential for pharmacist
involvement in this area and many community pharmacies in South Africa
already have private areas for consultations, which offers an ideal
space for HIV/AIDS management and prevention activities.
The study uses three sources for information: documentary analysis,
telephone survey, and interviews with three key informants. Documentary
analysis
included both governmental and pharmacist reports. The government’s
health sector strategic framework for 1999–2004 clearly acknowledged
the importance of the pharmacist in the management and prevention of
HIV/AIDS, tuberculosis and sexually transmitted infections — decreasing
the incidence of these would help to lower the mortality rate of AIDS-related
deaths. The HIV/AIDS and STI strategic plan has four areas where pharmacists
can contribute: prevention; treatment, care and support; human and legal
rights; and research, monitoring and surveillance. The telephone interviews
with pharmacists addressed their current HIV/AIDS-related activities
with 82 per cent involved in “some sort of HIV/AIDS-related activity”.
However, the study notes the division between private and public health
care sectors in South Africa; community pharmacies form part of the private
sector. Thus, currently, the majority of activity is based on the treatment
of patients with access to private health care facilities. Some pharmacists
are involved in public sector activities, such as family planning, but
doctors will provide the remainder of the treatment, counselling and
monitoring.
The government’s strategic framework would target pharmacists having
a more independent and comprehensive role in the treatment of STIs. However,
it is a fact that pharmacists do not play a significant role in preventive
efforts, and while some HIV/AIDS-related activities take place in community
pharmacies in Johannesburg, they fall short of aims of the strategic
framework. Responding to the government’s objectives for pharmacists,
a programme for AIDS resource centres in pharmacies was established.
Pharmacies providing support, counselling and other services to those
living with AIDS were urged to comply with requirements and become accredited
as AIDS resource centres. Pharmacists were interviewed following the
launch of the programme, and the findings disappointingly show that only
54.5 per cent had heard of the programme, with 33 per cent of these having
only little knowledge about it.
This study discusses the opportunity available to pharmacists in South
Africa to reclaim their full professional role. Analysis shows the commitment
of the professional pharmacy establishment to develop the profession’s
role within the government’s strategic framework. Yet, this study
shows a low level of awareness “suggesting knowledge dissemination
and/or inadequate uptake of information by the community pharmacist on
the ground”. Pharmacy in South Africa has the potential to place
itself at the centre of the professional team working to confront the
HIV/AIDS epidemic but only with adjustment, communication and goodwill. |
The
Pharmaceutical Journal