|
The concept of self care is firmly embedded
in the political agenda and pharmacists are integral to the strategy.
Lin-Nam Wang (on the staff of The Journal) reports
Self care opportunities and challenges
Pharmacists need to rethink their role in self care because they will
be integral to the strategy, Colette McCreedy, director of pharmacy practice
at the National Pharmacy Association, said. “Off the cuff, community
pharmacists think that self care is about providing advice and treating
minor ailments, but pharmacists have a role to play within the NHS and
outside it,” she explained. For example, although minor ailments
schemes give pharmacists an NHS role regarding the sale of over-the-counter
medicines, it is clear that the government wants to increase the number
of medicines for sale from pharmacies. “I think we will end up
with three categories of [pharmacy] medicines, minor ailments, lifestyle
medicines (eg, simvastatin) and long term conditions,” she added.
Treating long term conditions is an area of great potential, according
to Ms McCreedy. “Given the POM to P switches of treatments for
long term conditions, I see no reason why we cannot extend pharmacist-led
minor ailments schemes to pharmacist-led long term condition schemes,” she
said.
However, these opportunities for pharmacy are not without challenges,
a major one being the contract requirement that pharmacists keep records
for clinically significant pharmacy sales. People who buy medicines think
of themselves as customers and will not be used to having records kept
for the sale of a pharmacy medicine. This may not be welcome and could
present a tension, Ms McCreedy pointed out. This contrasts with some
concern from stakeholders, such as GPs, that there is no record kept
of sales when they are considering POM-to-P switching. “We need
to make people aware of the change happening in community pharmacy and
make them welcome these changes,” she said. However, Alison Blenkinsopp,
professor of the practice of pharmacy, Keele University, asked what would
need to be done to engage the public and whose job this would be.
Concern was also voiced at the session, about the large amount of recording
requires by the new contract.”What is going to be our saviour is
the IT implementation,” Ms McCreedy said, but “we will have
to grit our teeth until we get the IT in place,” she added.
Another potential difficulty is how to deal with expert patients. Ms
McCreedy used asthma as an example. If asthma medicines were to become
available over the counter, the patient wanting to purchase an inhaler
could be an expert patient. He or she will not expect to have a long
intervention in the pharmacy and might even become annoyed. However,
the scrutiny on pharmacy when POM-to-P switches are made demands that
pharmacists demonstrate that they are providing professional advice,
so such situations may present a challenge. The trick is to identify
how much help somebody needs. “We have to work out if someone is
a novice, an expert or, more importantly, if they think they are an expert
but they are not,” she said.
Another interesting area is the NHS-non NHS interface. “People
who buy medicines think of themselves as consumers. People who get prescribed
medicines think of themselves as patients. Pharmacists may need to consider
this and deal with people accordingly,” Ms McCreedy said.
In addition, pharmacists will need to reflect on how they conduct consultations
with patients, she warned. “I do not think that pharmacy has thought
about this in terms of how it conducts a consultation — whether
that consultation is prescription led, if we are providing a medications
use review service, or any other service”.
Ms McCreedy said that, although they understand the need for concordance,
pharmacists tend to concentrate on the treatment. “Maybe we should
think more about asking at every consultation: what step can I take to
help this patient along the road to empowerment,” she suggested.
WWHAM framework not used properly
Medicines counter assistants are not making as much use as they think
they are of the WWHAM framework (Who is it for? What are the symptoms?
How long has it been going on? Action taken? Medicines taken?)
In a survey in Scotland, 90 per cent of medicines counter assistants
reported using the framework and the same proportion acknowledged its
importance. But when the researchers looked at its use in practice, they
found that it was not used as much as assistants reported. On average,
each consultation involved just two of the five questions being asked,
according to Margaret Watson, a research fellow at the University of
Aberdeen. Of particular concern is that less than 40 per cent of consultations
established whether or not any other medicines were being taken, so there
is a potential for drug interactions, Dr Watson said.
Assistants could play a role in self care, but they are the least trained
and recognised members of staff in community pharmacies. Easy ways of
making sure that medicines counter assistants are not only seen as shop
assistants include wearing name badges that include job titles and displaying
training certificates.
Pharmacists can support POM-to-P switches
Asthma drugs could be switch candidates if more pharmacists get
involved in managing the condition |
Pharmacist prescribing has a role to play in self care, but it will
never replace POM-to-P switches because of the limited locations in which
services could be provided from, said Helen Darracott, director of legal
and regulatory affairs at the Proprietary Association of Great Britain.
The continuous drip feed of POM-to-P switches has altered the over-the-counter
market, moving the “comfort zone” from treatments for minor,
self limiting conditions (eg, headaches and colds) to recurrent conditions
(eg, thrush and irritable bowel syndrome) and now to long term maintenance
and prevention (eg, smoking cessation and allergy prevention). “And
in the future, who knows,” Mrs Darracott commented.
Not all treatments, however, are good switch candidates. Among other
factors, to be successful, a treatment needs to have the support of health
professionals. The GPs’ list for switches includes co-dydramol
and topical antibiotics for acne but they show little support for treatments
for asthma, hypertension and menopause, she said.
Moreover, success can take a long time. For example, it took 23 years
for Nurofen to become the analgesic brand leader and it has taken about
14 years for nicotine replacement therapy to become popular. Mrs Darracott
went on to outline changes in pharmacy that will support POM-to-P switches.
These include more consultation areas, the need to record OTC sales and
the implementation of local health campaigns. Another way to promote
switches would be for pharmacists to take on bigger roles in managing
conditions such as asthma and diabetes, and clinics for contraception
or hormone replacement therapy, Mrs Darracott said. |
The
Pharmaceutical Journal