International Social Pharmacy Workshop
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Pharmacists, psychologists and sociologists from
27 countries gathered to discuss pharmacy in a social context,
with an emphasis on public health. Angela Alexander reports
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The 14th International Social Pharmacy Workshop,
organised by the Centre for Pharmacy, Health and Society at the
University of Nottingham, was held at St Anne’s College,
Oxford, from 11 to 14 July. Abstracts of all the research papers
have been published as a supplement to the International Journal
of Pharmacy Practice.
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Public health and pharmacy — a match made in heaven or a marriage of convenience?
Paul Bissell, senior lecturer in public health at the school of health
and related research, Sheffield University, and Janine Morgall Traulsen,
associate professor at the Danish University of Pharmaceutical Sciences,
Copenhagen, highlighted how community pharmacists in the UK have a tendency
to interact with public health issues at the micro level, focusing on
the individual determinants of health, which could lead to “victim
blaming”, rather than the macro level of the wider social determinants
of health. This central tension, which needs to be debated and addressed,
has historical roots. Public health arises out of environmental issues,
but has been annexed by the medical profession.
It now seems that pharmacy is trying to capture its share; however, too
many pharmacists equate public health with health education which leads
to a “health professional knows best” attitude. Following
discussion the meeting agreed that there is a need to integrate an understanding
of the political issues around public health with the actual health issues.
Role of pharmacist assistants
The workshop heard how, in South Africa, following political change,
there has been an upsurge in thinking around the paradigm of public
health. Leah Gilbert, professor of health sociology at the University
of Witwatersrand, described how, since 1994, the whole approach to
public health has been through primary care and has focused on prevention
and rehabilitation. But it is difficult to change the perspective of
professionals whose emphasis has been on the curative approach to disease.
In a plenary session, Professor Gilbert described how, through promotion
of voluntary testing and counselling, the stigma of HIV/AIDS is being
reduced. Although all health professionals have a role in this change,
it is through deprofessionalisation that the disease is being seen as
belonging to the people. There is a shift in the balance of power taking
place away from the sole emphasis being on doctors and the treatment
they offer towards the pharmacist’s assistant assuming a more significant
role.
Another innovative public health activity involving pharmacists’ assistants
in South Africa was described by Hazel Bradley, lecturer at the school
of public health, Western Cape. A training programme to support their
role in tuberculosis recognition and referral has been developed and
piloted. Following the programme, there has been a significant increase
in the self-reported TB referral rates by the assistants. Community involvement
Encouraging pharmacists to work in rural areas of Australia is being
encouraged though clinical placements during undergraduate training.
Anne Leversha, senior lecturer at Victoria College of Pharmacy, Monash
University, described how vacancies in rural areas are three times
as many as those in metropolitan areas. The three-week placements,
which provide advanced practice experience, are supported through
compilation of a workbook based around rural issues and through mentoring,
via
preceptors and a peer-support scheme.
She presented information about the preceptor programme (which can
be found at www.preceptor.info).
The initiative has raised the profile of rural issues and rural pharmacy
for all students.
Perhaps in the UK there is a need to encourage similar initiatives
to develop an understanding of health and pharmacy practice in deprived
communities.
Contributing to the wider aspects of public health in Finland is encouraged
in students by participation in a social pharmacy project. Groups of
final-year students worked on a real-life project for the benefit of
by a local community. Kirsti Vainio, senior lecturer at the school
of pharmacy in Kuopio, showed an example of how a project on medicine
education
for children at local schools has enabled students to gain many new
skills, such as working in the community, working as a team and and
managing
projects, in addition to achieving a worthwhile outcome. Through harnessing
the enthusiasm of students at this stage it is hoped that they would
continue to take on new community projects in their practising life.
Such a worthwhile enterprise should be encouraged among UK undergraduates. Experiences of health and illness
An understanding and sharing of individuals’ experiences of health
and illness is important not only for health professionals but
also to support people undergoing similar
experiences.
Sue Ziebland, senior research fellow in the department of primary care,
Oxford University, presented a plenary session describing the electronic
multimedia resource DIPEX (www.dipex.org). In addition to providing information
about illness and treatment, visitors to the site can find out more through
viewing recorded interviews with people sharing their experiences. The
site is based around questions that patients themselves want answers
to and not the questions that health professionals think are important.
The recorded interviews can also be used as a resource for research and
the training of health professionals.
Participants viewed two interviews describing interactions with pharmacy
services, which were not complimentary. They described the experience
of trying to obtain emergency hormonal contraception from a rather judgemental
pharmacist and the difficulties a mother had in obtaining medicines for
her child, who had congenital heart disease. Ecological public health
The bigger picture of public health was expanded upon by Geof Rayner,
visiting research fellow at City University, London. He said that while
lifestyle and behaviour do explain much of health and illness, we needed
to look at what lies behind lifestyle. Societal, dietary and environmental
factors are certain contributors. Dietary factors, such as the rise
of processed food, the increase in fat content and the rise in consumption
of soft drinks, are evidence of good marketing but demonstrate a government
failure and poor consumer knowledge. On the latter point he thought
that consumers are “evolutionally vulnerable in cheap food economies”;
we tend to eat the same weight of food, regardless of its composition.
Looking beyond the influencing factors to how things could change,
Professor Rayner, thought that a major limitation of the current behaviour
change
models is that they do not take into account the societal change that
also needs to happen. Nor do they recognise the influence of social norms
and peer influence. The approach that he favoured is an ecological public
health model, which recognises that behaviour has multiple roots, and
which acknowledges the role of anti-health forces. Pharmacy-based public health
Exploratory interviews with key players in pharmacy-based public health
were presented by Joe Bush, PhD student at Aston University school
of pharmacy, with Scotland and Wales appearing to be the most advanced.
One possible explanation for this is that Scotland and Wales are seen
as more socialist and have different political orthodoxies — a
fact that has been highlighted by devolution. The interviews had been
used as the basis on which to develop a survey to identify the contributions
that pharmacy is currently making in primary care organisations (PCOs).
The results suggested that over three-quarters of PCOs have some pharmaceutical
input when formulating public health plans; however, there was a lack
of uniformity on the level of input.
In Ireland a study of pharmacists’ attitudes to the delivery of
health promotion in the community pharmacy has identified the usual barriers
of time, space and expertise. But Catriona Bradley, Boots teacher-practitioner
at Trinity College, Dublin, also described how pharmacists believe that
another barrier is how they are viewed by other health care professionals,
policy makers and the public. Such constraints, which hinder pharmacists’ development,
need to be addressed. Empathy and caring
Some of the attributes of pharmacists, which are often quoted as being
contributory to our public health role, ie, empathy and caring, were
explored in other research presentations.
From a study conducted in Brighton and Hove Primary Care Trust, using
the Jefferson Scale of Empathy, Angela MacAdam, senior lecturer at the
University of Brighton school of pharmacy, reported that the mean empathy
score was higher for women pharmacists than for men. The main finding
was a statistical difference in empathy scores between GPs and pharmacists,
perhaps because the current undergraduate pharmacy curriculum has little
teaching on empathy, something she thought should be addressed.
The Caring Ability Inventory was used in Portugal among a sample of community
pharmacists. Afonso Cavaco, lecturer in the faculty of pharmacy at the
University of Lisbon, also described how women pharmacists’ scores
were significantly higher than those for men, consistent with the traditional
female role as carers in society. Significant differences were also found
among a group of pharmacists who had received additional training in
diabetes pharmaceutical care. Those who were actually providing the care
to patients had higher empathy scores than those who had yet to implement
the new service. Could it be that a lack of caring is a hitherto unidentified
barrier in progressing new services?
In the US, patients’ definitions and perspectives of caring pharmacists
showed that interpersonal behaviour was one of the key themes. Nancy
Fjortoft, associate dean of the school of pharmacy at Midwestern University,
Chicago, said that patients described caring pharmacists through interactive
behaviours such as smiling, expressive greetings, asking about families,
knowing
the patient’s name and inquiring about health. The second theme
was related to explaining drug therapy and other health-related issues.
Perhaps the new, more caring roles in our pharmacy contracts in the UK
will foster and develop similar behaviours. |
The
Pharmaceutical Journal