The Pharmaceutical Journal
Vol 277 (Supplement) F15
October 2006

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FIP Congress 2006

Schools should “train revolutionaries”

If the pharmacy profession wants change, then it must “train revolutionaries”, Christine Nimmo, of the American Society of Health-System Pharmacists, told the congress.

Listening to her joint presentation with Ross Holland, of PharmEd Consultants, US, the audience heard that changing the public and professional mindset on what makes a “good pharmacist” is a vital part of managing change. If pharmacy wants change, then professional organisations need to be influencing the views and expectations of potential future pharmacists through vocational guidance given to schools and by working to change undergraduate admissions criteria to schools of pharmacy.

Dr Nimmo explained that the dominant personality type in pharmacy is someone with a strong sense of responsibility, who is conscientious, practical and logical but not extrovert or “social”. Research had shown that one in five pharmacists has a fear of verbal communication.

For change to happen, some people will need “attitude readjustment”, and this is where national pharmacy associations can help, by shifting public perception of the qualities that make a good pharmacist and motivating corporations and pharmacy owners to believe that change is both desirable and doable.

The ability to communicate effectively is important because changing practice is much more than “just doing it”, for example, by creating new posts or writing new job descriptions. The first step is to work on what society needs, and consider the practice environment in the context of the wider health care system.

“We don’t exist in a cocoon, a vacuum; we interact with society,” Dr Nimmo said. So to make change happen, pharmacists need to influence both the public view and the views of other health professions. The profession needs to “get on their [stakeholders’] playing field” and use research to show that patients are not getting optimal care under the present system.

For health systems with third party payers, it is critically important to show that health care costs go down when pharmacists work in collaboration with other health care providers. This will be key to achieving a mechanism for payment for new services, she said.

Making change happen also needs what Dr Nimmo and Dr Holland called a “conducive practice environment” with the time and physical space for staff to take on new roles, plus relevant, high quality training. This needs leadership from pharmacy owners. They have to be clear on staff training needs, but should not be afraid to use national pharmacy organisations and schools of pharmacy to deliver continuing education programmes.

Progress in Finland

In Finland the TIPPA project has changed public perception of pharmacy but the process has taken “20 years of blood sweat and tears”, said Eeva Terasalmi, from Apple Pharmacy, Virkkala. “You must have a strong wish for what you want to have.”

The project, managed by the Association of Finnish Pharmacists, started in the 1980s at a time when community pharmacy was becoming increasingly vulnerable. The aim was to develop a professional concept for pharmacists and pharmacies and to promote a quality public health service. Their strategy had included lobbying, publications to promote key pharmacy activities, continuing education programmes for pharmacy staff and a change in basic education in schools.

Ms Terasalmi said that it is not just older practitioners who have to be involved in the change process. “We have to give a clear view to newcomers and educate them to challenge the old ways of working in pharmacies,” she said.

The pharmacy undergraduate curriculum had been designed in 1994; the next year a “quality pays” programme was launched. In 1998 ethical codes specific to community practice had been published. A key aim was for the public to understand the pharmacist’s role as part of the local health care team, and booklets on topics such as the pharmacists’ ethical code of practice and their role in self-medication and health promotion had been widely circulated to decision-makers.

Ms Terasalmi said there has been a big change in public perceptions over the past 10 years. The first national survey on consumer expectations had been done in 1988, five years after pharmacists had first been given “the duty to counsel”. Then, privacy had been the major concern for the public. The project has subsequently worked on promoting pharmacist’s role in self-medication.

By 2001, 65 per cent of pharmacies had in-house guidelines for patient counselling, and more than half were collaborating with other local health care providers on a regular basis. Their second consumer survey, in 2001 gave a clear message that the public wanted these practice developments to continue.

She warned that to maintain change, every pharmacist has to accept the need to change, and actually make the change. “It’s a cycle of change and we have to accept it is slow.”

Challenge in Germany

Martin Schultz, from the centre for drug information and pharmacy practice at Frankfurt University, Germany, said the shift from product to patient orientation is still proving to be a challenge for the profession.

Non-adherence to medication offers a “big role” for community pharmacy and is relatively easy to tackle as part of pharmacist’s duties as a drugs expert. However progress worldwide has been “disappointing”. This he suggested is because of lack of willingness to change, from politicians and payers down to pharmacy staff.

“We have to change, just staying as we are will not secure community pharmacy,” Professor Schultz told the meeting. That means focusing on factors that facilitate change, not the barriers to it.