FIP Congress 2006
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Various ways in which pharmacists have been involved
in public health campaigns and strategies throughout the world
were outlined at a session organised by the Community Pharmacy
Section. Graeme Smith (on the staff of The Journal) reports
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 The World Congress of Pharmacy and Pharmaceutical Sciences,
the 66th International FIP Congress, was organised by the International
Pharmaceutical Federation in association with the Federal
Council of Pharmacy of Brazil.
It took place in Salvador da Bahia from August 26 to 31, 2006
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How pharmacists can contribute to improving public health in the world
Pharmacy can and does play an important role in improving public health,
David Pruce, director of practice and quality improvement at the Royal
Pharmaceutical Society of Great Britain, told the congress. He said that
in many western countries health priorities are related to preventing
ill health.
For example, health priorities in the UK are to reduce the
number of people who smoke, to reduce obesity and improve diet and nutrition,
to increase exercise, to encourage and support sensible alcohol consumption,
to improve sexual health and to improve mental health.
He outlined the UK government’s health targets for 2010. These
are:
• to reduce inequalities in health by 10 per cent
• to reduce deaths
from coronary heart disease and stroke by 40 per cent
• to reduce deaths
from cancer by 40 per cent
• to reduce suicides by 20 per cent
• to reduce
adult smoking to 21 per cent or less
• to halt the rise in childhood obesity
• to reduce teenage pregnancies by 50 per cent
• to improve health
outcomes for people with long-term conditions
Why is pharmacy the ideal profession to help achieve these goals? What
can it offer to public health, he asked. Pharmacists are far more accessible
than other health care professionals; 94 per cent of people visit a pharmacy
in the UK at least once a year and each adult visits on average 12 times
a year. So pharmacists have opportunities to influence public health
that other health professions do not have. “We see ill people and
well people, so there are opportunities to give health advice. And the
UK government is increasingly recognising pharmacy’s role as a
key player in public health,” he said.
On smoking cessation, Mr Pruce told the congress that it had been shown
that brief advice from a health care professional to a smoker leads to
a 3–4 per cent one-year quit rate. In countries where nicotine
replacement therapy is available that figure rises to 8 per cent and
where there is specialist stop-smoking advice it rises to 15 per cent.
And
evidence shows that pharmacists are as good as any other health care
professional in achieving success. Not only that, pharmacy reaches a
wider population than other health professions. So there are are lots
of opportunities to encourage people to quit.
Mr Pruce told the congress that pharmacists have an important role in
obesity. Indeed, they are surprisingly effective at delivering healthy
eating and weight reduction advice. And the Royal Pharmaceutical Society
had produced practice guidance on obesity to help pharmacists in the
task.
Pharmacists also have a wide and varied role in providing sexual health
advice. Mr Pruce pointed out that in the UK there is a problem with rising
rates of chlamydia infection. He described a pilot project by Boots,
one of Britain’s large chain pharmacies, whereby chlamydia testing
kits were given out free of charge to 16- to 24-years-olds, and pharmacists
had been able to identify people with the infection and refer them for
treatment.
There had been enormous uptake of the service and good acceptance
of it from Boots’s customers. The reason for that, said Mr Pruce,
may be that there is less stigma attached to going to a community pharmacy
than attending a sexually transmitted infections clinic. “The success
of the scheme has helped to highlight the strengths of community pharmacy,” he
added.
Another major role of British pharmacists is in the provision of emergency
hormonal contraception. Mr Pruce told the congress that the UK has one
of the worst teenage pregnancy rates in western Europe. Since EHC had
been made available from community pharmacies without a prescription,
uptake had increased. Indeed, pharmacies are now the preferred choice
of women as EHC suppliers and visits to doctors and nurses have decreased. “This
is a success built on pharmacy’s accessibility,” he said.
A further important public health area for pharmacy is substance misuse.
British community pharmacists supervise the consumption of methadone
in their pharmacies and provide needle exchange schemes. This reduces
the health risks to drug users and to others, he said. And community
pharmacists can provide specialist advice to drug misusers because of
their regular attendance at pharmacies to consume their methadone and
exchange injecting equipment.
Turning to long-term conditions, Mr Pruce said that a priority of the
UK government is to increase people’s ability to care for themselves.
Since many people’s problems are medicines-related, community pharmacists
are able to provide advice about this and help to reduce hospital admissions.
About 10 per cent of hospital admissions in the UK are due to people’s
inability to cope with their medicines, especially elderly people. So
pharmacists are a vital source of advice and support.
There are also issues surrounding compliance, especially for people with
symptomless diseases like hypertension and diabetes, where non-compliance
rates in the population can be as high as 50 per cent. There is a need
to appreciate the factors behind non-compliance with medication regimens. “People
are human, and taking medicines can be a constant reminder of the presence
of illness,” he said.
Other areas where pharmacists have a role
in improving public health are identifying individuals with risk factors
for disease through blood pressure, cholesterol and diabetes testing.
Community pharmacists also have an emerging role in vaccination strategies
and in reduction of harm from alcohol consumption.
Mr Pruce hoped that he had given the congress a flavour of the sheer
breadth of what a pharmacist is able to do. Lessons learnt in Britain
are that community pharmacists should link giving advice to patients
with the sale or dispensing of a medicine.
In conclusion, he encouraged community pharmacists to become involved
in local and national public health campaigns. “Emerging evidence
definitely supports the pharmacist’s role,” he said.
“Take your blood pressure to heart!” — a hypertension
awareness campaign in France
On behalf of Isabelle Adenot, of the French National Order of Pharmacists,
who was unable to be present, Josette Dubray described a campaign entitled “Take
your blood pressure to heart!” that had been run by community pharmacists
to reduce hypertension.
The initiative was born out of the desire of the National Council of
Pharmacists to launch a campaign that would highlight the role of community
pharmacists in relation to a major health problem. Arterial hypertension
was chosen because it is a chronic disease of which there were 3.5 million
cases in France, with many others going undiagnosed. Patients with the
condition need information, advice and support in order to help them
change their lifestyles and so help prevent the progression of the disease,
said Ms Dubray.
She explained that the campaign involved the entire profession and was
led by the National Council of Pharmacists in co-operation with pharmacists’ unions
and other professional organisations. It was prepared and supervised
by a scientific committee including medical experts and health authorities.
To
promote the campaign, which ran for one month beginning on St Valentine’s
Day 2006, articles for pharmacists appeared in professional journals
and a special brochure was made available. To inform the public, leaflets,
badges, posters, television advertisements and paper bags were produced.
Politicians were sent a personal letter.
Assessment of the campaign showed that three out of five newspaper readers
had seen the press information and 31 per cent of those associated the
campaign with pharmacists and not with the French Cardiology Federation,
said Ms Dubray.
Public awareness of hypertension increased by 81 per cent and patients
said they appreciated the campaign and were encouraged to find out more
about the condition. They also expressed confidence in the pharmacist’s
role as a health adviser. The poll showed a high level of public overall
confidence in pharmacists, Ms Dubray added.
Ninety-one per cent of French community pharmacists participated in the
campaign, 80 per cent approved of its public presentation of the profession
of pharmacy and 83 per cent said that they believed the campaign had
enhanced their role as health advisers.
A community pharmacy-based project to improve the health of men who
have sex with men in Thailand
 The development of a community pharmacy-based sexual health service
for men who have sex with men (MSM) was described by Surarong
Chinwong,
of the faculty of pharmacy at Chiang Mai University, Thailand.
He explained
that the rationale behind the service was that the population of MSM
in Chiang Mai was growing and, at the same time, cases of sexually
transmitted infections and HIV were increasing. The objective, therefore,
was to promote the well-being of MSM with regard to their sexual health.
The result is that 16 community pharmacies in Chiang Mai now participate
in a network for sexual health promotion activities that is co-ordinated
by an organisation called “Mplus+”. It aims to motivate men
to be more concerned about their health, to push them to be more responsible
about their sexual activities and to encourage them to consult a doctor
when they have a problem.
Before the project went live, a needs assessment for community pharmacists
and MSM was carried out through focus group discussions. This helped
the pharmacists involved to obtain a good understanding of and a positive
attitude towards MSM clients. All were given advice on health counselling
and on STI drug treatment, said Dr Chinwong.
The health services offered by the 16 community pharmacies are advertised
in media produced by Mplus+, in local newspapers, on radio, and in literature
available at the Mplus+ centre (a drop-in centre for MSM, outreach workers,
sex workers and students).
MSM clients can be referred by community pharmacists to an STI clinic
or to the Mplus+ centre, where a doctor is available twice a week from
5 to 8pm.
Dr Chinwong told the congress that seven projects, conducted by pharmacy
students, had taken place over the past two years under the supervision
of his university faculty. The data obtained had been useful for the
development of services at Mplus+ and at community pharmacies. The data
were also useful in providing helpful printed media for MSM clients.
In particular, a guideline document for pharmacy services to be provided
to MSM clients at community pharmacies was produced.
“This is an example of how community pharmacists in Thailand can improve
people’s health,” Mr Chinwong concluded.
Preparing for an influenza pandemic in Canada
The Canadian Pharmacists Association is ensuring that community pharmacists
play a vital role in Canada’s preparations for an influenza pandemic,
Warren Meek, vice-president of the association, told the congress.
However, pharmacists have concerns, which the association is attempting
to allay through strengthening its communications mechanisms and providing
pharmacist- specific tools. It is mailing education materials to 8,000
pharmacies across Canada.
Pharmacists are worried about understanding their role in emergency preparedness,
said Mr Meek. They are also worried about running out of medicines and,
indeed, of staff, since it has been estimated that 20 per cent of a workforce
is likely to be unavailable for work during a pandemic. As well as their
personal and family health concerns, pharmacist are also worried about
dealing with a mass influx of patients and public panic.
Mr Meek said that pharmacists in Canada are being encouraged to participate
in national and local preparedness activities and to raise awareness
among the public. During a pandemic, he hoped pharmacies would be involved
in direct patient care through acting as a triage centre and assisting
in the referral of patients.
Pharmacists should also be involved in providing
information to the public, providing surveillance of how a pandemic
is progressing and planning the supply of medicines and medical equipment. |
The
Pharmaceutical Journal