PJ Online | Pharmacists "brilliant" at public health, but contribution needs recognition
The Pharmaceutical Journal
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Pharmacists "brilliant" at public health, but contribution needs recognition
Pharmacists do a brilliant job in a range of areas and touch upon a whole range of issues around public health and public health medicine, according to Professor Roger Walker, director of pharmaceutical public health for Gwent Health Authority.
"I'm always impressed by pharmacists' willingness to become involved in syringe exchange and taking on methadone addicts without even being part of paid structures. Many doctors don't touch drug addicts yet pharmacists are willing to take them on board," Professor Walker said.
Focusing on areas in which community pharmacists already find themselves working for public benefit, Professor Walker reflected on how a Gwent pharmacist had been key to the identification of a batch of illicit nalbuphine which put drug abusers at risk. While collecting his daily dose of methadone, an addict had asked the pharmacist to have a look at a friend who felt unwell. The pharmacist realised that the second addict had probably tried something he was not used to as a result of a local shortage of heroin. The relationship had been such that the addicts were happy to give the pharmacist the vial of drug they had bought so that it could be analysed. Local police had been amazed that a pharmacist could have the confidence of drug addicts to that extent.
Head lice were a classic demonstrator of how pharmacists could be used in the surveillance of public health. "It's community pharmacists who always know what's happening first, but we don't have a network which links them to be able to use that information effectively and efficiently," Professor Walker said. "When there are outbreaks of coughs and colds, pharmacists are there but we're not capturing the data in a way that we can use."
Professor Walker took the view that there was a tremendous amount of work that could be capitalised on in the area of sexual health. For example, pharmacists had always supplied condoms but should they be supplied free in order to address public health issues? Pharmacists were also highly accessible and had potential to provide high quality and confidential advice. But there were question marks over how confidential pharmacies are and whether they were teenager-friendly.
"Sometimes we have to think a little bit more about how we present ourselves. We have some good ideas, but do they work?"
Showing a series of posters used for a new sexual health programme in Wales, Professor Walker said that pharmacists had been uncomfortable with the posters, but that students had thought them to be amusing and that they got the point over.
A further example had been a new sexual health advice service which had been opened from 9am to 1pm on Saturdays to provide an emergency service for problems arising from Friday nights. Hardly any young people used the service because it was too early and they were still in bed.
"Who are we trying to engage with?" Professor Walker asked. "We've got to think things through from their perspective and have a better awareness."
His point for pharmacists was that public health demanded an awareness of the communities involved and the health issues that needed to be addressed. This sort of information would be essential to the successful development of local pharmaceutical services.
The usefulness of public health data to the development of new services was demonstrated by reference to tuberculosis. Public health data for Gwent recorded exactly how many people were infected with TB because it was a notifiable disease. But prescribing data suggested that most patients only received treatment for one or two months and were then lost to the system, even taking into account prescribing data from neighbouring areas. "Why can't we get them registered with pharmacies. That's a classic area for medicines management," Professor Walker said.
Emergency planning was another area with potential for pharmacy involvement. Depots around the UK contained supplies that could be quickly accessed to deal with national emergencies. These included, for example, emergency supplies of doxycycline which would need to be distributed, along with relevant advice. Prescribing advisers were to issue supplies using patient group directions because there would be a continuing need for community pharmacists at their own premises.
Professor Walker took the view that pharmacists and medicines management had a significant role to play in public health and that there was the potential for pharmacists to become involved and to develop an awareness of pharmaceutical public health to their benefit.
He suggested that people were confused by the messages they received and by the strength of some of them. The amounts spent on promotion by sectional interests were huge compared to the sums spent on specific health issues. For example, in the United States the National Cancer Institute spent $1m a year encouraging Americans to eat more fruit and vegetables. This contrasted with the $866m annual marketing budget for Coca Cola, and McDonald's annual marketing spend of £1.1bn. World-wide, the annual spend on water and sanitation was $9bn, while in Europe alone $11bn a year were spent on ice-cream.
"Do we have life in perspective?" Professor Walker asked. "The messages are strong and powerful and people are confused out there. I think that pharmacists are ideally placed to be the outposts of public health in the high street."
Citation: The Pharmaceutical Journal URI: 20006596
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