Defining the role of pharmacists in addressing the social determinants of health

As one of the overreaching goals of Healthy People 2030, addressing the social determinants of health (SDOH) to reduce health disparities is a nationwide concern, with objectives informed by interdisciplinary teams of experts. However, there remains much discussion regarding the roles of healthcare providers in addressing SDOH. While current guidance suggests that all members of the healthcare team must be empowered to address SDOH, current guidance explicitly references physicians, nurses, social workers and staff, and do not specifically include pharmacists. While pharmacists are taught about the impact of SDOH in pharmacy curricula, actionable strategies for pharmacists to address SDOH in practice have not been clearly outlined. Pharmacists have multifaceted interactions with patients and may be influential in meeting individual patient needs, identifying social risk factors, and addressing upstream causes of health disparities. This paper proposes a framework for the role of pharmacists in addressing the SDOH through strategies at the patient, practice, and community levels. The concepts presented in this paper are meant to serve as a launch point for discussion and to promote the inclusion of pharmacists in the conversations around sustainable efforts to achieve health equity. This framework is not intended to limit the scope of pharmacists in addressing SDOH – on the contrary, it is our hope that this outline may be used to expand the education of future healthcare professionals regarding their role in addressing the social determinants of health.     

Pharmacist involvement in Healthy People 2010

OBJECTIVES: To review opportunities through which pharmacists can help the United States achieve its public health goals as expressed in Healthy People 2010, a document issued by the federal government that expresses the areas of focus for Americans in the first decade of the 21st century. SUMMARY: Healthy People 2010 provides general goals for 10 leading health indicators (such as tobacco use, over-weight and obesity, and immunizations), and these are then further subdivided into 28 focus areas, many of them with quantifiable goals (such as, "Reduce hospitalization rates for three ambulatory care-sensitive conditions--pediatric asthma, uncontrolled diabetes, and immunization-preventable pneumonia and influenza."). As health care professionals, pharmacists have the responsibility to help the country meet these goals. Ideas for increased pharmacist involvement are described in the article, including the conduct of screening programs and provision of specialized services that focus on such areas as hypertension, diabetes, asthma, patient education, smoking cessation, or general medication management. Pharmacists can build their efforts in these and similar areas by collaborating with physicians and other appropriate professionals, identifying target patients who have obtained services at the pharmacy, contacting patients in at-risk populations within the pharmacy's patient base and/or the community, choosing and monitoring an objective of interest, and maintaining efforts for sustained time periods. CONCLUSION: The message of Healthy People 2010 is that the health of the individual is closely linked to the health of the community and hence the health of the nation. Pharmacists, uniquely positioned as the most accessible health care providers in the community, can dedicate their considerable strengths toward using Healthy People 2010 as a tool to organize their own efforts and motivate their patients.     

The role of colleges and schools of pharmacy in the advent of Healthy People 2020

As the need for more experiential sites increases, colleges and schools of pharmacy should consider innovative and strategic approaches to expansion including adding programs that would address the target areas emphasized by Healthy People 2020. Healthy People 2020 encompasses the following areas: adolescent health, early and middle childhood, genomics, global health, health information technology, healthcare-associated infections, hearing and other sensory or communicating disorders (ear, nose, throat-voice, speech and language), weight status, older adults, quality of life and well-being, and social determinants of health. Academic leaders should consider what role exists for pharmacy practice in these areas and focus future program and curriculum development on Healthy People 2020 topic areas.     

Pharmacists' role in increasing pneumococcal and influenza vaccination.

PURPOSE: The role of the pharmacist in increasing pneumococcal and influenza vaccination rates and the clinical efficacy of pneumococcal and influenza vaccines are discussed. SUMMARY: Institutional pharmacists often play key roles on multidisciplinary committees and have the opportunity to make preventive therapies, such as vaccination, a priority. Standing-order programs authorize health care professionals to screen for vaccine eligibility and contraindications, administer vaccines, and monitor for adverse effects when following a physician- or institution-approved protocol. Current vaccination levels for the influenza and pneumococcal vaccines are suboptimal and well below the Healthy People 2010 goal of 90% of high-risk patients. Pharmacists should be familiar with the composition, immunogenicity, dosage, administration, efficacy, adverse reactions, contraindications, precautions, and cost-effectiveness of each vaccine, as well as with Advisory Committee on Immunization Practices recommendations and the supporting literature. CONCLUSION: Health-system pharmacists have the opportunity and responsibility to protect those at highest risk of pneumococcal disease and influenza through the use of standing-order vaccination programs.     

Influenza vaccination for patients with chronic obstructive pulmonary disease: Implications for pharmacists

Background

Influenza virus is responsible for substantial morbidity and mortality. Specific populations are at higher risk for exacerbations from influenza virus, such as patients with chronic obstructive pulmonary disease (COPD). Influenza vaccination coverage among COPD patients is low. Pharmacists can improve influenza vaccination among COPD patients by recognizing factors that influence vaccination and addressing these factors.

Using health observances to promote wellness in community pharmacies

OBJECTIVES: To provide pharmacists in community practice a framework for using national health observances as opportunities to promote patients' health through education and screenings, to discuss obstacles pharmacists may encounter when developing services within their pharmacies, and to outline examples of activities pharmacists can perform for specific health observances. DATA SOURCES: Articles published between January 1970 and April 2002 were identified through MEDLINE using the search terms wellness, disease prevention, health promotion, Healthy People 2010, treatment of high cholesterol, treatment of high blood pressure, and levels of participation. Additional articles were identified from Web sites and reports from the federal Office of Disease Prevention and Health Promotion (ODPHP), American Heart Association, American Diabetes Association, National Osteoporosis Foundation, National Cancer Institute, American Cancer Society, National Heart, Lung, and Blood Institute, Consumer Product Safety Commission, and Centers for Disease Control and Prevention. DATA SYNTHESIS: Healthy People 2010 is a federal program with the goal of increasing the quality and years of healthy life and eliminating health disparities among populations. ODPHP publishes a list of national health observances each year. Community pharmacists can use these month- and week-long observances as opportunities to work toward achieving Healthy People 2010 goals by advocating, facilitating, and/or providing education and screenings to their patients. This article presents advice for pharmacists who want to develop pharmacy-based health promotion activities at various levels of resources and commitment. Specific suggestions include tips on preparing for and implementing education and screening programs and overcoming potential obstacles. CONCLUSION: As the most accessible health care professionals, pharmacists are in a unique position to help the nation achieve the goals of Healthy People 2010 through their involvement in the promotion of wellness.     

DIFFICULT CHALLENGE FOR HEALTHY PEOPLE 2010: PUTTING POLICY INTO PRACTICE. A COMMENTARY

ABSTRACT

Claude Earl Fox, M.D., M.P.H., Director, Johns Hopkins Urban Health Institute, public health professor in the Johns Hopkins Bloomberg School of Public Health and former Administrator of the Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services, outlines the difficulties in achieving the stated goals of Healthy People 2010 for one population identified within the document as having health disparities – i.e., lesbian, gay, and bisexual (LGB) individuals in the United States. [Gender identity and transgender health issues were not addressed in Healthy People 2010.] The dearth of data on LGBT health disparities is discussed, as are many of the social, economic, systemic, and attitudinal barriers that prevent many LGBT persons from achieving equal access to comprehensive, culturally competent, community-based health care services. Health care providers, health purchasers, policymakers, researchers, academicians and consumers are urged to learn more about LGBT health care issues; to revamp the public health system's approach to health care delivery, research, and education; to include sexual orientation and gender identity measures in research proposals; to address sexual orientation and gender identity in health professions curricula; to include sexual orientation as part of cultural competency in the development of cultural competence standards; and to involve LGBT persons in all phases of health services planning, delivery, and evaluation.     

Do increasing levels of income deprivation have an effect on the prescribing of OTC medication?

□ People who are on a low income frequently visit their general practitioner to obtain medication that is also available over the counter, because it will be dispensed at no cost to them □ This activity reduces the amount of time available for the GP to treat more serious illnesses □ This leads to inequity when compared with the service provided in more affluent areas □ Pharmacists should be more involved in the provision of free health care to these patients     

Collaborating with pharmacists to advance health equity for patients with diabetes through communication

Health disparities are closely linked with economic, social, or environmental disadvantage and are the differences observed between groups as related to disease morbidity and mortality, injury, or violence. U.S. Food and Drug Administration Office of Minority Health and Health Equity and the American Pharmacists Association are both committed to the advancement of health equity and to increasing education and awareness of diabetes-related health disparity issues. Pharmacists are strategically located within the health care system and have the knowledge and skills to support the reduction of health disparities in patients with diabetes. This article highlights some of the many approaches and resources pharmacists can use in addressing health disparities and describes culturally competent, health literate, and numerate techniques for providing education and communicating with patients who have diabetes.     

Developing Pharmacy Student Communication Skills through Role-Playing and Active Learning

Objective. To evaluate the impact on pharmacy students of a communication course, which used role-playing to develop active-learning skills.Design. Students role-playing pharmacists in patient care scenarios were critiqued by students and pharmacist faculty members. Grading was performed using the rubric inspired by Bruce Berger’s Communication Skills for Pharmacists. Written skills were evaluated using student written critique questionnaires. Students completed precourse and postcourse self-assessment surveys. Preceptor evaluations were analyzed for course impact.Assessment. Students demonstrated improvement in oral skills based on role-play scores (45.87/50) after practice sessions. The average score based on the student questionnaire was 9.31/10. Gain was demonstrated in all defined course objectives. Impact on introductory pharmacy practice experience (IPPE) communication objectives was insignificant. Student evaluations for course and teaching strategy reflected a high average.Conclusion. Study results demonstrated improvement in oral and written communication skills that may help improve interprofessional teamwork between pharmacists and other health care providers.     

Advice provision for women: community pharmacists' attitudes and skills

Objective To assess the frequency of community pharmacists' advice‐giving to women and to determine pharmacists' attitudes and perceived knowledge, confidence and embarrassment in providing such advice. Method A postal questionnaire was sent to a random sample of 600 Northern Ireland community pharmacists for self‐completion. One reminder was sent. The questionnaire asked pharmacists to rate their knowledge on a list of women's health topics and to rate their confidence in dealing with women's health issues. Pharmacists were asked what actions they took to increase women's comfort in discussing potentially sensitive topics. They were also asked about the availability of women's health services locally. Closed response data were entered into SPSS for analysis while open question responses were collated and analysed separately. Key findings Pharmacy customers were predominantly female and the majority of pharmacists reported providing advice on women's health on a daily basis. Most pharmacists reported being confident and knowledgeable on women's health issues. Pharmacists had strategies to ensure that women felt comfortable discussing personal problems and they were not embarrassed dealing with such problems. Respondents felt more comfortable responding to, rather than initiating, such discussions. Personal views made it difficult for some respondents to provide advice on emergency contraception. Male pharmacists considered themselves to be less confident, less knowledgeable, more embarrassed and to have greater difficulty initiating a conversation on sensitive issues compared with female pharmacists. Conclusion Pharmacists on the whole were confident when dealing with requests for advice. Counselling confidence was related to counselling frequency. Initiation of conversations on women's health issues was difficult for some pharmacists. More active collaboration with the providers of other professional services available to women may enhance pharmacists' overall service provision for women customers.     

Assessment of knowledge,attitude and practice among community pharmacists towards dental care: A national cross sectional survey

BackgroundCommunity pharmacists’ contribution in health maintenance and promotion is significant but more studies are still needed to evaluate their role as healthcare providers.ObjectivesOur primary objective was to assess knowledge, attitude, and practice among community pharmacists in Lebanon towards dental care. Secondary objectives included assessing the barriers to a good dental care practice and assess their educational needs for oral health counseling.MethodsA national cross-sectional study was carried out using an online questionnaire and targeting community pharmacists in Lebanon. Five, three and six questions were used to assess pharmacists’ perceived knowledge, attitude and practice respectively. Stepwise linear regressions were conducted taking each time a different scale score as the dependent variable.Results497 (78.88%) pharmacists completed the survey (62% females). More than half (53.3%) exhibited good perceived knowledge, 39% a positive attitude and 47.3% a good practice regarding oral health. Pharmacists reported a good perceived knowledge regarding common oral conditions (good, very good and excellent knowledge: 73.2%). Most of the pharmacists (86.52%) perceived oral health promotion as an important part of their services. Moreover, 28.77% (n = 143) of pharmacists declared having difficulties in obtaining oral health information. The main barriers to a good practice included limited interaction between dentists and pharmacists and lack of training regarding oral health. The multivariable analyses showed a significant positive intercorrelation between perceived knowledge, attitude and practice. Working in the pharmacy for more than 40 h a week was associated with higher perceived knowledge (Beta = 2.846). Having a PhD degree was associated with lower practice scores (Beta = 3.676), whereas female gender was associated with lower practice scores (Beta = 2.334).ConclusionsPharmacists have the overall required knowledge and attitude to play an important role in the patients’ counseling towards dental care.     

Syringe services programs and real-world research: An overview for pharmacists

ObjectiveTo review key arguments supporting and criticizing syringe services programs (SSPs).Data sourcesPeer-reviewed literature and publicly available documents.SummaryPharmacy organizations—including the American Pharmacists Association and the American Society of Health-System Pharmacists—have stated that pharmacists should support programs that supply sterile injection materials to persons who use injection drugs. SSPs may include needle exchanges or other programs that meet these aims. Pharmacists should know that observational public health research demonstrates that SSPs can lower the transmission of blood-borne illnesses, improve linkage to care for substance use disorders, reduce health care expenditures, and reduce drug overdoses. Concerns about SSPs and increases in syringe litter or crime have not been borne out by research. Despite these findings and the positions of professional organizations, contemporary research suggests that pharmacists may be reluctant to support SSPs and other programs that would increase supply of sterile injection supplies to their communities.ConclusionThe review of evidence in this commentary should help pharmacists better understand the evidence in favor of SSPs, the potential criticisms of SSPs, and the reasons that their profession is moving to support these programs.     

药师在药物临床试验机构建设中的作用

本文立足于国内药师所处的政策形势,从内蒙古自治区人民医院药物临床试验机构的发展史出发,阐述了药师在药物临床试验中的机构办公室管理、伦理方案审查、专职化药物管理、试验药物配制和方案设计等方面所起到的作用。药师在药物临床试验机构建设的发展中占有举足轻重的地位,应抓住时代机遇,在临床试验中发挥更大的作用。     

A policy of free access to asthma medicines in Brazil: an opportunity for pharmacists to optimize asthma treatment

Asthma is a chronic inflammatory disorder of the airways that is characterized by recurrent symptoms associated with airflow limitation and by bronchial hyper-responsiveness. Free asthma treatment has been guaranteed in Brazil since 2003, notably after the Brazilian government decided to support drugs for the most serious forms of the disease. The asthma treatment access policy in Brazil offers a new opportunity for pharmacists to work closely with patients, and for caregivers and health care teams to promote educational activities and patient counselling about asthma. Pharmacists have an important role in the management of drug therapy within the health care team. Pharmacists should be prepared to engage with the latest concept of health care delivery proposed for Brazilian Unified Health System. These are centred on forming health care networks and strengthening multidisciplinary teams to integrate all professionals who are in charge of patient care.     

Educational opportunities and anti-doping roles and responsibilities for pharmacists

Drug use and abuse by athletes has become a common problem. Pharmacists can assist by managing the legitimate medication needs of athletes to prevent them from accidentally using a banned substance. Pharmacists can also educate athletes and the public about the health consequences of using performance-enhancing substances. Pharmacists can play a variety of roles to assist with anti-doping. Such roles include educating, advising, dispensing and monitoring medications and supplements; and working with anti-doping agencies. There are few established educational opportunities for pharmacists and pharmacy students. Educational programs in sports pharmacy and doping control need to be developed for instruction in the classroom, for post-graduate training and for experiential programs. Classroom instruction should include information about performance-enhancing substances and general principles of doping control. Student activities for an established advanced pharmacy practice experience include education on performance-enhancing substances and assay technologies, preparing and providing presentations to athletes and others regarding these substances, performing literature research on drugs and dietary supplements used to improve athletic performance, writing a monograph on these substances, and participating in doping control programs.     

New Zealand pharmacists’ alignment with their professional body’s vision for the future

ObjectiveTo determine the alignment between New Zealand pharmacists’ views and the New Zealand Ten-Year Vision (TYV) document and explore factors associated with individuals’ alignment.MethodsA postal survey of 1892 practicing pharmacists was conducted. The questionnaire included 37 attitude statements informed by analysis of 6 focus groups in which pharmacists discussed 24 statements representing 12 main vision areas. Responses are reported by proportion. Bivariate analysis compared differences in demographic characteristics and alignment with vision statements between 3 professional subgroups: community, hospital, and pharmacists working in District Health Boards or Primary Health Organizations.ResultsNine hundred and eighty (54.6%) analyzable surveys were returned. Respondents broadly agreed with the 12 vision areas. There was a clear patient focus and strong support for extending roles to better serve patient care. Pharmacists believe that current practice and funding models need to change and want greater involvement in setting health policy. There are significant differences in agreement and level of agreement between professional subgroups. Notably, community pharmacists are more likely to put their relationship with the patient above that with the doctor, to believe that other professions would resist role extension, to support minor ailments schemes, and to indicate a shift in funding models was necessary to support innovative pharmacy practice. There are statistically significant and potentially important demographic differences between professional subgroups, including age, sex, formal postgraduate training, and experience working in health care in other countries. Further analysis is required to understand the interplay of these factors and how this may influence alignment with the TYV document.ConclusionsPharmacists’ responses indicated a high level of alignment with vision outlined in the TYV. Pharmacists appear receptive to practice and funding changes in order to facilitate greater contribution to patient care. Respondents demonstrated a clear desire to be involved in setting medicines-related health policy and feel underrepresented at this level.