Rural community pharmacy: a feasible site for a health promotion and screening service for cardiovascular risk factors

ABSTRACT: A pharmacist-delivered health promotion and screening service for cardiovascular risk factors in rural community pharmacy was implemented in the Upper Hunter Valley, New South Wales (NSW). We describe the development of the service and profile 204 participants at their initial screening. A standardised clinical protocol guided the pharmacist through delivery of the service. The mean age of participants was 44 years ( SD ± 13 ). Over half (54%) had a Body Mass Index (BMI) > 25, 54% had cholesterol > 5.0 mmol L^-1 and 18% a systolicBP > 140 mmHg and/or diastolicBP > 90 mmHg. Most (80%) received lifestyle information (dietary, exercise or smoking cessation). One third required referral to a general practitioner. Provision of the service through community pharmacy increased the community's access to screening, 28% reported that they had never had their cholesterol measured. Since this new service was able to identify, educate and refer people at risk of cardiovascular disease in a rural community, we recommend a broader adoption through rural pharmacies.     

Rural pharmacy in New Zealand: effects of a compulsory externship on student perspectives and implications for workforce shortage

Objective: To explore student perceptions of rural pharmacy practice, factors affecting interest in rural work and effects of an educational intervention designed to raise awareness of rural practice. Design: Qualitative and quantitative survey questionnaire administered before and after a week-long rural externship. Setting: Undergraduate – rural pharmacy externship. Participants: Third-year Bachelor of Pharmacy undergraduate cohort (n = 123). Intervention: Week-long exposure to rural pharmacy practice Main outcome measures: Rural/urban origin of students, interest in working in rural practice, views held of rural practice and towards externship. Results: Rural-origin students were significantly more likely to report they would consider working in rural practice prior to the intervention than urban-origin students (77% rural origin versus 40% urban origin). The intervention significantly increased the overall proportion (48% pre-versus 73% post-externship), proportion of female students (48% pre versus 79% post-externship) and proportion of urban-origin students (38% pre-versus 67% post-externship) prepared to consider rural practice. Despite apprehension towards the externship, students reported overwhelmingly positive experiences of it. Negative aspects related mainly to travel and accommodation costs incurred. Conclusions: This targeted, experiential intervention affected perceptions of rural practice in a positive direction among urban-origin students by raising awareness and challenging their preconceptions of rural pharmacy practice. Further research is required to see whether this will affect recruitment and to investigate what appears to be a particular effect on female students.     

Evaluation of the national pharmacy preceptor education program

OBJECTIVE: The process evaluation findings and key issues from a trial of the effectiveness and national applicability of a national online educational curriculum for pharmacist preceptors are presented. DESIGN: A multi-method triangulated research design was used to elicit qualitative and quantitative data preceptors. The data collection method involved an anonymous questionnaire with both quantitative components and open-ended qualitative responses. SETTING: An online education program for preceptors of Australian pharmacy students in rural areas. PARTICIPANTS: Rural pharmacists in the three states were invited to trial the package and participate in the associated research/evaluation project. MAIN OUTCOME MEASURES: The Australian Pharmacy Preceptor Education (APPE) program is an important and valuable educational tool for the professional development of pharmacists. It contained pertinent information and appropriate activities, and the delivery strategy was well accepted. The evaluation findings support a national implementation. RESULTS: Program strengths include the ease of access, self-directed learning and the interactive nature emphasising the benefit of sharing ideas and feedback. Potential program limitations include technical delays and unclear instructions for undertaking the program. CONCLUSION: The online APPE program is a flexible delivery strategy which has the potential to dramatically improve the skills and knowledge of pharmacists acting as preceptors and, thereby, impact on the learning provided in rural hospitals and community pharmacies for undergraduate students and new graduates alike.     

Public health and pharmacy: A critical review

Community pharmacy in the UK is often described as the most accessible of all primary healthcare providers, situated on the ‘high street’ and requiring no appointment. But what does the new public health movement mean for pharmacy, and where is pharmacy in terms of the new public health agenda? In this paper, the authors provide a critical assessment of pharmacy's response to this agenda through a review of key pharmacy relevant policy documents. In particular, in the context of pharmacy's re-professionalization agenda, they assess the contribution of pharmacy to public health from a micro- and macro-level framework. The aim is to provide a critical context in light of current proposals for the profession to develop a public health strategy.     

加快建设\

为满足健康中国战略需求、促进全民健康实现,医药学高等教育在人才培养中需探索如何融入新公共卫生元素。新公卫建设要秉持大卫生、大健康理念和预防为主的方针,将其融入循证药学“一主三学”教学模式中,不仅能够促进学生的自主学习,提升临床药学的价值,而且有助于临床药学专业人才的培养,为高等医药院校的教学改革提供了参考依据。     

Prevention and promotion in decentralized rural health systems: a comparative study from northeast Brazil

Policies to reform health care provision often combine the organizational restructuring of decentralization with ideological restructuring through a new model of health care that gives greater weight to prevention and promotion. Decentralization provides a discretionary space to the local health system to define and develop its own activities. The central policy aim to shift the model of health care therefore must rely on incentives rather than directives and is likely to result in variation at local levels in the extent and mode of its implementation. The local processes affecting variation in local implementation of policies for prevention and promotion have not been studied in a developing country. This study does so by comparing two rural health systems with different levels of prevention and promotion activities in one of the poorest regions of Brazil, Ceará State in the northeast. The health system with greater activities of prevention and promotion also has a more advanced stage of decentralization, but this is in combination with many other, interacting influences that differentiate the two health systems' ability to adopt and implement new approaches. While beyond the scope of this paper to detail options for regional and national managers to encourage the adoption of a greater focus on prevention and promotion, it is clear that strategies needs to target not only the vision and actions of local health system staff, but critically also the expectations of the local population and the attitudes of local government.     

社区卫生服务站药房规范化管理模式探讨

宁波市鄞州区姜山社区卫生服务中心依托标准化社区卫生服务站的建设,就社区卫生服务站药房规范化管理模式进行了探索,取得一定成效。文章重点就此规范化管理模式进行了论述。     

永州市农村居民药学服务需求调查

目的 了解农村居民对药学服务的需求情况,为在基层农村有效开展药学服务提供理论指导。方法 抽取湖南省永州市11个县区的28个基层乡、镇的6 145名居民进行药学服务需求问卷调查。结果 在药学服务涵盖的13个要素中,能解释总方差>62%的5个服务要素为个体健康状况、合理用药知识教育、多种药物的选择、降低费用、用药剂量,相对权重依次为17.32%、15.27%、13.08%、12.25%、10.49%;不同年龄段居民对药学服务需求的重点差异有统计学意义,30~39岁居民对用药副作用的需求高于≥40岁居民（x²=4.58,P<0.05）,≥50岁居民对用药知识教育的需求高于﹤50岁居民（χ²=4.02,P<0.05）,≥60岁居民在多种药物选择和降低费用方面明显高于<60岁居民（χ²=7.61、6.86,P<0.01）。结论 永州市农村居民合理用药知识匮乏,需要安全、合理、有效与经济用药的药学服务。     

Community pharmacy as a primary health and self-care resource: a framework for understanding pharmacy utilization

A number of different models exist to help explain health care utilization behaviour, though none have been applied to the use of community pharmacy. In policy terms pharmacy utilization is an important one to address as Government is keen to support a shift in GPs' workload to community pharmacy. The paper begins by outlining the different health utilization models. We then draw on the different frameworks to help explore the nature of community pharmacy use. Using data from two separate pharmacy studies that included observational work, interviews and a literature review, we identify what key influences are important in conceptualizing pharmacy utilization. Previous research has tended to focus on factors associated with socio-demographic characteristics of service users, but the current research on which the paper draws, highlights the importance of factors associated with need and demand issues in shaping how pharmacies are utilized. Process factors and the impact of internal and external organizational factors are also highlighted as important.     

Community health promotion: The church as partner

The purpose of this paper is to review the literature relative to church-based health promotion programs to assist health professionals in establishing effective prevention alliances with African-American churches. While the literature describing the role of churches, particularly African-American, is limited, the available evidence supports the assertion that many churches are engaged in providing primary prevention, preventive health, and social services to at risk populations. Two mini-cases, illustrative of programs which have been reported in the literature, are presented. What each program had in common is an alliance between ministers, health professionals, and trained church volunteers. Pastors acted as gatekeepers and advocates for a health program. The health professionals served as consultants (particularly in technical design, training, and evaluation). Interested church members, once trained, conducted health programs serving themselves, fellow members, and their community.     

健康促进对结核病控制工作的干预研究

目的分析健康促进对结核病控制工作的影响,为更好地开展结核病健康促进工作提供有益的启示.方法在规定时间内对目标县采取一系列健康促进活动后,采用直接和间接评价指标,全面分析健康促进对结核病控制工作的干预效果.结果健康促进活动开展前后人群结核病知识知晓率分别为19.93%和63.95%,可疑者年就诊率由0.83%上升到1.35%o.涂阳肺结核病人登记率由项目实施前的9.21/10万上升到项目实施后的20.63/10万;初治涂阳治愈率由90.42%上升到95.63%;复治涂阳病人治愈率由75.00%上升到85.29%.结论健康促进对结核病控制工作的影响是极为显著的,在结核病控制的进程中必须注重科学全面的健康促进.     

Community pharmacy in Ghana: enhancing the contribution to primary health care

It is widely believed that pharmacists could make a greater contribution to the provision of primary health care, especially in developing countries. Particular strengths of pharmacy services commonly cited include their accessibility within many communities and the opportunities for advising on the management of health problems. The potential for pharmacy to respond to health care needs and contribute to specific health policy objectives is receiving greater prominence both internationally and in individual countries. However, despite this widely acknowledged potential, developments have been limited. Pharmacy is concerned with promoting the safe and appropriate use of drugs. Drug use in developing countries has frequently been described as irrational. It is influenced by a wide range of factors, including health and drugs policy, the organization and provision of health care, the availability of objective information, and health beliefs and cultural perspectives regarding health and drug therapy. The practices of pharmacy retailers, which are conducted in the context of wider structures and processes of health care provision, have also been questioned. The aim of this paper is to consider possible directions for community pharmacy service development in Ghana. The paper draws on the literature relating to health care, drug use and pharmacy in Ghana to describe the background against which pharmacy services operate. In the context of current directions in pharmacy practice and policy, potential opportunities and barriers regarding the development of services are then addressed.     

开展农村社区健康教育与健康促进对农民健康的影响与体会

目的：探索农村社区健康教育与健康促进的工作模式。方法：将湖州市吴兴区经济发展及人文条件基本相似的二个乡镇分别设为实验区与对照区。实验区实施行政干预,开发促进健康行为规范的规章制度,改善影响健康的卫生设施,在社区卫生服务工作基础上开展各项健康干预;对照区仅做日常的社区卫生服务。课题研究前后分别开展基线与终末调查。结果：实验区干预有关的绝大部份项目明显高于对照区,并且实验区干预前后有非常显著差异。结论：农村社区健康教育与健康促进是新农村建设中的软肋,必须将农村社区健康教育与健康促进纳入政府工作范畴,制定支持性公共卫生政策,建立并完善基层健康教育网络,真正落实农村社区卫生服务六位一体,形成政府—健康教育机构—社区互动的长效管理机制,提高农民的健康素质。     

2006—2010年苏州市艾滋病健康教育与健康促进工作分析

目的了解苏州市艾滋病健康教育与健康促进现况,并作出相应分析。方法计算覆盖率,采用动态数列方法列出增长率的动态数列表。结果 2006—2010年该市艾滋病健康教育与健康促进工作各项指标,如健康宣传(11.3%～28.1%),宣传资料入户(4.0%～34.7%)、宣传材料放置(1.3%～42.0%)、墙体广告(0.6%～83.3%)、学校宣传和讲座(27.4%～37.3%)、广告牌及宣传栏表(13.3%～100.0%)等覆盖率均有大幅度增加。结论该市艾滋病健康教育与健康促进工作已逐步走向常规运作,主要采取多种途径、多种方式,针对不同地区、不同人群的特点开展工作,覆盖面有所扩大,增长率逐年提高,上升幅度明显。     

Childhood injury prevention advice: a survey of health professionals responses to common scenarios

AIM: To determine the responses of health professionals when asked at what age a child could safely engage in a number of common activities and scenarios. METHODS: Eleven scenarios reflecting everyday activities were adapted from the BBC book Play it Safe. Questionnaires were completed by a convenience sample of health professionals. Respondents were asked to give the minimum age they felt a child could safely engage in each of the activities. The literature was searched for an evidential basis for answers to the activities and scenarios posed. RESULTS: A total of 215 questionnaires were completed. For all questions there was a spread in responses of at least 9 years. Recommended answers were found in the literature for six of the scenarios, however, in only four of these was this confirmed to have an evidential basis. Fifty-four per cent of responses were at least 2 or more years from these recommended answers. DISCUSSION: Injury prevention advice needs to be consistent and, where possible, evidentially based. Health professionals often need to rely on their own opinions to provide advice. This survey shows opinions vary and highlights the need for evidence-based guidelines for parents and professionals.     

Regional Differences in Prescribing Quality Among Elder Veterans and the Impact of Rural Residence

Purpose: Medication safety is a critical concern for older adults. Regional variation in potentially inappropriate prescribing practices may reflect important differences in health care quality. Therefore, the objectives of this study were to characterize prescribing quality variation among older adults across geographic region, and to compare prescribing quality across rural versus urban residence. Methods: Cross‐sectional study of 1,549,824 older adult veterans with regular Veterans Affairs (VA) primary care and medication use during fiscal year 2007. Prescribing quality was measured by 4 indicators of potentially inappropriate prescribing: Zhan criteria drugs to avoid, Fick criteria drugs to avoid, therapeutic duplication, and drug‐drug interactions. Frequency differences across region and rural‐urban residence were compared using adjusted odds‐ratios. Findings: Significant regional variation was observed for all indicators. Zhan criteria frequencies ranged from 13.2% in the Northeast to 21.2% in the South. Nationally, rural veterans had a significantly increased risk for inappropriate prescribing according to all quality indicators. However, regional analyses revealed this effect was limited to the South and Northeast, whereas rural residence was neutral in the Midwest and protective in the West. Conclusions: Significant regional variation in prescribing quality was observed among older adult veterans, mirroring recent findings among Medicare beneficiaries. The association between rurality and prescribing quality is heterogeneous, and relying solely on national estimates may yield misleading conclusions. Although we documented important variations in prescribing quality, the underlying factors driving these trends remain unknown, and they are a vital area for future research affecting older adults in both VA and non‐VA health systems.