The Contribution of Pharmacy

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THE CONTRIBUTION OF

PHARMACY TO TODAYS HEALTH

CARE PROVISION

Introduction

Pharmacists are experts on the action &

uses of drugs, including the chemistry, the

formulation of medicines & the way inwhich dru

gs are used to manage

diseases.


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Pharmacists are employed in many different

areas of practice, include the traditional ones

of hospital and community practice,

As well as newer advisory roles at helth

authority/ health board level,

and working directly with generalpractitioners as part of the core, practice-

based, primary health care team.


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Some extemporaneous dispensing is still

required and pharmacists remain the only

professional trained in these skills.

If the pharmacist was not required to

compound medicines, and was not required

to give general advice on diseases, what wasthe pharmacist to do?


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The Profession

Four main areas in which pharmacy shouldmake a major contribution to health

outcomes were identified :

a. the management ofprescribed medicines;

b. the management of chronic conditions;

c. the management of common ailments;

d. thepromotionand support of healthy

lifestyles.


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During the consultation process, pharmacists

expressed their views on the way the

profession should change. These, too, may

be summarized under four main headings :

a. The strengths of pharmacy;

b. Demonstrating the value of pharmacy;

c. Changes in practice;d. A sustainable future.


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The current and future roles of Pharmacists :

Community pharmacy

Dispensing: the focus of dispensing now

rests not only on accurate supply of

medication, but on checking that

medication is appropriate for the patient

and counselling the patient on its

appropriate use.


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Responding to symptoms: provision of

advice to customers presenting in the

pharmacy for advice on self care is now

an accepted part of the work of apharmacist, which as described earlier

has been enhanced by the increased

armamentarium of pharmacy medicines.


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Health promotion and health improvement

The pharmacist is one of the best placed

health care professionals to providehealth promotion information and health

education material to the general public.

Service to specif ic patient groups

Certain groups of patients have particular

needs which can be met by communitypharmacists more cost effectively than by

any other health professional.


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Primary care pharmacy

Many pharmacists now provide doctors

with advice on GP formulary development

and undertaking patient medication

reviews, either seeing patients face to

face or through review of patient records-

globally or on an individual basis.


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2008 11

Pharmaceutical advisers

Pharmaceutical public health

Most of those also have a senior pharmacist

adviser, operating at consultant level, as

part of the public health team.

Hospital pharmacyClinical pharmacy services have been

established in the hospital setting for some


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time; indeed many or the innovations

identified for community pharmacy come

from earlier experience in hospitals

Clinical effectiveness

Clinical effectiveness is a term often used to

describe the extent to which clinical practicemeets the highest known standards of care.


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CONTINUING EDUCATION ANDCONTINUING PROFESSIONALDEVELOPMENT

The council of the RPSGB, through the

Code of Ethics, requires that all

pharmacists undertake at least 30 hours

of continuing education each year.

Courses of all four centres are provided

free to pharmacists who are employed in

theprovision of pharmaceutical services

to the NHS ( National Health Service).


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Communication skills for the

pharmacist

Almost everything we do in life depend on

communicartion. Pharmacists spend a

large proportion of each working day

communicating with other people, patients

doctors, other health care professionals,

staff and others.


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Assumptions and Expectations

This initial judgment of a person is oftenbased purely on what we see and hear and

includes appearance, dress, age, gender,

race, and physical disabilities.

Make assumptions about us based on initial

impressions , e. g. a pharmacist wearing a

white coat in a clean, clinical environment


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may inspire more confidence than a

pharmacist wearing a scruffy jumper and

working in a cluttered, untidy environment.

Tone of Speech, accents, common

expressionsAll of these have an impact on

communication.Our response to a person

speaking with a whining, complainingtone will differ from our response to

someone who greets us in a friendly

welcoming manner.


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Body language

It is well documented that our impression

of another person is very often created at

first glance.

Body language can be broken down into

several component parts which include

gestures, facial expression, eye contact,physical contact, body posture and

personal space.


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Gestures

Hand gestures in particular are useful

when emphasizing a point or to help to

describe something.

Facial expression

It has been suggested that, after the

spoken word, facial expression is themost important part of communication.


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Eye contact

The maintenance of eye contact during a

conversation is vital to ensure thecontinuation of the process, it indicates

interest in the subject.

Physical contact

It can be used to enhance verbal

communication. A sympathetic touch onan arm can often say more than any

number of words.


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Body posture

We can usually control the words we say,

we are not so good at controlling our body

language. Body posture can have a major

influence on how well communication

progresses.

Good communication will provide much

useful information which can then be used

to the benefit of the patient.


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Personal space

We all have our own space in which we

feel comfortable.

Four main areas:

General area: this is approximately 3m or

more;

Sociable area: this is approximately 13m

Personal area: this is approximately 0,5-1m

Intimate area: this is usually 050 cm


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Patterns of Behaviour in Communication

- assertiveness;

- aggressive behaviour;

- passive-aggressive behaviour;

- submissive behaviour.

Technique is assertive communication

Use of I and You statements

- repeating the message;

- clear communication;

- extracting the truth;


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- self talk:

* choose the right situation;

* prepare for situations;* behave assertively during the

situation;

* review the situation afterwards.

Empathy

Ilness is often associated with differentemotional aspects, like uncertainty,

stress, fear and dependency.


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Empathy :

* the ability to enter the life of other people

and to accurately understand both their

meaning and feelings;

* one of the cornerstones incommunication skills and is an essential

part of assertiveness.


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Facilitating empathy

Being empathy requires that pharmacistsare able to communicate their readiness

and willingness to listen to other people

and to establish a safe non-threatening

atmosphere where they can express

themselves.

Perceiving feelings and meaning


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Responding

involves the verbal and non-verbal

expression of how much we understand

and that we are intersted to hear more.

QUESTIONING SKILLS

- one of the most widely used social skillsgood question skill


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Use of open and closed question.

Closed questions:

* are you taking any medicine at present?* have you ever taken this medicine

before?

* do you understand how to take it?* do you have any questions about the

medicine?

* did the medicine work to you?* will you work in the dispensary for me

next Sunday?


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Open questions:

- describe your symptoms to me;

- tell me about any over-the-counter

medicines you are taking just now;- how do you relieve the symptoms of

headache?

- what do you do when that sensationoccurs?


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The use of open and closed question in a

pharmacy setting

- open questiontakes time ;- closed questionlimited to one word

answersmakes the patient feel as

they have been through aninterrogation.

- using the combination of open and

closed questions which can ensure thataccurate and complete information is

obtained.


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Application of questioning skills

Questioning skills are not required for

face to face communication.

LISTENING SKILLS

Asking question is a part of communication,

mlistening to the answers is of equalimportance.


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BARRIERS TO COMMUNICATION

Common barriers are :

* environment* patient factors

* the pharmacist

* time Environment

- a busy pharmacy

- lack of privacy- noise

- physical barriers


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Patient factors

- physical diabilities

- comprehension difficulties- illiteracy

The pharmacist

- lack of confidence

- lack of interest

- laziness


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- delegation of responsibilities to

untrained staff

- a feeling of being under pressure,especially time pressure

- being preoccupied wioth other matters.

Time

it is worthwhile checking what time people

have available before trying to embark onany communication.


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CONFIDENTIALLY

Ethical guidelines and privacy laws setthe rules about confidentiality in

pharmacy. Any information relating to an

invidual which the pharmacist or any

other staff member acquires in the course

of their professional activities has to be

kept confidential


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- body language includes gestures,

expression, eye and physical contact, body

posture, space and proximity;

- after the spoken word, facial expression is

probably the most important part ofcommunication;

- eye contact must be maintained, but mustnot become a stare;


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- an awareness of personal space is needed

to allow effective communication;

- assertive behaviour treats other people as

equals, and is not to be confused with

aggressive behaviour which violates other

peoples rights.

- assertive communication will tend to use I

rather than You repeat messages,


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- questioning skills also involve listening to

answers;

- in the working environment there are many

potential barriers to effective

communication including the environment,

patient and pharmacist and the time

implications;


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- confidentially must be assured in the

practice of pharmacy;

- the special needs of patients must be met

without being patronizing;

- hearing loss is common in the elderly and

will present a barrier to effectivecommunication;


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- a number of signs help identify those with

hearing loss and many steps can be takento help the situation;

- pharmacists need to maximize their

strengths and minimize their weaknesses

of communication.

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The Contribution of Pharmacy

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