Exploring the role of pharmacy in the primary health care and the prevention agenda
By: Gonçalo Sousa Pinto
Community pharmacists and pharmacies have a key role to play in supporting healthy ageing and the maintenance of good health and quality of life across the life course. Harnessing their widespread distribution and accessibility, their close relationship with and knowledge of the community they serve, their long opening hours and, in most countries, teams of highly qualified health professionals, will allow pharmacies to play an even greater role in developing and delivering primary health care strategies, in collaboration with colleagues across the health care team.
Three core areas in which pharmacy plays a key role in healthy ageing and primary health care include the effective management of non-communicable diseases (NCDs), the promotion of vaccination and immunisation, and the support of adherence to treatments.
Prevention, screening and management of non-communicable diseases
NCDs, such as cardiovascular diseases, cancer, chronic respiratory diseases and diabetes, are conditions of long duration and slow progression, having the most significant impact on quality of life and mortality worldwide.1 Their devastating social, human, economic and public health impact is recognised as a global burden by societies and economies across the world. According to the WHO, more than 36 million people die annually from NCDs, representing more than 60% of deaths worldwide, with 15 million people dying before the age of 70. At any one time, one in five people in the western world are expected to have more than one chronic condition.2
Incidence rates of NCDs and their complications could be reduced if affordable, evidence-based preventative actions were implemented efficiently, and therapy was directed to a broader population. Measures include screening for and early detection of diseases; prevention through education to promote behavioural change; a re-evaluation of access to medicine; evidence-based therapy; disease management to initiate and implement therapy; and fostering adherence to treatment. Prevention and control of NCDs require interventions that are therapeutically cost-effective, affordable and resource-feasible for both patients and health systems. Interventions need to be framed within national policies and in line with NCD and risk-factor indicators. Chosen interventions should contribute to improving equity in health care in both targeted populations and individuals, as well as improving health outcomes.2
Several studies have outlined the benefits of pharmacists in the therapeutic management of patients with chronic diseases3-5. In the past years, community pharmacists have engaged in generating hard evidence of the benefits of such roles, expanding the profession’s scope of practice.6
A 2019 report by the International Pharmaceutical Federation (FIP) points out that pharmacists can implement public health programmes, conduct preventive measures, screen and refer potential patients, support prescribing and improve patients’ adherence to a safe therapeutic plan, including pharmacological and non-pharmacological therapies. In the context of NCDs, pharmacists use their proven expertise and new technologies to be a valuable part of the multidisciplinary healthcare team, making a unique contribution to the clinical results of medicines therapy and consequently to quality of life.
Despite a rise in medication-related problems, pharmacists are under-utilised and inadequately remunerated for their role in delivering and improving health care.7
Improving vaccination coverage
As a result of population ageing, susceptibility to vaccine-preventable diseases is growing and so are the potential complications resulting from these diseases, as a greater share of the population has limiting comorbidities. Vaccine-preventable diseases, such as influenza, pneumococcal disease, herpes zoster and pertussis, are a significant cause of morbidity, loss of quality of life and mortality in older people.
Life-long vaccination programmes and the importance of vaccination for the elderly are often underestimated.10 It is of paramount importance to increase the focus on vaccination throughout the life course and to ensure access to vaccines that are relevant for each age group.
This requires new responses by health systems, and as outlined in a recent report by FIP, pharmacists can and should be part of the solution through a variety of roles, from providing evidence-based advice on vaccines, to administering vaccines to keeping vaccination records.
Improving adherence to treatments
Non-adherence to medication is a significant cause of treatment failure and a major public health concern. The consequences of non-adherence are greater in older people because they may require a greater number of medicines and may have greater difficulty managing their medication due to declines in cognitive function, memory, mobility or manual dexterity.
New medicines services, increased counselling services when a medicine is supplied repeatedly, dosage administration aids and reminder systems are among a list of pharmacy interventions with evidence of improving medication adherence in elderly patients with chronic conditions. A recent FIP report reviewed existing knowledge of pharmacy programmes and services to improve adherence in this growing patient population.
Collaborating towards healthy ageing
At the World Congress of Pharmacy and Pharmaceutical Sciences in Abu Dhabi, UAE, in September 2019, FIP organised a panel discussion for and with pharmacy leaders from around the world in collaboration with the ILC-UK and the International Federation on Ageing (IFA) in on the subject of “Prevention in an ageing world: The role of pharmacy”. With a panel moderated by Jane Barratt, Secretary General of the IFA, comprising representatives from a broad spectrum of countries and organisations, the panel discussed what role community pharmacy can play in delivering preventive health care. A consensus was agreed that primary health care requires a multidisciplinary approach involving all healthcare professions, including pharmacy. An important enabler of this collaboration and of better service to patients is granting access to patients’ shared health records to all health professionals providing care to the same individuals. The panel also pointed out that the remuneration model of community pharmacies needs to evolve to recognise the savings and health outcomes generated by pharmacists, and in order to ensure the sustainability and widespread implementation of these services.
This blog is part of the Prevention in an ageing world blog series. To find out more about the programme of work, please click here.
- World Health Organization. Global Status Report on Noncommunicable Diseases 2010. Geneva: World Health Organization; 2011. Available from: http://www.who.int/nmh/publications/ncd_report_full_en.pdf. [Accessed 2 September 2019]
- World Health Organization. Noncommunicable diseases progress monitor 2017. Geneva: World Health Organization; 2017. Available from: http://apps.who.int/iris/bitstream/handle/10665/258940/9789241513029-eng.pdf;jsessionid=84BDE82322A835F3344707A3F9185370?sequence=1 [Accessed 2 September 2019]
- Deters MA, Laven A, Castejon A, Doucette WR, Ev LS, Krass I, et al. Effective Interventions for Diabetes Patients by Community Pharmacists: A Meta-analysis of Pharmaceutical Care Components. Ann Pharmacother. 2018;52(2):198-211
- Kharjul M, Braund R, Green J. The influence of pharmacist-led adherence support on glycaemic control in people with type 2 diabetes. Int J Clin Pharm. 2018
- Tsuyuki R, Houle S, Charrois T, Kolber M, Rosenthal M, Lewanczuk R, et.al. Randomized Trial of the Effect of Pharmacist Prescribing on Improving Blood Pressure in the Community: The Alberta Clinical Trial in Optimizing Hypertension (RxAction). Circulation. 2015; 132:93-100
- Canadian Pharmacists Association. Pharmacists’ Expanded Scope of Practice. Ottawa: Canadian Pharmacists Association; 2018. Available from: https://www.pharmacists.ca/pharmacy-in-canada/scope-of-practice-canada/. [Accessed 2 September 2019]
- Mossialos E, Courtin E, Naci H, Benrimoj S, Bouvy M, Farris K, Noyce P, Sketris I. From retailers to health care providers: Transforming the role of community pharmacists in chronic disease management. Health policy 119 (2015) 628-639)
- Weinberger B. Vaccines for the elderly: current use and future challenges. Immun Ageing [Internet]. 2018 [cited 2019 Jun 5];15:3. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5778733/
Gonçalo Sousa Pinto
Lead for Practice Development, Advocacy and Data Management, International Pharmaceutical Federation (FIP)
Gonçalo Sousa Pinto is Lead for Practice Development, Advocacy and Data Management at the International Pharmaceutical Federation (FIP), the global organisation representing over 4 million pharmacists. He authored the FIP study “Pharmacy: a Global Overview – Workforce, Medicines Distribution, Practice, Regulation and Remuneration. 2015-2017” and co-authored in 2019 the reports “Beating NCDs in the community: the contribution of pharmacists ” and “FIP global vaccination advocacy tookit: Supporting and expanding immunisation coverage through pharmacists”.