Guest blog by Aniekan Ekpenyong and Gonçalo Sousa Pinto

In 2018, the International Pharmaceutical Federation (FIP) signed the World Health Organization (WHO) Declaration of Astana on Primary Health Care. The declaration was made to demonstrate the commitment of governments, civil society organizations and the global health community to strengthening Primary Health Care, as an essential tool in achieving universal health coverage and the sustainable development goals (SDGs). Preventative services are primarily delivered at the primary care level, thereby elevating the prevention agenda as a priority if the world will meet up with its commitment in 2030. The FIP represents over four million pharmacists around the world and, by signing this declaration, we reiterated our commitment that pharmacists and the entire profession will contribute to the provision of “primary health care and health services that are high quality, safe, comprehensive, integrated, accessible, available and affordable for everyone and everywhere, provided with compassion, respect and dignity”, and to empowering individuals and communities to maintain and enhance their health and well-being.

Primary health care provides equitable access to healthcare services, which is essential towards achieving universal health coverage and the sustainability of health systems in all regions and countries. Community pharmacies have a critical role in delivering primary healthcare – evidence in countries such as Australia demonstrates that annual visits to community pharmacies are three times greater than visits to general practitioners.(1) This indicates a level of trust and acceptance of pharmacists, an opportunity which can be leveraged to provide preventive services to individuals visiting the pharmacy, and within the community.

Pharmacy’s response to the pandemic: new roles that are here to stay

As accessible, trusted, and knowledgeable healthcare workers, pharmacists have contributed to pandemic response in a variety of ways. Emerging bodies of literature (2),(3) have shed light on the experiences and actions of frontline pharmacists in the fight against COVID-19. Pharmacies represent the first point of contact within the health system for many communities, and, as such, play an important educational role. Watson and colleagues recently published the outcomes of a scoping review of frontline pharmacists’ roles and services during the first year of the COVID-19 pandemic. The authors present a conceptual framework model of the different layers made visible by COVID-19 of pharmacist roles in public health, information, and medication management. They theorize that there is an invisible layer of change representing evolving professional role identity that may influence permanent role change following the pandemic. The most frequently mentioned pharmacists’ roles in the articles they reviewed were interprofessional collaboration, patient education, provider education, guidance and policy development, and remote patient counselling. This highlights the important services pharmacists provided as reliable evidence-based information sources surrounding the pandemic, treatments, and prevention strategies.(3)

Pharmacists have contributed to the prevention agenda through comprehensive vaccine programmes

In addition to providing vaccinations against diseases, such as COVID-19 (in at least ten countries, according to FIP data and media reports), seasonal influenza, infections caused by pneumococcus bacteria, shingles and whooping cough, which can particularly affect older adults, leading to increased mortality, reduced quality of life and loss of function.(4),(5),(6) pharmacists are also well placed to address vaccine hesitancy and worries. This highlights the importance of vaccination programmes across the life course and the diversification of vaccination pathways and providers. FIP therefore advocates for the autonomy of vaccination providers by eliminating the requirement for a medical prescription for vaccine administration, when clear eligibility criteria and protocols have been developed for each vaccine, as stated in the Immunisation For All Ages Manifesto.(7)

Pharmacists have an expanded role in the prevention of non-communicable diseases (NCDs)

The WHO estimates that 36 million people die annually from NCDs, with those above 65 years making up the majority.(8) Pharmacists working in the community can provide NCD prevention services through patient awareness, education and counselling, risk factor identification, coaching and supporting lifestyle changes in areas such as nutrition, weight management and smoking cessation.(9) Evidence shows positive clinical outcomes in patients where pharmacists have had to lead preventive interventions. For instance, patients with high blood pressure and high blood cholesterol levels participating in a pharmacy-based education and therapy management programme recorded better outcomes, improved medication adherence and a decline in cardiovascular events.(10)

Community pharmacists are uniquely placed to deliver early screening and detection services

One way to prevent disease progression is through early screening and detection. Pharmacists working in community pharmacies are uniquely placed to conduct early screening of symptoms, using point-of-care measurements such as blood pressure, blood sugar and cholesterol levels, and waist circumference, and to make timely referrals to physicians where needed.(9) Moreover, pharmacists can provide disease state management services to NCD patients with the aim of preventing aggravation of chronic diseases.

Ensuring patient safety and preventing harm from the use of medicines is another key area where pharmacists are distinctively positioned to intervene

Globally, approximately 42 billion USD are lost each year due to medication errors, according to the WHO.(11) Through services such as medicines use reviews and medicines reconciliation (12),(13),(14), pharmacists are leading the advocacy and the delivery of value through the prevention of inappropriate medicines use and the reduction of medication errors.

Accessibility is a key benefit to supporting pharmacists to deliver prevention in an ageing world

Convenience of access and making every contact count are key aspects of any prevention strategy. Most community pharmacies have a consultation room offering privacy to patients, their carers or any member of the public, often without the need for an appointment. Pharmacists are also increasingly offering teleconsultation services by phone or videoconferencing to support individuals,(15) and providing home care services to older adults and those unable to visit the pharmacy.(16)

Maximising the potential of pharmacies

To ensure increased access to preventive services across the life course, there is a need to leverage the availability, accessibility and specialist knowledge of community pharmacists, in collaboration with other members of the healthcare team. Through this, the unique advantage of pharmacists can be utilised, and we will have improved clinical, social and economic outcomes and more efficient and sustainable health systems. Therefore, for this to happen, it is essential to rethink funding mechanisms for healthcare interventions and to invest in preventive care, thus ensuring that evidence-based, cost-saving interventions are supported and incentivised through appropriate remuneration models.

Notes

Find out more about ILC’s Delivering prevention in ageing world programme here.

References

1. Australian Journal of Pharmacy. (2019). Pharmacy visits up. (accessed 15 April 2020).
2. Sousa Pinto, G; Hung, M; Okoya, F; Uzman, N. (2021). FIP’s response to the COVID-19 pandemic: Global pharmacy rises to the challenge. Res Social Adm Pharm 17(1): 1929–1933. doi: 10.1016/j.sapharm.2020.07.004
3. Watson, K.E.; Schindel, T.J.; Barsoum, M.E.; Kung, J.Y. (2021). COVID the Catalyst for Evolving Professional Role Identity? A Scoping Review of Global Pharmacists’ Roles and Services as a Response to the COVID-19 Pandemic. Pharmacy, 9, 99. https://doi.org/10.3390/pharmacy9020099
4. International Pharmaceutical Federation (FIP). (2019). FIP global vaccination advocacy toolkit: Supporting and expanding immunisation coverage through pharmacists. The Hague.
5. G. Finnegan. (2019). Pharmacy pilot project increases flu vaccination by 32%. Vaccinestoday.eu (accessed 15 April 2021)
6. Kristensen M, van Lier A, Eilers R, McDonald SA, Opstelten W, van der Maas N, van der Hoek W, Kretzschmar ME, Nielen MM, de Melker HE. (2016). Burden of four vaccine preventable diseases in older adults. Vaccine. 10;34(7):942-9. doi: 10.1016/j.vaccine.2015.12.052. Epub 2016 Jan 3. PMID: 26752065.
7. Immunisation for All Ages. (2021). Immunisation for All Ages. Manifesto: Promoting immunisation throughout life. (accessed 23 April 2021)
8. World Health Organization. (2017). Noncommunicable diseases progress monitor 2017. Geneva. (accessed 15 April 2021)
9. International Pharmaceutical Federation (FIP). (2019). Beating non-communicable diseases in the community – The contribution of pharmacists. The Hague.
10. Bunting BA, Smith BH, Sutherland SE. (2008). The Asheville Project: clinical and economic outcomes of a community-based long-term medication therapy management program for hypertension and dyslipidemia. J Am Pharm Assoc (2003). 2008 Jan-Feb;48(1):23-31. doi: 10.1331/JAPhA.2008.07140. PMID: 18192127.
11. World Health Organization. Global campaign: Medication without harm. Geneva. (accessed 15 April 2021)
12. International Pharmaceutical Federation (FIP). (2020). Patient safety. Pharmacists’ role in medication without harm. The Hague (accessed 23 April 2021)
13. International Pharmaceutical Federation (FIP). (2020). Medicines use review: A toolkit for pharmacists. The Hague (accessed 23 April 2021)
14. International Pharmaceutical Federation (FIP). (2021). Medicines reconciliation: A toolkit for pharmacists. The Hague (accessed 23 April 2021)
15. Littauer, S. L., Dixon, D. L., Mishra, V. K., Sisson, E. M., & Salgado, T. M. (2017). Pharmacists providing care in the outpatient setting through telemedicine models: A narrative review. Pharmacy Practice 15(4), 1134–1134. https://doi.org/10.18549/pharmpract.2017.04.1134
16. Reidt, S, Morgan, J, Larson, T, Blade, MA. (2013). The Role of a Pharmacist on the Home Care Team, Home Healthcare Nurse: February 2013 – Volume 31 – Issue 2 – p 80-87 doi: 10.1097/NHH.0b013e3182778f5f