Τρίτη 5 Ιανουαρίου 2010

Community Pharmacy and alcohol

Community pharmacy involvement in public health services
There is evidence of the effectiveness of community pharmacy-based public health
interventions such as smoking cessation and methadone maintenanceix for addictions, and in the management of osteoporosis, diabetes and raised cholesterol, but to deliver brief interventions, pharmacists and their staff will need substantial training and support. One study (on methadone-maintenance interventions) suggests that training in motivational interviewing changes pharmacists’ attitudes and belief in self-efficacy. Service users report positive experiences of using community pharmacy-based public health services, suggesting these services are acceptable as well as effective. Pharmacists can be reluctant to initiate discussions with customers on what they perceive to be ‘sensitive’ subjects, and as a result they tend to be reactive rather than proactive.

Choosing Health Through Pharmacy identified opportunistic advice, brief interventions and offering floor space to other health professionals as areas where community pharmacy could make a contributionxiii. These are activities with which community pharmacists can engage, particularly as their public health role has recently been formalised in the new contractual arrangements for Scotland, England and Wales. In England and Wales, pharmacies are required to participate in up to six public health campaigns each year, with topics decided by local primary care organisations (PCOs). In Scotland, Tier 2 of the public health component of the pharmacy contract stipulates participation in up to four public health campaigns each year and allocation of dedicated display space for posters.

Interventions for alcohol misuse
1. Alcohol screening and assessment
ease and speed of use
good sensitivity (to identify people at risk of alcohol misuse)
good specificity (to identify people not at risk of alcohol misuse)
2. Brief interventions
Brief interventions for alcohol misuse are of four main types:
 alcohol education
 simple advice
 simple advice plus brief counselling and continued monitoring
 referral to specialist services for diagnostic evaluation and treatment.
The main characteristics of brief interventions include the following:
 duration of five to 45 minutes
 optional use of protocols or guidelines
 they are distinct from brief advice (which usually lasts up to three minutes).
3. Leaflets displayed
4. Cooperation with other Pharmacies, NHS services
5. Appropriate training, communication, psychology of change
http://www.rpsgb.org.uk/pdfs/commpharmalcmisuseservices.pdf
http://www.hm-treasury.gov.uk/d/pbr_csr07_psa25.pdf

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