Karl Krajic  |  Petra Plunger  |  Ursula Reichenpfader  |  Jürgen M Pelikan
4. Status quo of Patient-/ User oriented health promotion in general practice and community pharmacy in Europe.
A Cross analysis of Country Reports on the status quo of health promotion in general practice and community pharmacy in Member States of the European Union participating in the project

A. Introduction
B. Country Reports: Cross-Analysis relating to General Practice
Background
1. Material and Methods
1.1. Country Reports
1.2. Literature Search
1.3. Personal Communication
Results
1. Health Promotion in Professional Role and Practice
1.1. Professional Organisations: Policy and Position
1.2. Role Concepts and Professional Practice
2. Health Promotion in Education and Training: Extent and Character
2.1. Undergraduate Level: Basic Medical Education (BME)
2.2. Postgraduate level: Vocational Training:
2.3. Continuing Professional Development
3. Health Promotion in General Practice Research
3.1. Research in General Practice/ Primary Health Care: Character and Infrastructure
3.2. Research on Health Promotion in General Practice/Primary Health Care: Issues in Literature
4. Health Promotion and General Practice Infrastructure
4.1. Reimbursement and Incentive Policies
4.2. Organisational Factors and Practice Pattern
References

C. Country Reports: Cross-Analysis relating to Community Pharmacy
1. Background
1.1 Methods and Sources:
1.1.1 information from national CR:
1.1.2 Literature search and other published material
1.1.3 Personal communication (project meetings, other conferences)
2. Results
2.1 How strong is the interest of community pharmacy in health promotion and to what extend is health promotion an element of everyday practice?
2.2 What are supporting factors and barriers for health promotion in community pharmacy?
2.3 Role definition (and self-understanding) and perception of professional role of community pharmacists by relevant actors with respect to health promotion
2.3.1 What is the position of professional bodies regarding health promotion in community pharmacy?
2.3.2 What is the professional understanding of health promotion in community pharmacy and how does it relate to the professional role?
2.3.3 What is the perspective of health policy regarding health promotion in community pharmacy?
2.3.4 What do patients expect regarding health promotion in community pharmacy?
2.3.5 What are future perspectives on the development of the professional role in health promotion
2.4 Community pharmacy infrastructure
2.4.1 Factors related to organisation of work in community pharmacy
2.4.2 Remuneration systems/ adequate resources
2.4.3 Co-operation
2.5 Education and training
2.5.1 What is the status quo on education and training related to health promotion?
2.5.2 What are future scenarios for education and training related to health promotion?
2.6 Research
2.6.1 What is the status quo of research related to health promotion in community pharmacy?
2.6.2 What are future perspectives for research in this area?
References
Appendix


Appendix

Framework for Country Reports - Health Promotion in Community Pharmacy (provided to the authors by LBISHM, December 1999)

The same framework has also by provided for the Country Reports on General Practice.

Scope and purpose

The country reports comprise the collection of
- a limited number (5-10) of existing initiatives, models of good / best practice (Part A I)
- a list of existing national guidelines (Part A II)
- the description of relevant preconditions for POHP in community pharmacy in your country (Part B).

The collection of a wide range of initiatives and models of good / best practice will serve as a European knowledge base on potentials of POHP in community pharmacy.
A collection of information on relevant preconditions for POHP in community pharmacy will be important for a better understanding of the models in their context and would be useful for the proposed development of a European policy document.
Before providing a structure for the description of models and guidelines, we have to address the issue what health promotion in this project can mean.

1. What is the meaning of Health Promotion in this project?
For a first orientation, we include the Health Promotion definition from the class="text-italic">official WHO Health Promotion Glossary.
As you will see, this is a rather broad health policy definition of health promotion. It is helpful for identifying specific patient/user oriented models, initiatives, guidelines and preconditions for these interventions only so far as some general concepts and principles are being highlighted.

Therefore, in January 2000 we shall forward a supplement to this framework including a proposal for a more specific working definition for Patient/ User oriented Health Promotion in community pharmacy (including examples). The project team is currently preparing this proposal and shall discuss it with the members of Task Force 1 of the project.

"Health promotion
is the process of enabling people to increase control over, and to improve their health (Reference: Ottawa Charter for Health Promotion. WHO, Geneva,1986).
Health promotion represents a comprehensive social and political process, it not only embraces actions directed at strengthening the skills and capabilities of individuals, but also action directed towards changing social, environmental and economic conditions so as to alleviate their impact on public and individual health. Health promotion is the process of enabling people to increase control over the determinants of health and thereby improve their health. Participation is essential to sustain health promotion action.

The Ottawa Charter identifies three basic strategies for health promotion. These are advocacy for health to create the essential conditions for health indicated above; enabling all people to achieve their full health potential; and mediating between the different interests in society in the pursuit of health.

These strategies are supported by five priority action areas as outlined in the Ottawa Charter for health promotion: Build healthy public policy, Create supportive environments for health, Strengthen community action for health, Develop personal skills, and Re-orient health services (....).

The Jakarta Declaration on Leading Health Promotion into the 21st Century from July 1997 confirmed that these strategies and action areas are relevant for all countries. Furthermore, there is clear evidence that:

Comprehensive approaches to health development are the most effective. Those that use combinations of the five strategies are more effective than single-track approaches;
- Settings for health offer practical opportunities for the implementation of comprehensive strategies;

- Participation is essential to sustain efforts. People have to be at the centre of health promotion action and decision-making processes for them to be effective;

- Health literacy/ health learning fosters participation. Access to education and information is essential to achieving effective participation and the empowerment of people and communities.

For health promotion in the 21st century the Jakarta Declaration identifies five priorities: Promote social responsibility for health Increase investments for health development, Expand partnerships for health promotion, Increase community capacity and empower the individual, Secure an infrastructure for health promotion
(......)."
WHO Health Promotion Glossary ()

A Framework for the description of initiatives, models of good (best) practice and collection of guidelines/ guidance documents at the national level

Part A of the country reports is a collection of
- 5-10 national initiatives, models of good or best practice for patient/user oriented health promotion in Community Pharmacy (POHP in CP)
- a list of national guidelines or other tools to develop POHP in CP

I. Structure for the description of initiatives/ Models of Good (Best) Practice:
Please use the following structure for a description of those models (5-10) you have identified as important/relevant in your country. All these models will be included in a Euopean database on POHP in community pharmacy and will be made publicly available.

Identification of initiatives and models should not be limited to examples with systematic information on clinical outcomes or cost- effectiveness, and can include promising initiatives/ models that so far can offer information only on "softer" criteria for evaluation, e.g. acceptability, feasibility, effectiveness concerning HP outcomes and intermediate health outcomes.(37)

1. Name of the initiative/ model
2. Contact person: name and address (please include Phone, Fax, e-mail, website)
3. Who has commissioned the initiative/ model?
4. Who has co-ordinated the initiative/ model?
5. What is running time of the initiative/ project?
6. What is the current state of the initiative/ project (e.g. concept development, pilot phase, finished, integral part of everyday practice)?
7. Short description of the initiative/ model:
- Which problem is being addressed?
- What are the goals, aims and targets?
- What are the specific strategies and measures applied? (please describe also planned measures that have not been implemented so far)
- What is the scope of the initiative/ model ? (e.g. local, regional, national)
- Which partners have been involved in development and implementation? (e.g. professional organisations, health policy actors, patient organisations, other relevant actors)
8. Has any systematic project evaluation been conducted on the model/ initiative?
9. If information available: What is the knowledge about project results so far? Please provide a short summary on acceptability, feasibility, effectiveness, sustainability, economic evaluation (according to information available).
10. If information available: Which were the most important factors supporting the development and implementation? (e.g. knowledge and skills of actors/ key persons, support by professional organisations, support by health policy and other relevant actors; etc.)
11. If information available: Which were the most important barriers concerning development and implementation?
12. Which specific aspects of the model/ initiative would you consider especially well developed or otherwise instructive and thus relevant for transfer to other EU member states?
13. Please list available publications, reports, self-descriptions (preferably in English language) - Please do also provide copies.

II. Structure for the description of National Guidelines/ National Guidance Documents for POHP
1. Name or title of guidelines/ guidance document
2. Date of publication
3. Who has been commissioning its development?
4. Which actors been mainly involved in its development?
5. Is there any knowledge about utilisation of the guidelines/ guidance document so far?
6. Please provide the document and available publications, reports, self-descriptions.

B Framework for the description of relevant preconditions for POHP in CP

1 What are the general characteristics of the health care system and specific characteristics of Community Pharmacy relevant for POHP in your country?

1.1 General overview of the Health Care System
A short overview (o,5 pages) assembling information on organisation, financing and most important providers can be compiled by LBISHM and be forwarded to you for comments and corrections.

1.2 Specific Situation of Community Pharmacy in your country (maximum 1 page)
- How is CP organised in your country?
A short overview can be compiled by LBISHM and be forwarded to you for comments and corrections.
- What are the main characteristics of the professional role of the community pharmacist with respect to the served population?
(e.g. supply of drugs, provision of other services, first contact care, involvement in domiciliary visits)
- Is health promotion a defined part of the professional role? How is HP being defined?
- Is there any systematic overview available describing patient/ user profile (e.g. age, gender, patients/ carers/ relatives, people with incidental needs/ chronically ill/ healthy people looking for advice)? If yes, please provide a short summary.

1.3 Current POHP practice in CP: Is there any recent scientific study/ survey available exploring the extent and types of POHP activities in everyday CP practice in your country? If yes, please provide a short summary.

2 Preferences and Expectations

2.1 Has there been any recent survey on CPs' opinion of their role and extent of involvement in POHP activities ? How would CPs assess their patients' /users' preferences and acceptance regarding POHP offers? If yes, please provide a short summary.

2.2 Is there any recent scientific study/ survey available exploring patients'/ users' preferences and acceptance of POHP activities in CP? If yes, please provide a short summary.

3 Structural preconditions for the development and current practice of POHP in CP

3.1 Laws, Rules and Regulations
- Are there any legal regulations furthering or hindering POHP in CP (e.g. HP included in rights and duties of the profession)
- Are there any rules and regulations within the profession (e.g. mandatory continuing education covering POHP topics) or with other partners (e.g. financial incentives or disincentives) furthering or hindering POHP in CP?
- Have there been any incentive schemes or specific remuneration/ economic rewards for POHP activities set up in CP? If so, to what kind of POHP activities are such incentives related (e.g. specific preventive measures; achievement of specific targets)? Please also specify the main actors providing such incentives (national/ regional health authorities; sickness funds; other private or public bodies).

3.2 Education and Training
- Have POHP topics and key skills necessary for POHP been integrated in undergraduate/ graduate pharmaceutical education and training or CPPE (e.g. prevention, epidemiology, communication skills, specific areas of POHP like counselling, health education etc. explicitly mentioned in the curriculum)? How are these offers accepted?

3.3 Specific Policies, Programmes and Projects for POHP in CP
- Is POHP explicitly mentioned in policies, programmes and projects of CP professional a/o scientific organisations in your country? If yes, which areas and target groups are covered?
- Is POHP in CP explicitly mentioned in policies, programmes and projects of health policy actors (e.g. National Health Service, health insurance). If yes, which areas and target groups are covered?
- Which are the most important actors co-operating with CP with regard to POHP? (e.g. departments in central government, regional government, local government, sick funds/ health insurance, patient/consumer organisations, foundations, NGOs, pharmacy practice research and development institutes, private businesses, European professional a/o scientific organisations, pharmaceutical industry etc.)
- Which specific areas and topics of POHP in CP are targeted by the activities of these actors?
- Is POHP in CP supported by discussion in journals/ at conferences, newsletters, information campaigns, lobbying?

4 Other relevant preconditions for POHP in CP not explicitly addressed in this framework

5 Appendix
List of references