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Ludwig Boltzmann-Institut for Sociology of Health and Medicine
2. Proposal for a "Working Definition of Health Promotion in Community Pharmacy"

This “Working Definition” has been developed as basis for common understanding in the Project “Health Promotion in Primary Health Care: General Practice and Community Pharmacy”. The frame of reference for this proposal of a working definition of health promotion have been concepts of health promotion and their realisation to date within the profession (see “Background Paper” for a summary analysis), and the definition of health promotion as set out in the Ottawa Charter (WHO 1986) along with the Health Promotion Glossary.(Nutbeam 1998)

Drafts of this paper and several previous forms have been discussed with the project expert group, other partners in the framework of a task force and at a project meeting in May 2000.


Proposed Working Definition

"Health promotion in community pharmacy should be understood
1) as a patient-focused (1) communication and interaction process (2) by which the community pharmacist (3)
2) aims at enabling (4) or empowering (5) the patient/ user of community pharmacy services (6)
3) to better control and improve her/ his health (7)."


Integrating the perspective of WHO on health promotion and the professional discussion in community pharmacy on relevant topics, two topics emerge: Developments/ discussions centred around an explicit understanding of health promotion by and in community pharmacy can be observed mainly in the UK, but also in Scandinavian countries like Finland. Furthermore, we can see that also other reform concepts, especially „Pharmaceutical Care“ are of interest for this project - a view that has been shared by others(8): Pharmaceutical Care initiatives and models share several common ideas and principle with health promotion(9).

Focusing on patient/ user-oriented tasks of community pharmacy as the main action area of potential individual empowerment, it seems useful to distinguish between „core tasks“ (what is provided by pharmacies in practically all member states) and additional, optional or „add-on tasks“.(what varies with the different systems and the specific positioning of Community Pharmacy)(10)

Health promotion activities in community pharmacy aiming at enabling people can therefore comprise of different issues, related to core tasks or optional/ add-on tasks:

Core task provision of prescribed drugs:
- information about adequate use of medicines in general to prevent abuse and misuse (when medicines should be used, alternatives to medicines) (which can be seen as related to protection of general health)

- information about all aspects of a condition-specific medication regimen: adequate, effective and safe use of prescibed medication, side effects, duration of medication regimen, interactions, expected outcome (emphasize client priorities, quality of life and clinical status ) to empower the user/ patient to make informed decision about drug treatment and to manage and monitor regimen (PGEU 1998)(Chewning, Sleath 1996) (Coulter, Entwistle et al. 1999) ( 1997)

- lifestyle advice to promote and support healthy lifestyles, especially in the case of chronic illness where lifestyle is important/ to ensure the therapeutic goal by lifestyle interventions (complementary to information about safe use, storage , administration and disposal of medicines): e.g. asthma, COPD, osteoporosis, hypertension, diabetes II (PGEU 1999), (PGEU 1998), (FIP 1993; Royal Pharmaceutical Society of Great Britain 1997) (Maguire 1996; Maine 1998; N.N. 1997) (Anderson 1998), (Anderson, Todd 1994) (Marklund, Almroth et al. 1999) (The Association of Finish Pharmacies 1999) (Anderson 1998) (N.N. 1997) (Desselle, Schwartz et al. 1997)

- information about self help groups (Coulter, Entwistle et al. 1999)

Core task provision of self medication
- information about adequate use of medicines/ self medication to prevent abuse and misuse

- information about all aspects of condition-specific self medication regimen: adequate, effective and safe use of self medication, side effects, duration of medication regimen, interactions, expected outcome (emphasize client priorities, quality of life and clinical status ) to empower the user/ patient to make informed decision about drug treatment and to manage and monitor regimen (PGEU 1998)(Chewning, Sleath 1996) (Coulter, Entwistle et al. 1999)

- information about self help groups/ identify the “best” healthcare providers (Coulter, Entwistle et al. 1999)

- lifestyle advice to promote and support healthy lifestyles
(PGEU 1999), (PGEU 1998), (FIP 1993; Royal Pharmaceutical Society of Great Britain 1997) (Maguire 1996; Maine 1998; N.N. 1997) (Anderson 1998), (Anderson, Todd 1994) (Marklund, Almroth et al. 1999) (Coulter, Entwistle et al. 1999) (The Association of Finish Pharmacies 1999) (Anderson 1998) (N.N. 1997)


Add-on task provision of health related goods/ products

- information about adequate use, how products may contribute to maintain/ improve health, improve specific condition, about alternatives to these products

- primary prevention related to sale of products: wellness maintenance through health education; topics: smoking, use of intoxicants (alcohol use, inappropriate use of medicines), physical exercise, weight, prevention of infectious diseases (needle exchange), safe sex, dental health
(1983; The Association of Finish Pharmacies 1999) (Royal Pharmaceutical Society of Great Britain 1997) (Maine 1998)

Add-on task (group) health education/ advice/ counselling (e.g. smoking cessation) as
- information about healthy lifestyles (PGEU 1999), (PGEU 1998), (FIP 1993; Royal Pharmaceutical Society of Great Britain 1997) (Maguire 1996; Maine 1998; N.N. 1997) (Anderson 1998), (Anderson, Todd 1994) (Marklund, Almroth et al. 1999), supported by appropriate material/ using an appropriate format (Maine 1998)

- information about adequate use of the health care system (Downie, Fyfe et al. 1990) (Blenkinsopp, Panton 1992) (Anderson 1994)e.g. immunizations (Grabenstein 1992) rehabilitation (Blenkinsopp, Panton 1992)

- information about adequate use of medicines

Add on task screening & diagnostic testing ((potential) parameters: blood pressure, cholesterol, blood glucose, urine sugar, CO, pregnancy testing, BMI, body fat index, pregnancy testing, weight (Morrow, Maguire 1989), (Maguire 1989))
- information about meaningfulness of testing: benefits and risks

- information about/ explain parameters tested and implications of findings

- information about influence of lifestyle issues on specific condition and general health and how to deal with it

It has to be mentioned that this last area seems to be rather controversial: lacking patient register, context, quality – testing equipment, procedures, setting – privacy, risks – taking of blood samples (Allison, Page et al. 1994); appropriate training (PGEU 1998) and established procedures/ protocols (PGEU 1998) (Royal Pharmaceutical Society of Great Britain 1992) are felt to be necessary preconditions)


References
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The Royal Pharmaceutical Society of Great Britain (1997): From Compliance to Concordance-Achieving shared goals in medicine taking. The Royal Pharmaceutical Society of Great Britain.

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