Ludwig Boltzmann-Institut for Sociology of Health and Medicine
European Conference on Health Promotion in General Practice and Community Pharmacy: Experiences and Perspectives
10-11 November 2000, Brussels
1. Opening statements by representatives of European
2. Keynotes: Claire Anderson, Ilona.Kickbusch, Sylvie Stachenko, Chris van Weel, Sue Ziebland
3. Parallel Sessions
Parallel Session 1.2: Development and Evaluation of Patient Education and Lifestyle Interventions in General Practice: Ton Drenthen, Sirkka Keinänen-Kiukaanniemi, Juan Mendive
Parallel Session 1.3: Health Promotion and Pharmaceutical Care: Hanne Herborg, Marion Schaefer, Martin Schulz
Parallel Session 2.1: Researching Current Practice of Health Promotion in General Practice and Community Pharmacy - Country Reports: Lotte Fonnesbæk
Parallel Session 2.2: Health Promoting Pharmacotherapy in the Triangle Patient/General Practitioner/ Community Pharmacist: Paul Grassby, André Macy, J. Lars G. Nilsson, Ailís Ní Riain, Fiona A. Stevenson
Parallel Session 2.3: Health Education and Counselling in Community Pharmacy: Stuart Anderson, Lolkje de Jong-van den Berg, Tamas L. Paal, Lenka Praznovcova
Parallel Session 3.2: Lifestyle Counselling in General Practice and Community Pharmacy: The Case of Smoking Cessation: Ton Drenthen, Bernard D Frijling, Helle Jacobsgaard, Martina Pötschke-Langer, Eeva Teräsalmi
Parallel Session 3.3: Quality Assurance and Information Systems in General Practice and Community Pharmacy: Miriam Armstrong, Lilian M Azzopardi, Han de Gier, Anthony Serracino Inglott, Peter R. Noyce
4. Closing statements by representatives of European
360.000 general practitioners and 500.000 community pharmacists are serving the 370 million inhabitants of the European Union. Many - if not most - have contacts with these Primary Health Care professionals at least once a year - and for many it is much more often.
These several hundred million contacts, although primarily taking place in the context of diagnosis and treatment, provide an excellent opportunity for health promotion interventions. So the European Commission in the framework of its Public Health agenda, Action Program for Health Promotion (DG Health and Consumer Protection) is currently funding a European project "Health Promotion in General Practice and Community Pharmacy" (co-financed by the "Fonds Gesundes Österreich", Vienna, Austria).
The project (9/1998 - 2/2001) has been dedicated to make visible the many initiatives taking place already and - through exchange of experiences, mutual learning and creating cross-national and inter-professional synergies - to strengthen health promotion in these two settings.
A major milestone of this project was the "European Conference on Health Promotion in General Practice and Community Pharmacy - Experiences and Perspectives" that took place in Brussels on November 10-11, 2000.
The conference brought together representatives of professional associations, general practitioners, community pharmacists, health policy actors, patient representatives and health scientists from all parts of Europe. A central aim was to discuss practical options to further develop health promotion within the two professions as basis for further European action. Another issue was the discussion how a joint commitment of general practitioners and community pharmacists to health promotion could increase health gain through improved co-operation between the two professions in specific areas.
See detailed information on Scope and purpose of the conference and conference committee.
In an opening panel and closing panel, top representatives of these organisations (who also were co-organising the conference) highlighted their organisations' experiences and perspectives on the further development in the area. There was broad consensus that a lot of health promotion is going on in the two settings in Europe already, but also that this area would be well worth further development. The discussants expressed their conviction that their organisations would be very interested in this development. Support from European health policy would be needed especially in the area of research. The development of Recommendations from the Commission to the Council on the basis of the results of the project might be an important contribution. The following organisations were represented:
- European Commission - Health Promotion Action Program (represented by Mr.Wilfried Kamphausen, DG Health and Consumer Protection, F3)
- EUROPREV - European Review Group on Prevention and Health Promotion in Family Medicine and General Practice (Dr.Carlos Brotons, Chairman)
- IAPO - International Alliance of Patients' Organizations (Mr. Albert van der Zeijden, Chairman)
- PGEU - Pharmaceutical Group of the European Union (drs Loek Arts, President)
- WONCA - Region Europe-ESGP/FM (Professor Chris van Weel, President)
- FIP - International Pharmaceutical Federation (Professor TH.F.J.Tromp, Chairman Community Pharmacy Section)
- EuroPharm Forum (Mr. Hans-Günter Friese, Former President)
- IUHPE EURO (Dr.Ines Garcia-Sanchez, Deputy Co-ordinator)
- WHO Regional Office for Europe (Dr.Sylvie Stachenko, Head Health Services department)
- Chair: Dr. Hans Stein, Ministry of Health, FRG.
The conference aimed at creating opportunities for exchange of experiences and discussion of implementation and results of models and initiatives, discussion of concepts of and innovative proposals for health promotion in Primary Health Care settings, and for the discussion of hindering and furthering factors for health promotion in both professions
The conference gathered 103 participants from 14 member states of the European Union and 8 other countries (primarily candidate countries). 40% of the participants came from a Community Pharmacy background, 20% from General Practice and the other 40% were representatives from health policy and health administration, patient representatives, experts in health promotion and other health scientists.
Overall, participants commented about the conference very positively, underlining the relevance and quality of inputs, a good, constructive climate of collaboration and the possibility to see much intra- and inter-professional common ground.
By making visible a wide range of ongoing activities, models of good practice and demonstrating an elaborate level of discussion, the conference reached its aims to a high degree and should serve as an important step in an ongoing process.
Part of this success was due to a very generous, friendly and warm hosting by Association Pharmaceutique Belge (A.P.B.) and Association Belge des Syndicats Médicaux (ABSyM/BVAS) on the premises of A.P.B.
Opportunities for health promotion in General Practice and Community Pharmacy
The Ottawa Charter (1986) defines health promotion in the Ottawa Charter 1986 as "the process of enabling people to increase control over and improve their health". The key strategies addressed in the Ottawa Charter are advocating for health, enabling individuals and groups, and mediating between interests. This landmark document also outlines five key action areas, one of which is strengthening health promotion within the health services.
Three keynote lectures highlighted perspectives on the specific opportunities for the two professions: Professor Ilona Kickbusch (Yale University, USA) from a health promotion perspective, Professor Chris van Weel (University of Nijemegen, NL, President WONCA Europe/ ESGP - FM) from a general practice and family medicine viewpoint and Dr. Claire Anderson (Nottingham University, UK) from a community pharmacy perspective.
All three speakers underlined that general practitioners and community pharmacists are key providers in primary health care. In many parts of Europe their role in the health care system is that of a first contact point. They get to see patients and healthy people from all age groups and all walks of life and have to deal with a wide range of health issues - general practitioners as providers of primary medical care and community pharmacists as specialists for medicines and advisors for self-medication, respectively.
Professor Kickbusch highlighted the particular contribution both professions have to make towards enabling/empowering individuals through the personal contacts within everyday practice. Referring to a current discussion in the US on "Health Literacy" she underlined specific opportunities to further relevant skills in Primary Health Care settings - an important contribution these professionals could make to counter increasing social inequalities in health. She also underlined that the growing (private) market for health related interventions would offer significant chances for the two professions - for the benefit or health.
Professor van Weel underlined the importance of empowerment - a core concept of health promotion - as the "missing link" between what is possible in health care and health development and what actually happens. This is relevant not only for health enhancement and disease prevention, but also in the treatment of diseases. He also underlined the close relationship between the health promotion perspective and Primary Care concepts. The development of the role of the general practitioner not only as medical generalist but as personal doctor links very well with the empowerment approach. Empowering individuals in the day-to day practice to increase their health and strength is very much in line what a personal doctor could do.
Dr. Anderson provided an overview about many areas of health promotion models and initiatives in community pharmacy practice that demonstrated a wide range of activities and a move towards quality development, moving away from simple concepts like display of leaflets to systematic educational and consulting interventions, primarily related to the dispensing of prescribed drugs and provision of OTC drugs as core tasks of pharmacists. She underlined the significance of these opportunities for further professional development of community pharmacy - opportunities not only to further health, but also to make visible the importance of the pharmacists in a changing health care environment.
Lectures by Dr.Sylvie Stachenko (WHO - Euro) and Dr.Sue Ziebland (Oxford University, UK) further enriched the picture. Dr.Stachenko brought in a health systems and health policy perspective and underlined the different determinants asking for an increased relevance of health promotion in the health services (ageing, changing patterns of disease, increased citizens' expectations) as well as the constraints in further health service development (financial constraints for publicly financed services, challenges of a medical environment becoming increasingly evidence based).
Dr.Ziebland highlighted that empowerment of the patient/ user of health care services asks for a much deeper understanding of the patient's experiences than what is reflected in current professional perspectives and also in much of the scientific discourse. The participants were most interested in her presentation of the DIPEX database on patients' perspectives on specific experiences with illness and treatment, based on rigorous systematic qualitative research of the subjective patient experience.
These lectures were complemented with nine parallel sessions, offering presentations and discussion on concepts, but especially on a variety of models and practice initiatives from widely varying health care environments. Topics were:
- Development and Evaluation of Patient Education and Lifestyle Interventions in General Practice
- Health Promotion and Pharmaceutical Care
- Health Promoting Pharmacotherapy in the Triangle Patient/ General Practitioner/ Community
- Health Education and Counselling in Community Pharmacy
- Lifestyle Counselling in General Practice and Community Pharmacy: The Case of Smoking Cessation
- Quality Assurance and Information Systems in General Practice and Community Pharmacy.
Specific working groups allowed for an in-depth discussion of the first three keynote lectures, and for further elaboration and discussion of the following project products:
- Country Reports on the Status quo: Models, initiatives, furthering and hindering factors
- Preliminary Conclusions and Proposals for the Development of Health Promotion in General Practice and Community Pharmacy.