Public Health in Community Pharmacy

Public Health in Community Pharmacy Fiona Macfarlane BSc MPH Health Promotion Officer NHS Forth Valley

Background • Scottish Executive – Dental Action Plan (2005)1 • NHS Forth Valley – Dental Health Strategy (2005)2 • 1 Year Pilot - Oral Health Initiative in Community Pharmacy (2007- 2008) • Pilot Service Evaluation and Client Experiences • The Scottish Executive. An Action Plan for Improving Oral Health and Modernising the NHS Dental Services in Scotland. Edinburgh: The Scottish Executive; 2005 • NHS Forth Valley. Multi-agency and Dental Health Strategy for NHS Forth Valley. Stirling: NHS Forth Valley; 2005

The experiences and perceptions of Community Pharmacists in NHS Forth Valley involved in delivering an innovative oral health intervention with clients accessing substance misuse services.

Objectives • To explore the community pharmacists’ perceptions of their public health role in contributing to health improvement amongst substance misuse clients • To identify factors that influence community pharmacists participation in public health interventions • To explore the experiences of community pharmacists who delivered oral health interventions to substance misuse clients

Objectives • To investigate the perceptions and attitudes towards oral health improvement with substance misuse clients • To determine if community pharmacists believe they can engage effectively with substance misuse clients to affect health behaviour and behaviour change related to oral health improvement • To investigate if community pharmacists are appropriately placed to deliver oral health improvement with substance misuse

Method / Data Collection • Qualitative Methodology • Non random sampling • Semi- structured interview schedule • Face to face interviews • Analysis and Interpretation • Data transcription • Thematic analysis and coding • Ethical Approval • University of Glasgow Faculty of Medicine Ethics

Experiences and Perceptions • Good Idea, Beneficial, Raised Awareness “A lot of them with regards to the oral health, you know, have mentioned about their teeth and they’ve had problems with, you know dental work and stuff so obviously the oral hygiene initiative is a good idea” Pharmacist 12

“I think…it may be of benefit [to] one of two cases out of the 6 in our particular case…” Pharmacist 13 “I think it just reminds them. I think they are all becoming a lot more aware of their oral health” Pharmacist 16

Intervention / Service Delivery • Easy to deliver and well organised “It is quite an easy way that it’s been set out. Its quite easy to give the information… simple and straight forward and not time consuming that’s the kind of things we need” Pharmacist 4

“It’s been, I think, very well organised… it’s been very straightforward and very easy to do… I think it’s been made very easy for me to do…” Pharmacist 13

Engagement / Attitude • Three quarters of pharmacists involved other staff in the delivery of the intervention • Staff engagement was viewed positively by the pharmacists • Mixed perceptions of client engagement • It’s just a freebie?

Effectiveness • Over half reported that the model was ‘effective’ or ‘very effective’ “They are guaranteed to come in for their methadone … utilising the pharmacists is the most effective way of doing it” Pharmacist 7

Impact on Client Attitudes and Behaviours • Some perceived impact on client attitudes and behaviours “I think its had a good impact, I think it just remind them … they are more aware of their health and oral health especially… I think it’s had a positive impact definitely” Pharmacist 16

“… It did have an impact, I wouldn’t say it was enormous, probably I would say significant” Pharmacist 1 “Hopefully we’ve maybe changed some of their attitudes… sort of dispelled their theories on oral health and methadone… I think we must have made an impact” Pharmacist 10

“… they’ve been coming here for while so they’re like ‘oh yes, I don’t wet the toothbrush’ and you know it seems that they’re remembering what you’ve told them” Pharmacist 12

Appropriateness • All of the pharmacists believed they were appropriately placed to engage and deliver the oral health intervention • Recurring themes • Regular / frequent contact • Existing relationship • Accessibility of the pharmacy

“ We’re best placed really, if we are seeing them everyday. That’s really the only healthcare professional they’re going to be seeing on a regular basis” Pharmacist 4 “I think that this is more than appropriate … we’re a bit of continuity for them and we do see them most regularly…” Pharmacist 16

Summary • Good idea, beneficial, raised awareness and influenced the behaviours and attitudes of some clients • Simple and straightforward to deliver, well organised and not time consuming • Largely positive experiences of the intervention • Community pharmacists feel appropriately placed to deliver the intervention • Could be adopted to address other health issues with this client group

Contact Details Fiona Macfarlane Health Promotion Officer NHS Forth Valley Tel. 01786 442940 Email. Fiona.macfarlane2@nhs.net

Public Health in Community Pharmacy