THE CONTRIBUTION OF

PHARMACY TO TODAYS HEALTH

CARE PROVISION
Introduction
Pharmacists are experts on the action &
uses of drugs, including the chemistry, the
formulation of medicines & the way in
which drugs are used to manage
diseases.
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Pharmacists are employed in many different

areas of practice, include the traditional ones
of hospital and community practice,

As well as newer advisory roles at helth

authority/ health board level,

and working directly with general

practitioners as part of the core, practicebased, primary health care team.

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Some extemporaneous dispensing is still

required and pharmacists remain the only
professional trained in these skills.

If the pharmacist was not required to

compound medicines, and was not required
to give general advice on diseases, what was
the pharmacist to do?
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The Profession
Four main areas in which pharmacy should
make a major contribution to health
outcomes were identified :
a. the management of prescribed medicines;
b. the management of chronic conditions;
c. the management of common ailments;
d. the promotion and support of healthy
lifestyles.
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During the consultation process, pharmacists

expressed their views on the way the
profession should change. These, too, may
be summarized under four main headings :
a. The strengths of pharmacy;
b. Demonstrating the value of pharmacy;
c. Changes in practice;
d. A sustainable future.
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The current and future roles of Pharmacists :

Community pharmacy
Dispensing : the focus of dispensing now
rests not only on accurate supply of
medication, but on checking that
medication is appropriate for the patient
and counselling the patient on its
appropriate use.
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Responding to symptoms : provision of

advice to customers presenting in the
pharmacy for advice on self care is now
an accepted part of the work of a
pharmacist, which as described earlier
has been enhanced by the increased
armamentarium of pharmacy medicines.

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Health promotion and health improvement

The pharmacist is one of the best placed
health care professionals to provide
health promotion information and health
education material to the general public.

Service to specific patient groups

Certain groups of patients have particular
needs which can be met by community
pharmacists more cost effectively than by
any other health professional.
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Domiciliary visiting
Pharmacists have traditionally
delivered oxygen to a patients
home, and many pharmacists will
visit a small number of patients to
deliver medicines and provide
advice on their use.

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Primary care pharmacy

Many pharmacists now provide doctors
with advice on GP formulary development
and undertaking patient medication
reviews, either seeing patients face to
face or through review of patient recordsglobally or on an individual basis.

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Pharmaceutical advisers

Pharmaceutical public health

Most of those also have a senior pharmacist
adviser, operating at consultant level, as
part of the public health team.

Hospital pharmacy
Clinical pharmacy services have been
established in the hospital setting for some
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time; indeed many or the innovations

identified for community pharmacy come
from earlier experience in hospitals

Clinical effectiveness
Clinical effectiveness is a term often used to
describe the extent to which clinical practice
meets the highest known standards of care.
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CONTINUING EDUCATION AND

CONTINUING PROFESSIONAL
DEVELOPMENT
The council of the RPSGB, through the
Code of Ethics, requires that all
pharmacists undertake at least 30 hours
of continuing education each year.
Courses of all four centres are provided
free to pharmacists who are employed in
the provision of pharmaceutical services
to the NHS ( National Health Service).
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Communication skills for the

pharmacist

Almost everything we do in life depend on

communicartion. Pharmacists spend a
large proportion of each working day
communicating with other people, patients
doctors, other health care professionals,
staff and others.

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Assumptions and Expectations

This initial judgment of a person is often

based purely on what we see and hear and
includes appearance, dress, age, gender,
race, and physical disabilities.
Make assumptions about us based on initial
impressions , e. g. a pharmacist wearing a
white coat in a clean, clinical environment
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may inspire more confidence than a

pharmacist wearing a scruffy jumper and
working in a cluttered, untidy environment.
Tone of Speech, accents, common
expressions
All of these have an impact on
communication.Our response to a person
speaking with a whining, complaining
tone will differ from our response to
someone who greets us in a friendly
welcoming manner.
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This is called verbal communication. The

other 90% is transmitted by non-verba;
communication which consists of how it is
said ( about 40%) and body language (
about 50%).

Vocal communication
Vocal communication, sometimes called
paralanguage, concerns the vocal
characteristics, the quality and fluency of
the voice.

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Body language
It is well documented that our impression
of another person is very often created at
first glance.
Body language can be broken down into
several component parts which include
gestures, facial expression, eye contact,
physical contact, body posture and
personal space.
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Gestures
Hand gestures in particular are useful
when emphasizing a point or to help to
describe something.

Facial expression
It has been suggested that, after the
spoken word, facial expression is the
most important part of communication.
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Eye contact
The maintenance of eye contact during a
conversation is vital to ensure the
continuation of the process, it indicates
interest in the subject.

Physical contact
It can be used to enhance verbal
communication. A sympathetic touch on
an arm can often say more than any
number of words.
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Body posture
We can usually control the words we say,
we are not so good at controlling our body
language. Body posture can have a major
influence on how well communication
progresses.
Good communication will provide much
useful information which can then be used
to the benefit of the patient.
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Personal space
We all have our own space in which we
feel comfortable.
Four main areas :
General area : this is approximately 3m or
more;
Sociable area : this is approximately 1 3m
Personal area : this is approximately 0,5-1m
Intimate area : this is usually 0 50 cm
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Patterns of Behaviour in Communication

- assertiveness;
- aggressive behaviour;
- passive-aggressive behaviour;
- submissive behaviour.
Technique is assertive communication
Use of I and You statements
- repeating the message;
- clear communication;
- extracting the truth;

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- self talk :
* choose the right situation;
* prepare for situations;
* behave assertively during the
situation;
* review the situation afterwards.

Empathy
Ilness is often associated with different
emotional aspects, like uncertainty,
stress, fear and dependency.
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Empathy :

* the ability to enter the life of other people

and to accurately understand both their
meaning and feelings;
* one of the cornerstones in
communication skills and is an essential
part of assertiveness.
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Facilitating empathy
Being empathy requires that pharmacists
are able to communicate their readiness
and willingness to listen to other people
and to establish a safe non-threatening
atmosphere where they can express
themselves.

Perceiving feelings and meaning

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Responding
involves the verbal and non-verbal
expression of how much we understand
and that we are intersted to hear more.

QUESTIONING SKILLS
- one of the most widely used social skills
good question skill

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Use of open and closed question.

Closed questions :
* are you taking any medicine at present?
* have you ever taken this medicine
before?
* do you understand how to take it?
* do you have any questions about the
medicine?
* did the medicine work to you?
* will you work in the dispensary for me
next Sunday?

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Open questions :
- describe your symptoms to me;
- tell me about any over-the-counter
medicines you are taking just now;
- how do you relieve the symptoms of
headache?
- what do you do when that sensation
occurs?
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The funnelling technique

a funnelling technique can be used

to allow direction and focusing of
ideas on a specific topic. This
involves initially asking background
open questions to provide basic
information.
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The use of open and closed question in a

pharmacy setting
- open question takes time ;
- closed question limited to one word
answers makes the patient feel as
they have been through an
interrogation.
- using the combination of open and
closed questions which can ensure that
accurate and complete information is
obtained.

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Application of questioning skills

Questioning skills are not required for
face to face communication.

LISTENING SKILLS
Asking question is a part of communication,
mlistening to the answers is of equal
importance.

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BARRIERS TO COMMUNICATION
Common barriers are :
* environment
* patient factors
* the pharmacist
* time
Environment
- a busy pharmacy
- lack of privacy
- noise
- physical barriers

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Patient factors
- physical diabilities
- comprehension difficulties
- illiteracy

The pharmacist
- lack of confidence
- lack of interest
- laziness
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- delegation of responsibilities to
untrained staff
- a feeling of being under pressure,
especially time pressure
- being preoccupied wioth other matters.

Time
it is worthwhile checking what time people
have available before trying to embark on
any communication.
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CONFIDENTIALLY
Ethical guidelines and privacy laws set
the rules about confidentiality in
pharmacy. Any information relating to an
invidual which the pharmacist or any
other staff member acquires in the course
of their professional activities has to be
kept confidential
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SUMMARY
Good communication is not easy and
needs to be practised. We have all
different personalities and skills which
means we have strengths in some areas
and weakness in others.

Key points
- non verbal communication is made up of
vocal communication (paralanguage) and
body language.
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- body language includes gestures,

expression, eye and physical contact, body
posture, space and proximity;
- after the spoken word, facial expression is
probably the most important part of
communication;
- eye contact must be maintained, but must
not become a stare;
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- an awareness of personal space is needed

to allow effective communication;

- assertive behaviour treats other people as

equals, and is not to be confused with
aggressive behaviour which violates other
peoples rights.
- assertive communication will tend to use I
rather than You repeat messages,
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employ clear verbal and non-verbal

communication and clarify issues without
emotion;
- empathy (active listening) involves
understanding other peoples feeling and
reflecting this back to them;
- questioning may be open or closed and in
most situations a balanced combination is
required;
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- questioning skills also involve listening to

answers;
- in the working environment there are many
potential barriers to effective
communication including the environment,
patient and pharmacist and the time
implications;
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- confidentially must be assured in the

practice of pharmacy;
- the special needs of patients must be met
without being patronizing;
- hearing loss is common in the elderly and
will present a barrier to effective
communication;
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- a number of signs help identify those with

hearing loss and many steps can be taken
to help the situation;
- pharmacists need to maximize their
strengths and minimize their weaknesses
of communication.

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