Community Pharmacists Management of AlcoholRelated Problems: Unchartered Waters

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Community Pharmacists Management of
Alcohol-Related ProblemsUnchartered Waters

• Ann Roche1
• Janie Sheridan2
• Natalie Skinner1
• 1National Centre for Education and Training on
  Addiction (NCETA), Flinders University
• 2School of Pharmacy, Auckland University
• APSAD Conference Fremantle 14-17 November 2004

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NCETAs Brief Includes

• Identifying emerging trends in the AOD field.
• Developing or enhancing workforce development
  strategies to respond to AOD issues.
• Identifying the appropriate workforces to respond
  to AOD problems.
• Developing models of best practice in these areas.

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Key trends in responding to AOD issues

• Emphasis on role of primary care providers
• especially GPs.
• Responses driven by increasingly strong evidence
  base
• early and brief interventions
• preventive strategies.

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Right vehicle wrong driver?

• Are GPs the most appropriate intervention agents
  for alcohol problems?
• Low levels of uptake of brief early
  interventions (Roche and Freeman, 2004).

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Alternative primary care delivery agents sought

• For example
• Practice nurses
• Community pharmacists.

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Why Community Pharmacists?

• Frequent contact with individuals in the local
  community
• Large workforce (11,829) (AIHW Pharmacy labour
  force 2001)
• Considered by general public to be experts in
  health-related matters (Anderson, 2000)
• Public image friendly, approachable,
  non-threatening.

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• Pharmacists problematic alcohol use
• Unchartered waters

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Community pharmacists expanding role

• Opiate pharmacotherapies Increasing role in harm
  reduction and treatment.
• Increased role in activities such as
• Screening activities
• Advice counselling
• Referrals to GPs.
• Addressing a range of health issues
• Smoking cessation
• Cardiovascular disease
• Sexual health.
• (Anderson, 2000 Hourihan et al., 2003
  Lloyd-Williams, 2003
• O'Loughlin, Masson, Dery, Fagnan, 1999)

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Pharmacists roles in addressing alcohol-related
problems

• 1. Prevention.
• Information provision, medications
  contra-indications
• Eg Alcohol information printed on prescription
  repeat folders (Pharmacy Guild AERF initiative)
• Screening Intervention
• Esp. early / brief interventions
• 3. Shared care withdrawal management.

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Future work

• Professional practice change intervention
• Potential for trials of shared care service
  delivery
• Trial of brief interventions based on the use of
  AUDIT-C

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• Anderson, C. (2000). Health promotion in
  community pharmacy The UK situation. Patient
  Education and Counseling, 39, 285-291.
• Hourihan, F., Krass, I., Chen, T. (2003). Rural
  community pharmacy A feasible site for a health
  promotion and screening service for
  cardiovascular risk factors. Australian Journal
  of Rural Health, 11, 28-35.
• Lloyd-Williams, F. (2003). The effect of an
  intervention programme to improve health
  education leaflet uptake and distribution in
  community pharmacies. Patient Education and
  Counseling, 49, 27-33.
• Maguire, T. (2003). Ways to help change
  behaviour. The Pharmaceutical Journal, 271,
  813-815.
• O'Loughlin, J., Masson, P., Dery, V., Fagnan,
  D. (1999). The role of community pharmacists in
  health education and disease prevention A survey
  of their interests and needs in relation to
  cardiovascular disease. Preventative Medicine,
  28, 324-331.