In this blog for people trying to live a healthier life, Adam Todd a community pharmacist and Robert Walton a general practitioner examine the latest Cochrane evidence on whether community pharmacies can provide effective lifestyle advice.
The days of community pharmacists wearing white coats, making up tinctures and potions in the back of the pharmacy are long gone. These things are better left to people working in the pharmaceutical industry where the process can be properly regulated and controlled.
So what do community pharmacists do now and why are they giving advice on healthy lifestyle?
Nowadays, the main function of a community pharmacist is to dispense people their prescriptions, as well as giving advice about minor illnesses, and using medicines you can buy over the counter. Recently though, someone (probably in an office in Whitehall?) recognised it may be a good idea for pharmacists – and their teams – to start offering people advice about their lifestyle – with a view to potentially changing unhealthy behaviour.
It makes sense for all people involved in healthcare to think about supporting people to remain well, rather than waiting for them to become sick, and then doing something about it. So, a good example is obesity. If someone is overweight, they are more likely to have a heart attack, get diabetes, and die younger. If we can offer support and advice to the person that is overweight, help them eat more healthily and do more exercise, that may reduce the chances of them having a heart attack, getting diabetes and so on. The benefits of this preventative approach are well established.
Why are community pharmacies well-placed to take on this new role?
The idea behind using a community pharmacy setting to deliver this advice is that millions of people use a community pharmacy every day. Sometimes it might be to get some support about using prescribed medication, or to ask if an illness will get better by itself or if it should be referred on to another healthcare professional. Pharmacies are also open at evenings and at weekends, and are available without an appointment, making them easily accessible.
If community pharmacists and their teams speak to people about their health, give advice, and potentially help them to change unhealthy behaviour, this would be a good thing for all concerned. It may help people improve their health in the long run, and also reduce the chances of them going to the doctor in the future, potentially saving money for the NHS. Of course, how this happens given the challenges associated with the COVID-19 pandemic will differ from region to region and even pharmacy to pharmacy. It could be that face to face conversations are not appropriate, but the use of technology could help promote these conversations about the healthy lifestyles.
This all sounds great in theory; the big question is though – if community pharmacies give people healthy lifestyle advice, do people listen to them, and ultimately change their behaviour in the long run? If community pharmacy teams could do this effectively then more could be made of this new role. If, however, this approach doesn’t have the intended effects, then people who have responsibility of developing health services would have to go back to the drawing board and have another think.
What’s the bottom line: can advice from community pharmacies be useful to people wanting to live a more healthy life?
A new Cochrane review on community pharmacy interventions for health promotion found a wealth of information on this topic (a total of 57 studies with over 16,000 people taking part). Healthy lifestyle advice from community pharmacists was compared with usual care (for example, using leaflets to promote health, self-support, or advice from other health professionals). There were lots of different examples of community pharmacy workers providing advice to people, including advice given about smoking cessation, managing hypertension or diabetes to mention a few.
Overall, the work showed that advice given in a community pharmacy probably improves behaviours related to health in the short term (e.g. stopping smoking) and probably slightly improves people’s quality of life. The services also probably provide value or money. Although these services probably have a small beneficial effect on clinical measures like cholesterol levels, that can indicate someone’s risk of events like stroke, none of the studies investigated the long-term benefits, for example in preventing strokes and heart attacks. It is not known whether there were any harms associated with advice from community pharmacists as none of the studies reported this.
So, the next time you visit a community pharmacy to pick up your prescription, buy some medication, or ask about a minor illness, if you are interested in improving your lifestyle and getting more healthy, you could consider asking the pharmacist – it could make all the difference!
Robert Walton is a Senior Fellow in General Practice at Cochrane UK. Adam Todd’s biography appears below.
Steed L, Sohanpal R, Todd A, Madurasinghe VW, Rivas C, Edwards EA, Summerbell CD, Taylor SJC, Walton RT. Community pharmacy interventions for health promotion: effects on professional practice and health outcomes. Cochrane Database of In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. More 2019, Issue 12. Art. No.: CD011207. DOI: 10.1002/14651858.CD011207.pub2.
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Disclosure of interest:
Adam Todd has nothing to disclose.
Robert Walton reports grants from NIHR Health Technology Asessment, grants from NIHR Programme Grants for Applied Research, personal fees and other from TTS Pharma, outside the submitted work; In addition, Dr. Walton has a patent WALTON R, MCKINNEY E, MARSHALL S, MURPHY M, WELSH K, others. GENETIC INDICATORS OF TOBACCO CONSUMPTION. Patent number: 2001038567. Filed date: 24 Nov 2000. Publication date: 01 Jun 2001 with royalties paid to gNostics, and a patent Tucker MR, Walton R, Matthews H, Miskin A. Method and Kit for Assessing a Patient’s Genetic Information, Lifestyle and Environment Conditions, and Providing a Tailored Therapeutic Regime. Patent number: US20110251243 A1. Application number: US 12/944,372. Filed date: 11 Nov 2010. Publication date: 13 Oct 2011 issued to None.