Flashcards in The Public - Sem1 Deck (66):
Describe the relationship between infectious disease and public health
- Control of microbes and understanding of infection is required to uphold public health
- Spread of infection has a negative effect on public health
What is the role of the pharmacist in managing public health?
- Understand the cause of the disease
- Manage spread of disease: treatment of those infected and educating on preventing transmission
- Work with other clinicians to find best course of treatment
- Educate public on symptom recognition and management
Describe the role of the community pharmacist
- Promotion of public health and pharmaceutical services
- Dispensing prescriptions
- Medicines disposal
- Encourage self care
What are the advanced pharmaceutical services?
- MEDICINES USE REVIEW: Discussing treatment with patients, especially for those with long-term conditions
- NEW MEDICINES SERVICE: Working with patients for new medicines, important to improve adherence
- APPLIANCE USE REVIEW: Improving the way an appliance in used by a patient
- STOMA APPLIANCE CUSTOMISATION: Customisation of a stoma device to increase comfort for the patient
- FLU VACCINATION: Seasonal, given to those at a higher risk
What are the local pharmaceutical services and what do they depend on?
- Depend on population needs
- Stop smoking
- Substance misuse
- Minor ailments
- Emergency hormonal contraception
- Chlamydia screening
What is the national agenda for pharmacists in GP practices?
- 470 pharmacists in 700 GP practices, carried out over 3 years
- Scheme = £31million
Describe the role of a GP pharmacist
- Prescription requests and medication queries/reviews
- Routine blood tests and patient clinics
- Reduce medication wastage
- Manage long-term conditions
- Train pharmacy mentees
What are the outcomes of public health from pharmacists working in GPs?
- Better access to healthcare
- Pick up excess from GPs and nurses, from budget cuts
- Ensure effective use of medication
- Become a first point of patient care
What are the entry levels of GP pharmacists?
- Pre-reg, senior staff have a support/mentoring role
- Junior pharmacist, senior staff support and mentor but juniors also support and mentor pre-reg. REFLECT on learning through this role
- Senior pharmacists, support those below them while reflecting on their now understanding of pharmacy
Describe the career pathway for GP pharmacists
- Progression from pre-reg to senior pharmacist
- Learning through mentoring others
Describe the direction of GPs and pharmacists
- Promote care through pharmacist - primary/secondary care
- Established career pathway, new roles for pharmacists
Describe the role of industrial pharmacists
- Drug development - discovery, design and research
- Manufacture for clinical trials, more pharmaceutical development depending on response
- Patenting, sales and marketing of drugs
Give an overview of the stages of drug development
- Understand the chemical properties of the drug and the importance to its design
- Design of formulation(s) and dose
- Understand how the chemical properties of the drug affect its absorption, solubility, metabolism,
- Understand how the rate/extent of absorption is affected by the dose and formulation
- Develop and manufacture the drug
- Create patent for the drug
Describe the role of a hospital pharmacist
- Ward-based role
- Working in the dispensary, preparing prescriptions for in- and outpatients
- Extemporaneous preparation of medicines in a sterile setting
- Providing information on medicines
- Managing medicines for patients/clinicians
Describe the role of an academic pharmacist
- TEACHING YOUNGER PHARMACISTS
- Involved in setting/marking assignments and exams
- Scholarship - Sharing of knowledge and practice and conferences
- Social - Media, events, school visits, expressing the importance of pharmacy in public health
Outline the evolution of clinical pharmacy
- Traditional pharmacy activities (e.g. dispensing)
- Ward/clinical roles
- Increased role of pharmacists in hospitals
What are the pay grades for a hospital pharmacist?
- Newly qualified (Band 6) = £26, 041 - £34, 876
- Further study and training (Band 7) = £31, 072 - £40, 964
- Senior pharmacist (Band 8A-8D) = £39, 632 - £81, 618
- Senior pharmaceutical manager (Band 9) = £77, 850 - £98, 453
- Salary varies depending on skills, training and knowledge, as well as between NHS and private
How do hospital and community pharmacists work together for patient care?
- Hospital pass on treatment plan to community after discharge
- Discuss information to improve compliance (MUR and NMS)
- Share info on patients with misuse history
Identify the contribution of hospital/academic pharmacists to public health
- Integration of pharmacy into healthcare - increase public awareness of pharmaceutical services
- Uphold standards of patient care
- Comprehensive disease management (public education etc)
What is the meaning of public health medicine? Identify its domains
PHM - Improving population health
- Health Improvement: Through monitoring public health and educating the population
- Improving Services: Planning new services based on evaluations of existing ones and their efficacy
- Health Protection: Protect from infection (prophylactic use of medication/education of reducing transmission)
What are the limitations to public health education?
- Action depends on the individual and their circumstances
- Some may be adverse/unable to change
- No effect on poverty
- Not very effective
Describe health promotion
- Combination of education and environmental/legislative change
- Makes healthier choices easier
- More effective than health education
How can pharmacists improve public health?
- Monitor prescribing data and identify inequalities
- Develop policies and practices for health education
- Improve services through regular evaluation
- Health protection practices: monitoring bacterial resistance and managing epidemics
Describe the role of the World Health Organisation in health promotion
- Worldwide guidance/standards for health and healthcare
- Working with governments to improve healthcare programmes
- Development and sharing of health technology and information
What are the 4 key commitments for the Bangkok Charter for Health Promotion?
Health Promotion should be...
1) A central part of the global development agenda
2) A core responsibility for all governments
3) A key focus of all communities
4) A requirement for good corporate practise
Define compliance, adherence and concordance
- Compliance and Adherence: Following a clinical prescription as directed by a clinician
- Concordance: Working with health professionals to decide a course of treatment (patient's needs taken into account)
How can compliance and adherence be measured?
- Direct: Measure drug concentration in the body, keep patients under observation during treatment
- Indirect: Tablet counts and dispensing records, electronic monitors, ask patient
What are the types of non-adherence?
- Intentional: Drug misuse/deliberately not taking for some reason
- Unintentional: Overdose/underdose due to poor understanding of treatment plan or poor fit to patient's life
What percentage adherence should be achieved to ensure efficacy of the treatment plan?
More than 80% adherence
How can adherence be improved?
- Simplify dose regimens: Lower frequency can make it easier for patients and prevent forgetfulness/effort to maintain treatment
- Alter formulation: May be able to combine medicines to prevent the amount taken/may make it easier for the patient to take
- Monitored dosage systems: Prevent over-/underdosing and forgetfulness
What can affect adherence?
- Disease: Long-term diseases may lower adherence due to the long duration of treatment and possible increase in the number of medications
- Patients lifestyle: Treatment plan should fit into their lifestyle as well as possible
How can concordance be measured?
- Patient's happiness regarding plan established together, ask about understanding of treatment plan (positives and negatives) and explain more if required
What is self care?
- Healthcare done by the patient themselves to maintain health and prevent illness
Why should self care be encouraged?
- Reduce resource wastage for minor treatments that do not require clinical attention
- Coping mechanism for a growing population
- Best mechanism for those with long-term conditions, they know best how the condition affects them and how to prevent this
What are the benefits of self care? (Patient)
- Better health and wellbeing
- Reduce severity of symptoms and disruption (e.g. from numerous hospital trips)
- Increased control, confidence and mental health
What are the benefits of self care? (Healthcare systems)
- Reduced need for emergency services
- Less wasted resources/unnecessary admissions
- Decrease GP visits by up to 40% and outpatient visits by up to 17%
- Decrease in A&E admissions by up to 50%
- Less use of medicines
What patients group would self care benefit the most?
- 60-80% of women
- Parents of young children
- Full time workers
- Elderly patients
Describe the role of the pharmacist in self care
- Decrease the amount of unnecessary GP appointments
- Treat minor ailments/give advice on treatment
- More convenient for quick visits
- Provide information on self care and make referrals where needed
- Provide information on medicines (e.g. suggesting non-proprietary version may reduce cost for patient)
What is the expert patients programme?
- Help for those managing long-term conditions
- Encourages patients to work with clinicians
- Run courses to teach patients self management
What is self medication?
- Selection and use of medications by the patient to treat a self-identified condition/manage the symptoms
- Can be used for prevention or treatment
What influences self medication?
- Less absence due to sickness
- Increased number of medicines from POM to P
- Better medicine availability
- May be better financially
- Communication regarding medicines
- Alternative treatments (e.g. home remedies)
What are the qualities of a profession?
- Specialised knowledge and skill applied to their work
- No self interest in their actions
- Objective and non-judgemental
- Adhere to guidelines for the profession
What are the benefits of being a professional?
- Status and higher social class
- Intellectually challenged
- Intellectual interests
- Job security
What is professional socialisation?
- Selection, training, recruitment and regulation of a profession
- In regards to those hired
How did medical, nursing and pharmacy professions develop into their current status?
- Regulations set
- Monopolies created - Single aim for each profession
Why is Pharmacy considered a profession?
- Specialised knowledge of drug use/pharmaceutical science
- Can prescribe
- Need to be present for sale of POMs
- Regulatory bodies (GPhC and Fitness to Practise)
- Advice and health promotion given
Why isn't Pharmacy considered a profession?
- Less skills needed for dispensing
- Medicines not always sold in pharmacies
- May be instructed by other clinicians
- Not exempt from self interest (sale of medicines in community)
How will current initiative affect the professional status of pharmacy?
- Increased professional status
- Reduce number of medicines sold OTC
- Training undertaken to prescribe
What qualities are required of pharmacy students? (Patient)
- Ability to communicate
- Ability to show empathy and compassion
- Accept patient diversity and always remain confidential
- Adhere to code of ethics
What qualities are required of pharmacy students? (Pharmacist)
- Be aware of personal limitations and learn from/fix mistakes
- Continue to develop knowledge as medicine develops
- Maintaining a professional appearance
How has the role of the community pharmacist in health promotion developed?
- Provide more health advice than was given before the NHS
- Dispensing of medicines and educating patients on proper use
What are the different levels of involvement for pharmacists within health promotion?
- Self-led by patient and supported by pharmacy team
- Programmes run by members of pharmacy team
Programmes run by qualified pharmacist
What are the barriers to involving pharmacies in health promotion?
- Time: For the pharmacist and patient
- Money: Pharmacist payment for services as well as financial status of patient to pay for treatment
- Privacy: Presence of consultation rooms
- Public view: Are pharmacists trusted?
- Relevance: Pharmacist's ability to help
What are the national priorities of the 'Choosing Health' strategy?
- Protect and improve national health
- Reduce health inequalities
- Create sustainable health care services
- Improve the public health system
How can a pharmacist contribute to the 'Choosing Health' strategy?
- Aim to reduce antibiotic resistance (education/avoid unnecessary use)
- Reduce incidence of TB (educate on transmission)
- Reduce the population undertaking harmful lifestyles (smoking, heavy drinking, obesity)
- Loss of/reduced normal response to a substance
- Excessive use of a substance that is unrelated to medical practice
Define psychological dependence
- A feeling that requires administration of the substance to prevent related discomfort
Define physical dependence
- Physical disturbances that occur from not taking a regularly used substance
What are the patterns of drug use?
- Experimentation: Does not always progress into addiction or abuse
- Recreational: Used for fun
- Problematic: Affects mood/ability to function, individuals may resort to crime as a form of supply
- Addiction: Dependent on a drug
What affects the addictive potential (high) of a drug?
- Route of administration: Injecting creates a much faster and more prominent high, therefore more likely to create and addiction
What types of drugs are there?
- Stimulant: Quickens action of nervous system, creating euphoria and excitement
- Depressant: Dampens action of nervous system, causing euphoria, content and wellbeing
- Hallucinogen: Perceptions become distorted, and something of a fantasy
What are the legal drug classes? (Give examples)
- Class A: Most serious; include, LSD, ecstasy, heroin, cocaine, crack, mushrooms, injecting amphetamines
- Class B: Amphetamines, cannabis, ritalin, pholcodine
- Class C: Painkillers, ketamine, tranquillisers
How is drug misuse measured?
- Offences (responsible for 68% of crime in Britain)
- Treatments (although not all misusers may be identified)
Why is 'harm reduction' adopted in terms of drug misuse?
- Drug abusers may not stop just because of damage to health
- May not seek advice due to fear of getting charged
- Approach to help misusers inject safely if they're going to do so - prevent wasted resources from injury through drug misuse