Issues reported by the interviewees to affect pharmacist involvement in health promotion activities were sorted into those that applied specifica^y to the pharmacist on the premises in which they were working at the time of the interviews. The issues were extracted hom entire transcripts of interviews, and not from responses to any particular questions. Issues presented in this section have only been included if the interviewee reported a link between the issue and the pharmacist's involvement in health promotion. This explains why the number of pharmacists reporting factors is low for some health promotion activities. Summaries of findings are presented for "health promotion" and for specific disease prevention services in Tables 4.29 to 4.33.
Table 4.29: Number of pharmacists reporting the most frequent issues which affect their involvement in "health promotion" in their pharmacy (n=50).
Issue "Health promotion"
Lack of remuneration 3
Time required 1
Cost of space 1
Cost of equipment 1
Customer demand 1
Table 430: Number of pharmacists reporting most frequent issues which affect their involvement in providing anti-smoking advice from their pharmacy (n=50).
Issue 1 Anti-smoking literature Verbal anti-smoking advice Leaflet availability 2 - Customer demand - 8 Time required - 1 Advice is ineffective - 1
"In the interests of the
profession" ■
1
The only issue which the pharmacists perceived to affect provision of anti-smoking leaflets was whether or not any leaflets had been delivered to their pharmacy. The most firequent issue reported to affect provision of verbal anti-smoking advice was the number of customer requests for advice on this subject Interviewees reported that lack of time and perceived ineffectiveness of advice given would hinder the provision of anti-smoking advice. One respondent was encouraged to provide anti-smoking advice by beliefs about benefits to the public and to the pharmaceutical profession.
Table 4 J l : Number of pharmacists reporting most frequent issues which affect their involvement in providing blood pressure and cholesterol testing from their pharmacy (n=50).
Issue Blood pressure
testing Cholesterol testing Lack of remuneration/payment 17 21 Time required 15 20 Space required 13 16 Customer demand 9 15 Staffing 6 7 Lack of privacy 6 5 Training required 5 3 Facilities required 4 4 Inaccuracies 2 3
Require liaison with other health care professionals
1 1
The most frequent issues reported to affect provision of both blood pressure and cholesterol testing services were lack of time, space, finance and customer demand. Other issues which the pharmacists perceived to be important with respect to diagnostic testing were the need for adequate facilities and privacy on the pharmacy premises, more staff, training and improved liaison with other members of the primary healthcare team. Concern was voiced about the accuracy of diagnostic testing equipment, the possibility of conflict with local GPs and how to deal with a worried customer necessitating referral. Four interviewees mentioned that the decision to provide diagnostic testing services was made by the owner of the pharmacy, and not by themselves.
The most frequent issue reported to affect provision of leaflets about safe injecting practices was whether or not any leaflets had been delivered to the pharmacy. The pharmacists reported that provision of leaflets about safe injecting practices would depend on whether they had any contact with drug misusers. Two interviewees admitted being reluctant to provide these leaflets because they did not want contact with IDMs. Five pharmacists were willing to provide the leaflets, as long as they did not have to display them openly. One pharmacist would not provide the leaflets because he was concerned about the public image of his pharmacy. The only interviewee who mentioned a positive incentive of providing the leaflets talked about the benefits of harm minimisation to public safety.
The most frequent factors reported to affect the pharmacists willingness to provide verbal advice about safe injecting practices were customer demand for the advice and current contact with drug misusers in the pharmacy. Some interviewees reported that
Table 4.32: Number of pharmacists reporting most frequent issues which affect their involvement in providing advice about safe injecting from their pharmacy (n=50).
Issue Literature about safe
injecting practices
Verbal advice about safe injecting
practices
Leaflet availability 20 -
Contact with IDMs 7 13
Not on display 5 -
Customer demand 2 25
Don't want IDMs in the pharmacy
2
Results in bad public image 1 2
Space required 1 -
Sympathy for IDMs - 3
Lack of privacy - 3
Lack of training - 2
Theft - 2
A pharmacy is not the right place - 2
Time required - 1
Advice is ineffective - 1
provision would be hindered by a lack of privacy in their pharmacy and the bad public image which provision of the advice would cause. Several pharmacists perceived that provision of the advice would result in theft of stock, abuse of the staff and loss of custom. Two pharmacists reported that they would require education and training about safe injecting practices themselves, before they would be able to advise others.
The number of customer requests was most frequently stated as an issue which affected whether or not the interviewees supplied sterile injecting equipment to IDMs. The other main issues included the perceived benefits for public health and the perceived negative effects on the pharmacy business, such as loss of custom. Concern was expressed about theft of stock, exposure of pharmacy staff to verbal abuse, and the risks associated with return of used needles to the pharmacy. One interviewee reported that he perceived that provision of the injecting equipment would encourage drug misuse in the area. Another pharmacist wondered how she would deal with "swarming" or large numbers of drug misusers coming into the pharmacy at the same time. Two pharmacists pointed out that the decision about provision of sterile injecting equipment was made by the owner of the pharmacy and not by the pharmacy manager.
Table 4 3 3: Number of pharmacists reporting most frequent issues which affect
their involvement in supplying sterile needles and syringes from their pharmacy (n=50).
Issue Supply of sterile needles and syringes
Customer demand 8
Theft 4
To reduce the spread of HIV-infection 4
Contact with IDMs or not 3
Results in loss of custom 2
IDM abuse/aggression 2
"Its not the pharmacist's problem" 2
"Swarms" of IDMs in the pharmacy 2
Company policy 2
The extent to which pharmacist-reported issues were associated with pharmacist involvement in health promotion and provision of disease prevention services, was explored during analysis of postal questionnaire data. Prior to collection of this data, the interview data provided an indication of the extent of current provision of specific disease prevention services from community pharmacies in the North Thames (East) Region of England.
43.7 Previous, Current and Intended Future Levels of Involvement of Pharmacists