Abstract

Introduction:
Community pharmacy has been acknowledged as a valuable and trusted public health resource1, however in order for public health activity to be sustainable, it needs to be seen as integral to the role of a pharmacy. The aim of this study was to explore the views and attitudes of pharmacy support staff on the Health Living Pharmacy (HLP) initiative.

Methods:
Face to face semi-structured interviews were conducted with 21 participants from 12 HLPs in Northumberland. HLP Champions (n=16) who had received Royal Society for Public Health training on understanding health improvement alongside non-champion staff (n=5) were included in the sample. Participants also covered a range of pharmacy roles including medicines counter assistants (MCAs) (n=9), dispensing assistants (n=6) and pharmacy technicians (n=6). National multiple (n=8), small chain (n=2) and independently owned (n=2) pharmacies were represented. Participants were recruited by contacting pharmacists in HLPs who nominated support staff for potential participation. Informed consent was obtained prior to conducting interviews. A topic guide was developed and underwent face validity testing and piloting with one participant. Interviews were audio recorded, transcribed verbatim and analysed using Framework approach. The study was approved by Robert Gordon University ethics committee. NHS ethics approval was not required.

Results:
One of the themes identified from the data was integration of public health activity into traditional pharmacy roles.
Participants discussing integration of public health activities with other pharmacy duties included examples of advice when conducting product sales and responding to symptoms. An example participants often referred to was sales of nicotine replacement therapy:
"...say if it's somebody [who came in to buy] nicotine replacement therapy, we would say that there are services available, had they thought about giving up. And it's just basically like a couple of lines like that." HLP Champion, MCA
Availability of in-pharmacy clinics was frequently described by participants as aiding integration. Participants also described examples of linking pharmacy sales with healthy eating advice, and advising patients about codeine dependence with requests for codeine-containing medicines. Many participants also expressed a perception that they were integrating public health activity subconsciously:
"...you don't realise that you are doing it. Because it's all part and parcel of the job." HLP Champion, MCA
There was little in the data describing integration of public health activity with dispensing, though one participant did describe a diabetic foot care campaign where people with diabetes were identified from prescriptions they presented. Another form of integration from dispensing that a couple of respondents described was clients browsing health promotion materials within the pharmacy when waiting for their prescriptions. Health promotion materials were widely described as a facilitator for interventions including alcohol awareness, sexual health, cancer screening and cardiovascular health.

Discussion:
Whilst participants in this study described integration of public health advice for some pharmacy roles seamlessly, participants were less able to describe integration into dispensing activity despite opportunity in areas such as diabetes and cardiovascular health. Contextualisation of public health activity within community pharmacies for support staff could enable further integration of public health into the role of community pharmacy. Facilitators from achieving this integration for medicines counter activities should be explored to inform better integration of public health into dispensary based activities.

References:
1. Department of Health 2010 White Paper Healthy Lives Healthy People. Available at: https://www.gov.uk/government/publications/healthy-lives-healthy-people-our-strategy-for-public-health-in-england (Accessed 13/04/14)