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Better Patient engagement? Time to value community pharmacy. (Matt Shanahan)

Writer's picture: dave shanahandave shanahan

One of the great challenges in modern healthcare is how to secure patient engagement and understanding of their disease and what if anything they can do to participate in influencing their symptoms and outcome.

Parks Associates in an analysis (Digital Health Consumers: A Lifestyle and Technology Segmentation, 2014) of 2500 US households with broadband, looked at the engagement of people with health content and not surprisingly found that younger people despite being the most technologically literate and digitally engaged, were the least likely to have interest in or access health content on the web.

Parks usefully divides health groups on their analysis as “Healthy and Engaged”, “Young and indifferent”, “Unhealthy and in denial” and “Challenged but mindful.”

The challenged but mindful were typically older people suffering with a chronic disease. Healthy and engaged were the exercising and nutritionally aware, typically without health issues. The unhealthy and in denial cohort were segmented as not being health conscious, but having chronic disease. This is a quadrant familiar to many in healthcare especially those at the coalfaces of delivering services.

All four segments were almost equal in size, at approximately 25% of the population. The young and indifferent are well named – why would one want to engage with health issues when young and perfectly well?

The construct is useful in considering how services or programmes designed to address individuals in these segments need to be delivered. Given some 40% or more of the Irish population carry private health insurance, it’s a fair bet the main subscribers fall into the two categories of healthy and engaged and the challenged but mindful (older people). What’s clear from this is the role education plays. No supporting research is required to suggest better education provides a higher standard of living. As only the more affluent people in society can afford health insurance, then logically these two segments come from the middle classes and pensioners. Pensioners, though they have suffered reverses in post Celtic Tiger Ireland, are not coping with mortgages, negative equity, school and university fees and the increased tax rates imposed on the working parents of middle Ireland. They also value healthcare access highly as health problems of ageing are commonplace in the over 65’s and often debilitating. In summary these two groups are interested and mostly well educated about their health and healthcare choices.

The unhealthy and in denial cohort are a special challenge. With the large rise in medical card eligibility before recent commitments given in respect of under sixes and pensioners by government, medical card holders will likely feature heavily in this cohort.

Medical cards are awarded on the basis of lower financial means and an existing illness. We know that medical card holders do not feature in the higher socio-economic groups of ABC1’s. They are more likely to come from disadvantaged areas. Their diet and lifestyle is less likely to reflect the healthier behaviour’s of more affluent citizens. Proportionately they experience greater levels of poor diet, higher prevalence of obesity, smoking, alcohol consumption and chronic disease.

At a time when government are contemplating introducing free GP care, and in the future, a universal single tier health system, it’s appropriate to consider the implications of expanded access. Will more healthcare lead to better health? For those who are young and don’t care, and those who don’t associate their present lifestyles with the development of chronic diseases and future health problems in themselves, or their children, does more healthcare address the real problem? Universal healthcare will be of little value if we don’t secure greater engagement in health by our young people and especially in securing behaviour change in those who are already unhealthy and in denial.

Recent work by IBM undertaken in the US via a “patient centred medical care home” shows profound improvements in overall health delivery, through better co-ordination and health engagement in community. In Ireland we already enjoy a much better primary care system than exists in the USA and a wide concentration of community based pharmacists who provide walk-in accessible health expertise in the community. In essence, our notion of the US patient centred care home can be the shared link between primary care centres and their related pharmacies and community homes. We are still treating pharmacy as a retail destination for health and beauty and a pick-up location for our dispensed medicines. We need to think much more broadly as we explore better health access for segments of our community who will greatly benefit from more localised, tailored services given by people they know and trust in easily accessible locations. Community Pharmacy is an untapped resource.

The medicines use review (MUR) scheme in the UK provides a service fee to community pharmacists for working with patients to ensure their medicines compliance is optimal and that their prescription is as their doctor intended. Ireland offers no professional service fees to Irish pharmacists for such a service. The vaunted consultation room in pharmacy prescribed statutorily by the Irish Pharmaceutical Union, provides a room in all Irish pharmacies where patients can access medical advice. There’s little evidence to suggest the adoption of these rooms by pharmacists or patients has been widespread. Indeed a good deal appear to function more for storage than consultation.

The Parks analysis shows that some 50% of the population are not health conscious. As long as we insist on structuring healthcare as a paternalistic service where citizens await illness and demand cure and care be delivered to them as opposed to being proactive in health, seeking advice and support and participating in health friendly behaviours, we will continue to sustain our present and rising trends of obesity, substance abuse and pervasive chronic disease.

There’s no easy answer. However one approach should be to seek to incentivise patients to become partners in their healthcare. We need not just more health promotion and public messaging on media. We need educational services which patients can access in an integrated and appropriate manner. This means considering Community Pharmacies, GP Surgeries, Hospitals, Community Clinics, Libraries and Schools as Health Destinations where engagement and promotion of health education and behaviour change is counselled, supported and adopted.

Moreover we need to invest in simple effective patient engagement models that meaningfully address patient behaviours and participation in primary prevention programmes in community. Pharmacists already operate consultation rooms for simple medical advice. Better patient engagement in community pharmacy where patients can access their pharmacist more easily than their GP is a no-brainer. It should be common sense to use the experience and systems of health insurers, industry and employers in concert.

Recognising the role of the community Pharmacist and the potentially immense role they can play in primary health protection would be a good start.

Matt

  • Ref: Digital Health Consumers: A Lifestyle and Technology Segmentation. Parks Associates, 2014. www.parksassociates.com


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