When I was a child, my mother always spoke to the local pharmacist when we were sick before she decided whether or not to bring us to the doctor. The pharmacist was a kindly, approachable figure in our community and he knew us all well.
In the intervening years, we've seen the development of impersonal pharmacy chains across Ireland and the rise of often inaccurate self-diagnosis via internet searches and online chatrooms, but community pharmacists are fighting back by offering a broader range of services and advice to their local communities, based on experience dealing with families through the generations.
"I feel like I'm emotionally immersed in village life. I remember children being born who are now coming into the pharmacy for Transition Year work experience and I've supported many people through difficult times," says pharmacist Kathy Maher, who runs the Haven pharmacy in Duleek, Co Meath, with her pharmacist husband, Tom Maher.
Ms Maher, who is a former president of the Irish Pharmacy Union (the IPU is the representative body for community pharmacists in Ireland) describes the local pharmacy as the "hub of the community". However, like many other family-owned pharmacies, the Mahers' joined a pharmacy co-operative, Haven, recently to allow them to bulk-buy products to compete with the lower prices pharmacy chains offer. "It also gives us contact with other pharmacists who are facing similar challenges in their own communities," she says.
We often think of pharmacies as the go-to place for prescription and over-the-counter medicines but while these aspects continue to be central, pharmacies now offer a range of services and advice that you might not expect.
“At this time of the year, many people come in for advice on how to deal with colds, coughs and sore throats. We reassure them by explaining that their symptoms are more likely to be caused by a viral infection. A viral cough can last up to four weeks and you can have ear pain or a sore throat from a virus for up to seven days,” says Maher.
However, she says families have to be more vigilant when children are ill. “I get a lot of calls from parents who say they’ve given paracetamol or ibuprofen to their child and the child’s temperature is still 40. I keep in touch with them and offer advice on whether they need to bring their child to the doctor or not,”says Maher. She also recommends the HSE website undertheweather.ie which offers advice from GPs and pharmacists on colds, flu, rashes and tummy bugs.
Maher also believes that pharmacists can support people with minor illnesses so that there is less overcrowding in doctors’ surgeries. “There is UK research that suggests 18 per cent of GP time is taken up with minor ailments that could be deal with by a pharmacist. We can filter people if they come to the pharmacy to see if an antibiotic is needed or not. We can also help them to manage viral illnesses with over-the-counter medicines, advice and self help,” she says
Tomas Conefrey is the pharmacist at the family-run Care Plus pharmacy in Pearse St, Dublin. His late father, Caillin "Con" Conefrey, set up the pharmacy over 60 years ago and Tomas's mother, Peggy, and brother, Caillin, also work in the pharmacy today. The family opted to join the Care Plus group to help them redesign the pharmacy, give them access to a range of branded information leaflets and better deals on medicines and cosmetics.
Conefrey says his regular customers either live or work locally. “There are a lot of Dublin City Council flats nearby and we know the families through the generations – from grandmothers to mothers, daughters and now their children,” says Conefrey. He says that the consultation room added to pharmacies in the past few years gives customers more privacy to discuss personal issues.
These consultation rooms are also used for flu vaccination which pharmacists are allowed to give since 2011. “We have older people and some pregnant women who come to us to get their flu vaccination,” he explains. Pharmacists are also allowed to prescribe various types of emergency contraceptives in recent years. “I’m delighted with that service because it can be done discreetly in the consultation room. And, it’s also an opportunity to bring up the subject of sexually transmitted infections and give people information leaflets on them,” says Conefrey.
Maher suggests it’s easier for pharmacists to encourage other groups such as healthcare workers and carers to get the flu vaccine. “We have a good opportunity to remind healthcare workers and carers to get the flu vaccine when they come into the shop. It’s important because by getting the flu vaccine, they aren’t just protecting themselves from catching the flu but they are also protecting those they care for,” says Maher. She also visits the local Men’s Shed group and advises the men there to get the seasonal flu vaccination. Since October, 2015, pharmacists can also give vaccination for shingles and the pnemococcal disease but reimbursement arrangements have not yet been put in place.
The IPU points out that in most states of America, pharmacists also offer vaccinations for tetanus and hepatitis A and B and travel vaccines. “We would like to see our pharmacy vaccination services extended to include a similarly wide range of vaccines,” says a spokesperson for the IPU.
Conefrey says that one of the most enjoyable parts of his job is supporting drug users to come off drugs via the methadone programme. “I feel like I’m giving back to the community by looking after these people. I always do my best for them. We see people on methadone more than they see their doctors, so we can be a friendly ear and let them offload if they need to,” he says.
Many pharmacies now offer a range of services – either through renting equipment from the shop or by inviting in healthcare specialists to consult with customers. “We have a new 24-hour blood pressure monitoring service that we rent to customers for €50. Following the home-monitoring, we print out a report that is given to the GP,” explains Conefrey.
The Mahers in Duleek offer cardiac assessment to their customers for €30. This 30-40 minute session includes checking family history, cholesterol and blood-pressure levels and providing a cardiac risk assessment report.
Some pharmacies also invite opticians, audiologists or cancer prevention specialists to give customers consultations. The Care Plus pharmacy on Pearse St, Dublin, invites a dietician into the pharmacy four times a year to give free consultations to customers. “Before the dietician’s visit, I have people in mind who I then set up with appointments for when she comes in,” says Conefrey.
And some pharmacists also go out into the community to give talks to patient groups. “I organise monthly talks in the community centre to groups with migraine, arthritis or heart disease. Sometimes, a patient will speak too. Really, I believe that it’s possible to have a fulfilling and good quality life with a chronic condition with the right information and support,” says Maher.
Managing the medications for people with long-term conditions such as diabetes or heart disease is another important role of pharmacists. This can range from sorting medicines (according to the time/day they need to be taken) into week-long blister packs to explaining potential side effects and keeping an eye out for drug interactions.
“When I was first qualified, I was petrified of drug interactions but over time, your judgment improves. We’re more likely to pick up on prescription errors such as incorrect drug dosage than drug interactions nowadays. We also advise people when is the best time to take their medicines,” says Conefrey.
There are a number of over-the-counter medicines that are on restricted sale because of their potential addictive nature. These include codeine-containing painkillers and paracetemol. “We have to ask who are these medicines for when someone comes in to buy them or ask questions if someone is continually coming back for more,” says Conefrey.
Kathy Maher believes pharmacists could have a greater role in encouraging people to take their medicines appropriately. “Non compliance is a huge area of cost [for a health system]. I always say that the most expensive medicine is the one not taken properly or not taken at all. People can end up with complications that require much more costly treatment by not taking their medicines correctly,” she says.
Maher says that community pharmacists who know their patients well can predict which people will decide not to take their medicines and who won’t take them correctly. “The IPU has called on the Government to follow the UK example by offering a new medicines’ service from pharmacists. This would involve a pharmacist having a pre-arranged phone call or face-to-face consultation 10-14 days after a new medicine has been prescribed. This would allow the person to talk about side-effects, ask questions and understand better what the drug is for. In the UK, compliance and [appropriate] GP referral have increased with this scheme,” she says.
Maher also believes that there are other measures that would relieve the overburdened GP services. These include a minor-ailments scheme in which pharmacists would be able to dispense over-the-counter medicines to medical card holders for free. Currently, medical card holders have to see their GP before they can get free access to over-the-counter medications for conditions such as athlete’s foot, vaginal thrush or dry eyes.
The issue of disposing of medicines safely is one that concerns many pharmacists. Most of us know that medicines can’t be put into householder’s waste disposal bins. But, the problem is that most pharmacists will only accept unused medicines from their own customers.
“There is a huge level of wasted medicines left over when people die. We get carrier bags full of medicines that if they had been taken, the person might not have died,” says Maher.
Going to the chemist’s
The Irish Pharmacy Union (IPU) estimates that there are about 1.5 million visits to a pharmacy every week. This makes pharmacists the most accessed healthcare professionals in Ireland. In their recent pre-budget submission, the IPU argued that the Government could get greater value and efficiency from the health budget if it allowed pharmacists to deliver more health services.
The union says that pharmacists here have the expertise, skill-set and contact with the public to introduce services like health screening, a minor ailment scheme, new medicine service or chronic disease management. They propose the introduction of a Minor Ailment Scheme in pharmacies which would give medical card patients access to free medicines for common illnesses without having to visit a GP. Last November, the IPU with the HSE, carried out a three-month Pharmacy Minor Ailment Scheme pilot in four towns around the country and the IPU is now recommending that this should be rolled out nationally.
The IPU also suggests that a New Medicine Service provided by pharmacies could better support people who have been newly prescribed a medicine for certain long-term conditions or therapies (such as asthma, COPD, Type 2 diabetes, hypertension, antiplatelet/anticoagulant therapy, statin therapy and chronic pain). The document suggests that such a scheme would help people to continue to take their medicines correctly while bringing cost savings to the healthcare system.
The IPU would also like to see an increase in the number of medicines available without prescription. These include newer anti-allergy medicines and a wider range of analgesics, many of which are already available without prescription in the UK and elsewhere.
