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Socio-behavioural aspects of treatment with medicines CHAPTER 4
promotion of rational and economic prescribing and
appropriate medicine use. According to GPP the objective of each element of pharmacy service should be
relevant to the individual, clearly defined and effectively communicated to all those involved.
In satisfying GPP requirements, professional factors should be the main philosophy underlying practice. Economic factors are also important, but they
should not be the driving force. Pharmacists should
give their input to decisions on medicine use, and a
therapeutic partnership with physicians and good
relationships with other pharmacists are important.
Pharmacists are also responsible for the evaluation
and improvement of the quality of services given.
There is a need for keeping patient profiles and to
record pharmacists’ interventions (see also Ch. 15).
Pharmacists need independent, comprehensive, objective and current information about medicines.
They should also accept personal responsibility for
lifelong learning and educational programmes should
address changes in practice. National standards of
GPP need to be put in place and adhered to.
According to the guidelines there are four main
elements of GPP: promotion of good health, supply
and use of medicines, self-care and influencing prescribing and medicine use. It also encompasses cooperation with other healthcare professionals in health
promotion activities, including the minimization of
abuse and misuse of medicines. Professional assessment of promotional materials for medicines should
also be carried out and evaluated as well as information about medicines and health care disseminated to
the public. The involvement in all stages of clinical
trials is also recommended. The guidelines include
further areas within the four main elements that need
to be addressed, such as national standards for facilities for confidential conversation, provision of general
advice on health matters, involvement in health campaigns and the quality assurance of equipment used
and advice given in diagnostic testing. In the supply
and use of prescribed medicines, standards are needed for facilities, procedures and use of personnel.
Assessment of the prescription by the pharmacist
should include therapeutic aspects (pharmaceutical
and pharmacological), appropriateness for the individual and social, legal and economic aspects.
Furthermore, national standards are needed for
information sources, competence of pharmacists and
medication records. Advice should be given to ensure
that the patient receives and understands sufficient
oral and written information. It is also important to
have standards on how to follow up the effect of
prescribed treatments and the recording of professional activities. When trying to influence prescribing
and medicine use, general rational prescribing policies
and national standards are needed. In research and
practice documentation, pharmacists have a professional responsibility to document professional practice experience and activities and to conduct and/or
participate in pharmacy practice research and therapy
research. These guidelines form an international consensus on current practice of pharmacy and point to
the direction for national guidelines and efforts to
improve it.
Outcomes of medical treatment
Evaluation and outcomes
research
Evaluation and outcomes research are fairly new
topics within pharmacy. They are integral elements
of pharmaceutical care and much more effort needs to
be put into these aspects of pharmacy practice and
research in the future. Evaluation has been defined as
making a comparative assessment of the value of the
intervention, using systematically collected and analysed data, in order to make informed decisions about
how to act or to understand causal mechanisms and
general principles. One important aspect from
society’s point of view is the question ‘What are we
getting for our money?’ According to the model originally proposed by Donabedian, evaluation of health
care can focus on:
*
Structure – e.g. facilities, equipment, money,
number and qualification of personnel
*
Process – e.g. activities by staff and patients,
prescribing, counselling
*
Outcomes – e.g. intermediate outcomes such as
patients’ knowledge and behaviour, and final
outcomes such as cure of the disease.
Traditionally evaluation has focused on structure and
process and to a lesser extent on outcomes. More
recently a whole new research field has emerged
within health care called ‘outcomes research’.
One difficulty in health-related outcomes research
is to demonstrate the linkages between the three elements of the model: structure–process–outcome. For
example, will a new computer-based patient medication record system in the pharmacy (structure)
improve the follow-up of a patient (process), so that
the pharmacist is able to detect more efficiently a
49
SECTION ONE Pharmacy practice and society
medicine-related problem in the use of the antihypertensive medicine with the outcome of lowered blood
pressure and the patient feeling better and living a
healthier, longer and happier life (outcome)? Even if
there is little empirical evidence, it is the general view
that good structure leads to a more appropriate process resulting in better outcomes.
A general observation in the healthcare field is that
we still lack evidence of many widely used procedures
and interventions. Since the mid 1960s new medicines have undergone clinical trials and an official
evaluation through the registration process. This does
not mean that all medicines currently on the market
or being marketed are safe, effective, economic or
appropriate. Furthermore, even if we have only
high-quality medicines on the market, the outcome
of medical treatment is ultimately dependent on how
the medicines are being prescribed by physicians and
used by patients.
Within the pharmaceutical field a more comprehensive framework has been proposed by Kozma
and his colleagues. This model, named ECHO, classifies outcomes in three categories: economic, clinical and humanistic outcomes. Clinical outcomes
have been defined as medical events that occur as
a result of the condition or its treatment. Economic
outcomes are the direct, indirect and intangible
costs compared with consequences of medical treatment alternatives. Humanistic outcomes include
well-being, health-related quality of life and patient
satisfaction.
Health-related quality of life
The primary objective of health care is to improve
patients’ quality of life. To what extent this objective
is achieved often remains unanswered. This may be
due to lack of proper measures, the knowledge and
attitudes of healthcare providers or some other factor.
The central feature and objective of pharmaceutical
care is to achieve outcomes by identifying, solving
and preventing medicine-related problems that will
improve a patient’s quality of life. In experimental
settings this has been shown to be the case. To what
extent it is achieved in ordinary everyday practice is
still an open question.
A classic list of outcomes in medical care has been
crystallized in the ‘five Ds’ – death, disease, disability,
discomfort and dissatisfaction. These include a wide
range of different aspects, but are all negative terms.
They will give partial answers to the questions about
the quality of life of the patient, but are not sufficient
to cover all aspects of quality of life. The term ‘healthrelated quality of life’ has been used quite differently
in the literature and daily practice. Explicit definitions
are quite rare because of the multidimensionality of
the concept. The domains of health-related quality of
life usually include functional health (physical activity, mobility and self-care), emotional health (anxiety,
stress, depression, spiritual well-being) social and role
functioning (personal and community interactions,
work and household activities), cognitive functioning
(memory), perceptions of general well-being and life
satisfaction, and perceived symptoms.
Health-related quality of life has been measured
with disease-specific instruments and general or g eneric instruments, e.g. health profiles and measures
based on utilities. Disease-specific instruments provide a greater detail concerning functioning and
well-being in that particular disease. The diseasespecific measures (e.g. those used in hypertension
and asthma) can also be further categorized as population specific (e.g. elderly), function specific
(e.g. sex ual) and condition specific (e.g. pain).
Examples of these instruments include the Asthma
Quality of Life Questionnaire and the Diabetes
Quality of Life Questionnaire.
The generic measures include health profiles,
which constitute a number of questions covering the
different aspects giving separate scores for each domain of life mentioned earlier. Examples include the
Nottingham Health Profile, Sickness Impact Profile,
McMaster Index and SF-36. The advantage of health
profiles is that they provide a comprehensive array of
scores that is multidimensional. If the measure used is
sensitive enough, through the profile we may be able
to distinguish, for example, when a medicine influences the emotional domain while having no effect on
the functional health domain.
The utility-based measures incorporate specific patient health states while adjusting for the preferences
(utilities) for the health state. The outcome scores
range from 0 to 1, where 0 represent quality of life
associated with death and 1 represents perfect health.
The preferences have been empirically tested in different populations and been through a validation process.
These utility-based measures have been extensively
used in pharmacoeconomics research and more specifically in cost–utility analysis (see Ch. 19).
The most accurate and comprehensive end result
may be achieved by using both a generic and a diseasespecific measure when possible. The focus in current
medicine is more on patient-perceived impact on
50
Socio-behavioural aspects of treatment with medicines CHAPTER 4
long-term morbidity than on limiting mortality. It is
good to remember that medicines can both increase
and decrease the quality of life. The goal of medical
therapy is to improve health and make patients feel
better. Physiological measures may change without
people feeling any better. Treatment of mildly elevated blood pressure is a good example of this. Nevertheless, treatment may improve subjective health
without any measurable changes in clinical parameters. There may also be a trade-off between positive treatment outcomes and adverse events.
Client and patient satisfaction
An important aspect when measuring the outcomes of
pharmacy practice and pharmaceutical interventions is
the satisfactionof clients and patients. Measurementof
client satisfaction can be an important tool in quality
assurance of pharmacy practice (see also Ch. 11).
There are difficulties in defining the quality of pharmacy services. One approach is to divide the quality
into a technical dimension (i.e. what is offered) and a
functional dimension (i.e. how it is offered). Different
proposals have been made to cover different aspects of
serviceprovisionin general. One comprehensivemodel
is that by Parasuram. He distinguishes between 10
different dimensions: reliability, responsiveness, competence, access, courtesy, communication, credibility,
security, understanding/knowing the customer and
tangibles. Hedvall has presented a somewhat simplified model. She has proposed four dimensions: professionalism, commitment, confidentiality and milieu,
which also contain the essence of what Parasuram has
proposed. Customers may have difficulties in distinguishing between all 10 dimensions and some of them
tend to overlap. The proposed dimensions represent
important aspects to both prescription and self-care
clients visiting the pharmacy. These aspects also have
a direct linkage to communication skills and pharmaceutical care.
Measurement of patient satisfaction has usually
focused more specifically on aspects in providing care.
Cleary & McNeil have listed the following dimensions
that are typically covered in the measurements of
patient satisfaction: accessibility and availability of
care, convenience, technical quality, physical setting,
efficacy, personal aspects of care, continuity and economic aspects. In these dimensions we can distinguish
a technical or cognitively based evaluation of the services offered and also an emotional or affective aspect
– how well they are offered. The significance of client
satisfaction can be correlated to patronage, patient
adherence, and ultimately to the survival of the pharmacy profession.
KEY POINTS
*
Medicines have a wider function than merely
treating disease
*
Rational use of medicines is defined in terms of
safety, effectiveness, appropriateness and
economics
*
Society expects medicines used to be safe and
attempts to achieve this by employing legislation
and regulation supported by pharmacoepidemiological studies
*
Patients’ medicine use behaviour is influenced by
complex social and behavioural factors
*
Prescribing is a complex process in which the
prescriber has to balance cost, effectiveness, sideeffects and the patient’s wants
*
The professional status of pharmacy can be
determined from its role in society and the service
characteristics of pharmacists in society
*
Pharmacy is changing from a ‘storage and supply’
function only to include an advisory and monitoring
role in the context of pharmaceutical care
*
Evaluation of health care is achieved by measuring
structure, process and outcomes
*
Outcomes may be economic, clinical or humanistic
*
Health-related quality of life can be assessed using
disease-specific questionnaires or general health
profiles
51
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Chapter Five
Pharmacy and public health
Roger Walker
5
STUDY POINTS
*
The principles of public health
*
The determinants of health and lifestyle
determinants of health
*
Different measures of deprivation
*
What is public health pharmacy?
*
Opportunities for pharmacists to be involved in
public health pharmacy
Introduction
Over the past 30 years, pha rmacists have received
wide recognition for their considerable knowledge,
skills and e xpertise in dealing with medicine-related
issues at the level of the individual patient. In contrast, they appear to have struggled with the concept
of contributing to the wider public health agenda.
Perhapsthishasarisenbecausepharmacistsaremost
comfortable operating in situations where they determine the agenda and their work is focused on
tackling medicine-related issues. Working with
other agencies as part of a multidisciplinary team
to address population-wide public health issues is a
relatively new challenge that requires additional
knowledge and skills.
There is an irony to the current situation because
for many years pharmacists have addressed a range of
public health issues by giving lifestyle advice on issues
such as smoking cessation, diet, substance misuse, sexual health, alcohol and exercise to the population they
serve. Pharmacists have, however, generally failed to
recognize these as public health interventions. Perhaps
only in recent years has pharmacy started to recognize
its public health contribution following the publication
of key government strategies to develop public health
pharmacy (Department of Health 2005). This chapter
will help the reader better understand the principles of
public health and the partnerships required to deliver
the public health agenda and identify what the pharmacist can contribute.
What is public health pharmacy?
There are many definitions of public health in common use but perhaps the one most widely used in the
UK is: ‘The science and art of preventing disease,
prolonging life and promoting health through the organized efforts and informed choices of society’
(Acheson 1998).
Central to this definition is the concept that
promoting public health is not solely an evidencebased science. For those working within public
health there is also a need to understand diffe rent
sociological groupings within society and work with
others to support and persuade the population or
sectors within society to make changes that may
bring health benefit. This can also be interpreted
as promoting a ‘health service’ in which resources
are expended on both encouraging people to adopt
a healthy lifestyle a nd protecting them from communicable diseases. This is in contrast to an ‘ill
health service’ that many feel the current healthcare system resembles and which prim arily targets
resources at those who a re ill.
Typically, those employed in public health work
across organizations such as local health service bodies, local authorities and local communities in settings
ranging from acute hospital trusts and local health
SECTION ONE Pharmacy practice and society
organizations through to local authorities, social services and the voluntary sector. Much of the work is
long term and will take several years before any outcomes materialize that will have a lasting impact on
health.
As a corollary to the definition of public health
presented above, public health pharmacy can be defined as: ‘The informed application of pharmaceuti-
cal knowledge, skills and resources to promote public
health’. This d efinition (Walker 2000)reflectsa
pragmatic approach to public health pharmacy and
can be applied to whatever the preferred definition
of public health is. This approach has proved useful
to help understand what pharmacy can contribute
but it has misled some to believe that public health
pharmacy is a discipline in its own right. This is incorrect. Public health requires a multidisciplinary
team approach and pharmacy is but one of the contributors, and often with a strong focus on medicinerelated issues.
If pharmacy restricts its public health contribution to medicine-related issues, and given that taking
amedicineisthemostcommoninterventionin
health care, it will always be in a position to have
some impact on public health. However, to influence the wider determinants of health is more challenging and requires an appreciation that more than
70% of what determines an individual’shealthlies
outside the domain of the health services and within
demographic, social, economic and environmental
conditions. To neglect these wider determinants will
result in pharmacy failing to make its o ptimal contribution to public health. For example, there is
limited o pportunity to improve the health of a patient with asthma by counselling them on the correct use of their inhaler when wider public health
issues are i nfluen cing treatment outcome . The individual may live in poorly heated, damp, infested
accommodation, have a low paid job that involves
working in a dusty or dirty environment, be poorly
educated, have few or no friends or family to support them and have poor mental health. In addition,
they may continue to smoke cigarettes, take little
exercise and eat too many cheap, high fat content
foods. It is clear that these factors will impact on
good disease management, but the influential factors are often much less obvious than described
above. To be aware of the wider determinants of
health is important as each c arries a significant
health burden. Moreover, many health burdens have
a significant link with deprivation. A number of
these are summar ized in Ta b l e 5 . 1 .
Wider determinants of health
Most measures of population health show that it has
improved markedly over the past 150 years. For example, life expectancy in England and Wales has improved in every decade since the 1840s. In 1841 life
Table 5.1 Examples of indicators that have been shown to have a significant association with deprivation
Domain Indicator Increased deprivation
significantly associated
with indicator
Lifestyle health determinant Smoking Yes
Excess alcohol consumption No
Healthy diet Yes
Physical inactivity Yes
Health status Obesity Yes
Physical functioning Yes
Bodily pain Yes
General health Yes
Vitality Yes
Social functioning Yes
Role – emotional Yes
Mental health Yes
Low birth weight Yes
Continued over
54
Pharmacy and public health CHAPTER 5
Table 5.1 (Continued )
Illness and injury Depression and/or anxiety Yes
Hearing Yes
Eyesight Yes
Limiting long-term illness Yes
Arthritis Yes
Back pain Yes
Respiratory disease Yes
Asthma Yes
Diabetes Yes
High blood pressure Yes
Heart disease Yes
Angina Yes
Heart failure No
Cancer registrations Yes
Pedestrian injury 4–16 years reported to police Yes
Pedestrian injury 65+ years reported to police Yes
Pedestrian injury 5–14 years hospital inpatient Yes
Use of health service Dentist Yes
Family doctor Yes
Hospital inpatient (persons) Yes
Coronary heart disease admission Yes
Angiography Yes
Revascularization Yes
Hip replacement Yes
Knee replacement No
Lens replacement No
Infant mortality Yes
Deaths All-cause persons Yes
All-cause females Yes
All-cause males Yes
All cancer Yes
Colorectal cancer Yes
Lung cancer Yes
Breast cancer Yes
Coronary heart disease No
Stroke Yes
Respiratory disease Yes
Unintentional injury Yes
Road traffic injury Yes
Unintentional fall Yes
Suicide Yes
expectancy for males was 41 and this had increased to
75 years by 1998. The equivalent improvement for
females was from 43 to 80 years of age. Much of the
improvement seen has been the result of environmental and social changes rather than developments in
medicine and health care. Despite these overall
improvements, social inequalities have widened, with
improvements in the health of the most disadvan-
taged groups being relatively small. To illustrate these
inequalities we can look at the life expectancy of those
who live in the most and least deprived areas of our big
cities. In Scotland, for example, people living in the
most deprived districts of Glasgow have a life expectancy 12 year shorter than those in the most
affluent areas (NHS Health Scotland 2004). In
London , boroughs a few miles apart have markedly
55
SECTION ONE Pharmacy practice and society
Figure 5.1*Schematic model of the determinants of health (Dahlgren & Whitehead 1991).
different life expectancies. Each of the eight tube
stations on the Jubilee line from Westminster to
Canning Town represents a decline of one further
additional year in life expectancy for the resident
population (Department of Health 2004).
The landmark work of Dahlgren & Whitehead
(1991) highlighted the main factors that determine
the health of a given population (Fig. 5.1). The age,
gender and genetic make-up of an individual clearly
influence the health potential of that individual although each is fixedand non-modifiable. Other factors
that influence health and which can be modified to
have a favourable impact include addressing individual
lifestyle factors such as smoking, diet and physical activity. Improving interactions with friends and relatives,
and developing mutual support within a community
can help sustain health. Other wider influences on
health include living and working conditions, food provision, access to essential goods and services, and the
56
overall socio-economic, cultural and environmental
conditions. There are too many factors to discuss in
detail here, but a number of the relevant, key determinantsare outlined below. However,the simple message
is that, whether attempting to evaluate mortality, morbidity or self-reported health, and regardless of whether it is income, class, house ownership, deprivation,
social exclusion or similar indicator or combination of
indicators that is used as the socio-economic indicator,
those who are worse off in society have poorer health.
Employment and
unemployment
Both employment and unemployment can be associated with adverse effects on health. Job security has
also been recognized as important for well-being. The
trend towards less secure, short-term employment
Pharmacy and public health CHAPTER 5
Box 5.1
Examples of the health burden on individuals
who may be unemployed
*
Increased smoking
*
Increased alcohol consumption
*
Reduced physical activity and exercise
*
Increased use of illicit drugs
*
Increased sexual risk-taking and sexually
transmitted diseases
*
Increased weight gain
*
Reduced psychological well-being, e.g. self-harm,
depression, anxiety
*
Increased morbidity
*
Increased premature mortality from diseases such
as coronary heart disease
*
Social exclusion and isolation
affects everyone but is a particular problem for less
skilled manual workers. Unemployment imposes a
number of health burdens on the unemployed and
some of these are summarized in Box 5.1.
In addition to job security there is considerable evidence that greater control over work is associated with
positive health such as lower coronary heart disease,
fewer musculoskeletal disorders, reduced mental illness
and less sickness absence. The relationship between
status in the workforce and health has been demonstrated across the gradient from the top jobs to those at the
bottom. The landmark studies with civil servants in
Whitehall, London (Marmot et al 1984, 1991)demonstrated that even those in the next grade down from the
top had worse health than those in the top posts. Despite being in well paid and relatively secure posts, a
health gradient was observed across a range of disorders
when compared to those in the top posts.
A confounding issue when trying to interpret the
effect of unemployment on health is that people with
poorer health are more likely to be unemployed. This
is particularly true for people with long-term conditions although this does not fully explain why the
unemployed have poorer health.
Environment air quality
One of the most enduring images of poor air quality are
the photographs taken in the 1950s of London in a
dense smog. Pollution arising from the burning of
domestic coal accounted for a significant number of
premature deaths among Londoners. In the London
smog of 1952 there was almost a threefold increase
in death in the over 65s, while deaths from bronchitis
and emphysema rose 9.5-fold, pneumonia and influenza increased 4.1-fold and myocardial degeneration
increased almost threefold, along with associated
increases in hospital admissions. Although the sulphur
dioxide and black smoke from domestic coal is now a
thing of the past, other pollutants have taken their
place, notably from burning petrol and diesel in cars
and other forms of transport. Ambient levels of air
pollution continue to be associated with raised morbidity and mortality and are particularly hazardous to the
elderly, children and those with pre-existing disease.
Crime
Crime affects not only the health of the victim but
also that of the community involved. Fear of crime is a
real phenomenon that impacts on both health and
well-being. As a consequence of crime or the perception of crime, people make adjustments to their lifestyle and behaviour such as not going out after dark,
not going out alone, avoiding certain areas, not using
public transport and avoiding young people. Because
crime is often concentrated in particular neighbourhoods and the avoidance measures outlined above are
adopted, this can weaken social ties and undermine
social cohesion in these neighbourhoods.
Energy and housing
It is recognized that energy obtained from fossil fuels
must be reduced to meet international commitments
on global warming and reduce their associated adverse
impact on health. In many UK cities the trend is for
falling use by industry but increased use by transport.
Heating of houses must also become more energy
efficient. Typically housing for low income families is
the most inefficient with the use of electric fires at
standard tariff prices costing three times more than
gas central heating. There is a fuel poverty strategy in
the UK which seeks to provide heating and insulation
improvement for those who spend 10% or more of
their income on heating their home. Cold homes exacerbate many existing illnesses such as asthma and
make the individual prone to respiratory infections
(Box 5.2). In addition, fuel poverty brings opportunity
loss. Poorfamilies spend a disproportionate amount of
their income in keeping warm and this has an adverse
effect on their social well-being, ability to adopt a
healthy lifestyle and overall quality of life.
57
SECTION ONE Pharmacy practice and society
Box 5.2
Examples of the health burden of poor housing
*
Increased respiratory infections
*
Increased cardiovascular morbidity (cold housing)
*
Increased risk of infection due to overcrowding
*
Increased risk of accidents due to faulty wiring,
dangerous appliances, lack of smoke alarms,
cluttered conditions
*
Increased risk of infestation with rats and
cockroaches and the associated health risks
*
Increased risk of indoor pollutants, e.g. carbon
monoxide, radon, lead
Lifestyle determinants of health
The individual lifestyle determinants of health represent the areas in which pharmacy has traditionally
made its most significant contribution to public
health. It is therefore important to appreciate that
poverty is associated with a number of behaviours that
may have an adverse impact on health. For example,
poor people are less likely to eat a good diet and more
likely to have a sedentary lifestyle, be obese and abuse
alcohol. Cigarette smoking has one of the strongest
associations with social disadvantage, with higher
levels recorded in more deprived sectors of the population, and this in turn has the greatest cost in terms
of premature death.
Smoking
In 2006 tobacco smoking was themain avoidable cause
of premature death in the UK, responsible for more
than 120 000 deaths. Smoking causes a wide range of
serious illnesses including cancer of the lung, respiratory tract, oesophagus, bladder, kidney, stomach and
pancreas, respiratorydisease includingchronicobstructive lung disease and pneumonia, circulatory disease
such as heart disease, strokes and aneurysms, and digestive disorders such as ulcers of the stomach and
duodenum. Second-handsmoke also putsothers at risk
and has been linked to lung cancer, strokes, respiratory
disorders and infections, particularly in children.
In 2007, before the introduction of the ban on
smoking in public in England, Wales and Northern Ireland (smoking in public was banned in 2006 in Scotland), approximately 28% of men and 23% of women
were smokers, accounting for up to 10 million people
in England alone. This remains a significant problem
despite the decline in smoking seen over the past 30
years from the 53% of men and 42% of women who
smoked in the mid 1970s. Factors that continue to
predict the likelihood of smoking include challenging
material circumstances, cultural deprivation and stressful marital, personal and household circumstances.
To reducethehealthburdenofsmoking,a number of
publichealthstrategies have been putin place and these
include reducing the public’sexposuretosecond-hand
smoke, providing more support for smokers to stop,
raisingpublic awarenessof the health effects of smoking
and the benefits of stopping smoking and reducing tobaccoadvertising and theimpactof tobacco promotion,
and regulating the sales and design of cigarette packets.
With respect to the no smoking agenda the major
contribution of pharmacy is in raising awareness of the
harm caused by smoking, supporting strategies to reduce the adverse impact of smoking on health, identifying smokers who want to stop and providing these
individuals with behavioural support or referring them
to alternative sources of smoking cessation support.
Pharmacists are often in a unique position to discuss smoking cessation and opportunities to raise the
topic with individuals who visit them and who may be
unhappy with their health, have respiratory problems
or dental problems, be proactively seeking other
lifestyle advice such as cholesterol or blood pressure testing, requesting health-related products such
as cough medicines or alternative/complementary
therapies such as St John’s wort, purchasing smoking
cessation-related products or presenting a prescription for nicotine replacement therapy, bupropion or
varenicline – all are potential windows of opportunity
for pharmaceutical intervention.
Weight management
The UK is experiencing one of the world’s fastest
growing rates of obesity. In 2006 obesity was considered to be at epidemic proportions with almost 24%
of men and women classified as obese and 25% of
children aged 11–15 years of age being overweight
or obese. Such classification is often based on determining the body mass index (BMI: defined as weight
in kilograms divided by the square of height in metres)
of an individual. A BMI in the range of 25 kg/m
30 kg/m
a BMI of greater than 30 kg/m
2
indicates the individual is overweight while
2
indicates obesity.
Being overweight can seriously affectan individual’s
health and may lead to high blood pressure, type II
2
to
58