European Pharmaceutical Students’ Association
Statement of Opinion on Self-care
APRIL 2017
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The European Pharmaceutical Students’ Association (EPSA): 1. Believes that healthcare professionals should be at the core of the evolution of self-care to ensure responsible patient empowerment. Pharmacists are, as highly quali ed and accessible healthcare professionals, competent to play a central role. 2. Supports the development of increasing levels of health literacy of the population through close involvement of healthcare professionals and policies which support the accessibility of evidence-based health information to patients. 3. Calls on policymakers to always place patient safety at the centre of self-care and self-medication policies creation through reliance in support from primary care health workforce, such as pharmacists. 4. Calls on national and local decision-makers to empower the pharmacy workforce in their healthcare structure through recognising the role pharmacists can play in self-care facilitation, through supporting the integration of pharmacists in the primary care network, through creating a legal framework allowing pharmacists to o er expanded pharmaceutical services and through remunerating pharmacists accordingly. 5. Calls on the European Commission to implement the proposed changes listed in the PGEU, EAFP, EPSA, EIPG Statement on future modi cations on the Directive on the Recognition of Professional Quali cations, containing the proposed addition to Article 44.3 to ensure ‘adequate knowledge to advise patients in the use of medicines, including non-prescription medicines and use of medicines in self-care’. 6. Calls on educational institutions to include more training on clinical decision-making skills in pharmacy curricula which, together with higher inclusion of soft skills and interprofessional education, will ensure more e cient and e ective use of pharmacists in self-care models.
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1.
Introduction
European health systems are facing the need to implement cost containment measures which, together with growing consumer/patient empowerment and increased accessibility of health information via the internet, result in self-care becoming increasingly present in health systems in Europe.1 Self-care puts responsibility on individuals for their own health and well-being, and is de ned by the World Health Organization (WHO) as “the ability of individuals, families and communities to promote health, prevent disease, and maintain health and to cope with illness and disability with or without the support of a health-care provider”2. This concept includes the elements of health literacy, healthy lifestyle choices and self-medication, both for minor ailments as for the self-management of chronic diseases3,4. The European Pharmaceutical Students’ Association supports the continuous promotion of self-care across Europe as this can help to reduce the pressure on health systems due to higher e ciency and lower costs3,5. However, patient safety can be at risk when people, taking responsibility for their own health, base these self-care decisions on insu cient or false information. Close self-care facilitation and support by healthcare professionals is therefore critical to ensure e ective self-care.6 Self-medication is, as referred above, also an important element of self-care. The accessibility of self-medication across Europe di ers quite extensively, with broadly seen two types of systems that exist: countries where non-prescription medicines are available exclusively in pharmacies and countries such as the UK, Ireland and the Netherlands where some are also available outside the pharmacy for example in supermarkets, gas stations, etc7. The decision of the countries to allow the sale of non-prescription medicines outside the pharmacy is linked to the structure of the health system and its regulation should therefore remain a national competence. However, as basing self-medication decisions on insu cient or incorrect information brings risk of adverse reactions or interactions with other medicines8, European pharmacy students call on policymakers to always place patient safety at the core of self-medication policies.
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2.
The role of the pharmacist in selfcare
Pharmacists should play, due to their highly accessible and approachable nature, a central role in the ongoing self-care development. Next to his crucial role in supervising the safe use and counselling of non-prescription medicines for patients, the pharmacist is ideally placed to advise on the most appropriate treatment for common illnesses and is also the rst port of call to identify the need for referral to the respective healthcare professionals when complementary medical treatment is needed. This adds value as it o ers a triage process reducing burden on doctors. A recent study3 of the European Commission analysing the cost/bene ts of self-care systems in Europe, highlights and analyses some good practices by pharmacists in Europe in this area. For instance in the UK, minor ailment services allow eligible people to select a community pharmacist as a rst port of call for the treatment of common illnesses, ensuring access to the medicines and advice they would otherwise visit their doctor for9. These minor ailment services have not only proven to reduce the often unnecessary workload of general practitioners, but have also proven to signi cantly reduce the costs for the healthcare system whilst o ering bene ts for patients such as shorter waiting time and no need for an appointment.3 One of the conclusions of this report is then also that “pharmacists will play an increasingly important role as rst contact points. This implies a change in the de nition of pharmacists, expanding from a “dispenser” to an integrated health care professional o ering counselling, advices and new pharmacy services”. Empowering pharmacists in consulting for common illnesses is therefore an interesting practice which member states need to consider when creating self-care legislation. The pharmacy gets visited daily not only by patients, but also by a high percentage of healthy people who are targetable for self-care support. This gives the pharmacist an enormous potential in the prevention of acute and chronic diseases through educating its customers on hygiene, nutrition and other preventive measures such as su cient exercise, whilst also having a current underused potential for screening and early detection of chronic diseases. Empowering pharmacists in prevention and health literacy support for patients is therefore a key factor to be taken into consideration for health systems when deciding on
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measures to ght both communicable and non-communicable diseases. Empowering pharmacists in self-care means that health systems should: 1. Recognise the role pharmacists can play in self-care facilitation. 2. Support the integration of pharmacists in the primary care network. 3. Create a legal framework that allows pharmacists to o er expanded pharmaceutical services. 4. Remunerate pharmacists accordingly.
3. Pharmacy education in regards to selfcare In order for pharmacists to develop their advancing role in self-care, European pharmacy students believe that pharmacy education should optimally prepare the students for this advanced role. EPSA issued a Joint Statement10 together with the Pharmaceutical Group of the European Union (PGEU), the European Association of Faculties of Pharmacy (EAFP), and the European Industrial Pharmacists Group (EIPG) on the future modi cations on the Directive on the Recognition of Professional Quali cations. In Article 44.3, describing the knowledge and skills that need to be acquired during the training of pharmacists, the 4 associations called for ‘adequate knowledge to advise patients in the use of medicines, including non-prescription medicines and use of medicines in self-care’. If pharmacists want to fully utilise their potential for self-care facilitation for patients and take up a more prominent role in counselling and advising on self-medication as described above, the European pharmacy students believe that more training on clinical decision-making skills in pharmacy curricula is required. In addition, it is equally important11,12 to ensure su cient communication and interaction skills with patients and constant contact with other healthcare professionals, as a strong interconnected primary care network is key to creating a safe healthcare environment wherein self-care can be practised by patients. These calls have been more speci cally described in the EPSA Position Paper on Soft Skills13 and the Joint Policy Paper on Interprofessional Education from the European Healthcare Students’ Associations14. In order to ensure continuous high standards during the pharmacist's professional career, Continuous Professional Development programmes should also contain training and support on self-care to ensure safe and e cient patient experience.1
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About EPSA The European Pharmaceutical Students’ Association (EPSA) is the umbrella association representing 160,000 pharmacy students within 43 member associations from 35 countries across Europe. EPSA is actively engaged on both student and professional levels, bringing pharmacy, knowledge and students together and encouraging personal development of its members. EPSA facilitates discussion between member associations, by being a platform for sharing knowledge and best practices. EPSA also acts as the voice of pharmacy students in Europe and advocates their interests. By organising events on a European level, EPSA ensures knowledge transfer as well as social and cultural exchange.
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References
1.
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9.
World Health Organiza�on. "Self‐care in the context of primary health care." (2009). Available from: h ◔�p://apps.searo.who.int/PDS_DOCS/B4301.pdf European Commission, A cost/benefit analysis of self‐care systems in the European Union. Available from: h◔�p://ec.europa.eu/health//sites/health/files/pa�ent_safety/docs/2015_selfcaresystemsstudy_en.pdf Ham, Chris. "The ten characteris�cs of the high‐performing chronic care system." H ealth economics, policy and law 5.01 (2010): 71‐90. Pisce ‐ Pilot project on the promo�on of self‐care systems in the European Union Available from: h◔�p://ec.europa.eu/health//sites/health/files/pa�ent_safety/docs/ev_20150608_co52_en.pdf Lucock, Mike, et al. "Self‐care in mental health services: a narra�ve review." H ealth & social care in the community 19.6 (2011): 602‐616. Mund, Menen E., et al. "Paracetamol as a toxic substance for children: aspects of legisla�on in selected countries." J ournal of Occupational Medicine and Toxicology 10.1 (2015): 43. GAP Taskforce on Self Care Towards Responsible Self Care: The Role of Health Literacy, Pharmacy and Non‐Prescrip�on Medicines Final Report Available from: h◔�ps://www.google.be/url?sa=t&rct=j&q=&esrc=s&source=web&cd=9&ved=0ahUKEwi4qNGrrrjSAhV DyRQKHSmNBiEQFghQMAg&url=h◔�p%3A%2F%2Fwww.globalaccesspartners.org%2FGAP_Taskforce_o n_Self_Care_Report_released_23_June_2015.pdf&usg=AFQjCNGFyPqyvtvaca2xj6QaDZ9tm7p7DA&sig 2=Zv5gQE7eVbLi9tc7qVCUlA&cad=rja NHS Scotland ‐ Minor Ailment Service (MAS) Available from: h ◔�p://www.communitypharmacy.scot.nhs.uk/core_services/mas.html
10.
PGEU, EAFP, EPSA, EIPG Statement on future modifica�ons on the Direc�ve on the Recogni�on of Professional Qualifica�ons
11.
PGEU survey on Pharmacy Educa�on in rela�on to Non‐Prescrip�on Medicines/Self‐care Available from: h ◔�p://pgeu.eu/en/policy/23:self‐care.html
12.
Bell, John, et al. "Self‐Care in the Twenty First Century: A Vital Role for the Pharmacist." A dvances in therapy 33.10 (2016): 1691‐1703.
13.
EPSA Posi�on Paper on So뀑� Skiils, available from: h◔�ps://drive.google.com/file/d/0B8MZ‐y9cXM2HRklTNUs1RDE5ZGwtMnVFLXJUM1dpdTJEZktn/view
14.
EHSAS Joint Policy Paper on Interprofessional Educa�on, available from: h◔�ps://drive.google.com/file/d/0B_E9yOj4w7rrNC16eS1EaFpfSVk/view
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