Janine Morgall Traulsen

Changes in Self-Concept While Using SSRI Antidepressants

In this study, the authors analyze how younger women see themselves within the context of using the antidepressants selective seroton in re-uptake inhibitors (SSRIs). Twelve in-depth interviews and 6 reinterviews were conducted with a community-based sample of women who had been taking SSRIs between 1 and 4 years. The empirical analysis revealed that SSRI users passed through stages in their careers as medicine users, these stages corresponding to how the users thought and felt about themselves. Four major changes in self-concept emerged: distressed and needing help, conflicts about taking the medicine, improvements in condition, and problems discontinuing the medicine. Users evaluated themselves from what they believed was the perspective of society, and the way they saw themselves was closely related to how they felt they functioned in everyday life.

9) Theories of professions and the pharmacist

In the preceding articles in this series we have discussed various issues impacting on pharmacy as a professional group. One key issue has been the migration of increasing numbers of women and ethnic minority groups into pharmacy. We have also discussed the re‐professionalisation agenda of pharmacy and where that links into the health services within the developed economies of the West. Both these issues raise questions about pharmacy as a profession, and in this article we attempt to understand issues affecting the pharmacy profession using sociological theories on the role of the professions in society. We begin with an overview of selected sociological theories of professions, followed by a focus on the pharmacy profession. Finally, we suggest research questions that are relevant today.

Sustaining delivery of the first publicly reimbursed cognitive service in Denmark: a cross‐case analysis

Objectives The aim was to identify local organisational factors that affect sustained delivery of the first Danish publicly reimbursed cognitive service, the Inhaler Technique Assessment Service (ITAS). The ITAS is a 10‐min interactive counselling session during which pharmacy staff assess the inhalation technique of individual asthma patients at the pharmacy counter, and correct any errors. Knowledge of how the organisation of a local pharmacy influences ITAS provision will be used to develop quality indicators as part of a targeted quality‐assurance system to support the sustainability of the service in all Danish community pharmacies.

Pharmaceutical policy and the lay public.

Almost every national and supranational health policy document accords high importance to the need to listen to and ‘empower’ patients. The relationship between pharmaceutical policy and the lay public is not direct but mediated by several actors, including health care workers, patient organisations, industry and, most recently, the media. Although the overall aim of health and pharmaceutical policy is to address the needs of all citizens, there are only a few, well organised groups who are actually consulted and involved in the policymaking process, often with the support of the industry. The reasons for this lack of citizen involvement in health and pharmaceutical policymaking are many, for example: there is no consensus about what public involvement means; there is a predominance of special interest groups with narrow, specific agendas; not all decision makers welcome lay participation; patients and professionals have different rationalities with regard to their views on medicine. Because the lay public and medicine users are not one entity, one of the many challenges facing policy makers today is to identify, incorporate and prioritise the many diverse needs. The authors recommend research which includes studies that look at: lay attitudes towards pharmaceutical policy; lay experiences of drug therapy and how it affects their daily lives; the problem of identifying lay representatives; the relationship between industry and the consumers; the effect of the media on medicine users and on pharmaceutical policy itself. The authors acknowledge that although lay involvement in policy is still in its infancy, some patient organisations have been successful and there are developments towards increased lay involvement in pharmaceutical policymaking.

The new consumer of medicine — the pharmacy technicians' perspective

Objective: Market research, and more recently health services research, has adopted the concept of the ‘new consumer’ to describe customers/patients who are becoming more demanding. This study aims to determine the relevance of the concept ‘new consumer’ for pharmacy practice, in light of the theory of ‘risk society’.Method: Qualitative in-depth interviews were carried out with seven pharmacy technicians from six different pharmacies in the Copenhagen area, Denmark. They were asked to describe developments, over time, in consumer behaviour. They were asked to focus on three themes: information, the authority of the pharmacy staff, and their predictions of the future pharmacy customer.Results: Young customers, particularly parents of pre-school children, as well as the chronically ill appeared to share the characteristics associated with the ‘new consumer’. They were: information strong (well-informed) and information seeking (inquisitive); asked critical questions; showed a desire to initiate dialogue; sought counselling and in general no longer blindly accepted the authority of the pharmacy staff.Conclusion: According to pharmacy technicians a ‘new consumer’ does exist and is visible in community pharmacies in Copenhagen. Seen in light of the theory of risk society, we further conclude that the behaviour of the ‘new consumer’ is indicative of an attempt to minimize risk of drug therapy.

Rational use of medicines – an important issue in pharmaceutical policy

In this article the authors deal with issues of drug utilisation from a clinical and policy perspective. They address the difficulties of managing drug therapy on a population level, which is known among professionals, as the problem of rational use of medicines. Various definitions and interpretations are presented and compared. This is followed by a presentation of the concerns associated with pharmaceutical marketing from a policy perspective, including the fear that the dominance of information produced by industry may lead to irrational drug use. Next, the authors review the tools for policy making including educational, managerial, and regulatory interventions. The (often overlapping) concepts of medicines management, clinical pharmacy and pharmaceutical care are then discussed to show how professionals, sometimes in collaboration with policymakers, have tackled the problem of nonrational use of medicines. The authors address the question as to whether the rational use of medicines a universal concept, whether it can be and whether it should be? They argue that, as with most concepts, the rational use of medicines must always be viewed in context. They conclude that pharmacy needs to adapt its way of thinking to include the issue of context. They point out that clinical pharmacists today already adapt their decisons to each patient and patient group. Policymakers are encouraged to adopt a similar approach because populations as well as particular market situations vary and therefore policy solutions cannot be considered universal.

Perceptions of young women using SSRI antidepressants — a reclassification of stigma

Objective — To contribute to an understanding of young womens perspective on using selective serotonin re‐uptake inhibitors (SSRIs).

Challenges to counseling customers at the pharmacy counter—Why do they exist?

Challenges to engage pharmacy customers in medicine dialogues at the counter have been identified comprising a new and extended clinical role for pharmacists in the health care system. This article seeks to expand understanding of factors involved in successful interaction at the pharmacy counter between customers and pharmacy staff to develop their relationship further. Practical challenges to customer encounters experienced by community pharmacists are discussed using theory from the field of mainly inter-relational communication and particular studies on pharmacy communication. Preconceived expectation of customers, the type of question asked by pharmacy staff, and differences in perception of illness and medicines between staff and customers are discussed. Both staff and customer influence the outcome of attempts by pharmacy staff to engage customers in dialogue about their medicine use through a complex mechanism of interaction. It is recommended that practitioners and researchers begin to distinguish, both theoretically and practically, between the content of a conversation and the underlying relationship when exploring and further developing the therapeutic relationship between pharmacy personnel and customers.

Studying and evaluating pharmaceutical policy—becoming a part of the policy and consultative process

In this last article in the series the authors focus on the issue of researching and evaluating pharmaceutical policy. The past five articles made an argument for why pharmaceutical policy is important and why it is different from health policy. The evidence base needed for pharmaceutical policymaking is also somewhat specialized in relation to health policy. Taking these differences into consideration the authors provide their definition of pharmaceutical policy. The knowledge base for good pharmaceutical policymaking needs to be broad and include approaches and methodologies ranging from the highly quantitative and experimental to the purely qualitative. Other policy questions such as those concerned with rational use of medicines and economics illustrate that pharmaceutical policy needs more varied approaches than randomized clinical trials alone can provide. The importance of gaining a thorough overview and understanding of the available design and methodological options for policy analysis is emphasized. Research into pharmaceutical policy has many commonalities with evaluation and policy analysis. Some of the main pitfalls that policymakers, researchers and analysts can fall into when formulating and evaluating pharmaceutical policy are discussed and include: using too narrow evaluation questions; choosing inappropriate methods/designs; and the problem of bias and self-censorship. The␣authors conclude this series by advocating a strong focus on research and an international evaluation culture around pharmaceutical policy. They emphasize the importance of pharmaceutical specialists’ (i.e., pharmacists’) involvement in pharmaceutical policy analysis and the policy consultative process.

Actual and perceived provision of pharmaceutical care in Danish community pharmacies: the pharmacists' opinions.

Objective: The study explores characteristics of community pharmacies with respect to implementing pharmaceutical care activities. The article addresses the provision of pharmaceutical care at reality level, perceived level and policy level. Method: A cross-sectional questionnaire was sent to all Danish community pharmacies to investigate the provision of pharmaceutical care (n=288). The respondents were pharmacists. Pharmaceutical care activities were operationalised by detecting and identifying medicine-related problems, setting goals to solve medicine-related problems, and documenting efforts to solve them. A non-respondent analysis was also performed. Main outcome measure: The identification of medicine-related problems (from self-report) was used as a proxy measure of pharmaceutical care activities and compared to pharmacies’ self-reported provision of pharmaceutical care. Results: The survey response rate was 75.7. The characteristics of pharmacies that detected medicine-related problems differed from those of pharmacies with only a perceived provision of pharmaceutical care. Pharmacies that actually detected medicine-related problems focused on external cooperation regarding their pharmacy activities. Conclusion: The profiles of the perceived providers of pharmaceutical care and the respondents that detected medicine- related problems were distinct, thus indicating two separate groups of pharmacies. Pharmaceutical care has only been implemented in Denmark to a limited extent. This may be explained in part by the top-down implementation strategy conceived by the proprietor organisation.