Provision of pharmaceutical care and public health services in an ambulatory elderly population

Abstract

Background: The general aim of this study was to determine an elderly population’s expectations and experiences of pharmaceutical care (PC) and public health services (PHS). The study emphasises the important role that the pharmacist should play as part of a healthcare team. It is the pharmacist’s responsibility to promote pharmaceutical services such as PC and PHS as members of the public are often not aware of the provision of these services. A literature review and empirical investigation were conducted. The literature review entailed an overview of the provision of PC and PHS to the ambulatory elderly. The role of the pharmacist in the provision of PC and PHS was also determined. Possible barriers to and benefits of PC were also identified. Method: The empirical study utilised a quantitative, cross-sectional descriptive method that employed a structured questionnaire to obtain data. The target population consisted of 150 active members of the CBCSS and the study population was 40 participants (a response rate of 26.7%), aged 60 years and older. An all-inclusive sample population was used, which meant that all members of the CBCSS centre who were willing to partake in the study were included. In order to determine the expectations and experiences of the elderly participants, a five-point Likert scale was used, (1) being “strongly disagree" and (5) being “strongly agree". Data were captured using Excel® and analysed using IBM SPSS Statistics for Windows, version 25.0. Variables were measured using descriptive statistics such as frequency, percentage, mean and standard deviation. All statistical significance was considered with a two-sided probability of p ≤ 0.05. The practical significance of results was calculated when the p-value was statistically significant (i.e. p ≤ 0.05). A dependent t-test was used to ascertain the difference between experience and expectation. The practical significance of the results was determined using Cohen’s d-value (with d ? 0.8 defined as a large effect with practical significance). Lastly, reliability was determined using Cronbach’s alpha with a reliable coefficient of 0.07 and higher. Results: The results of the study were presented in the form of two manuscripts. Manuscript One addressed the elderly population’s expectations and experiences of the provision of PC. A statistically significant difference was found between the population’s expectations and experiences. All three phases of PC, namely the assessment, care plan and follow-up phases, were examined. In this study, the results revealed that the elderly population expected to receive PC services when visiting the pharmacy, but this expectation was not necessarily met. Possible shortcomings of PC were also identified. Most of the participants indicated that their pharmacist neglected to contact other health professionals (d = 0.89) and identified incorrect medicine dosage(s) (d = 0.89) during the assessment phase. Participants mostly disagreed with the statement that the pharmacist provided goal criteria for their treatment (d = 0.92). Overall, participants were not aware nor expected the services provided during the follow-up phase. Manuscript Two dealt with the provision of PC and PHS. This manuscript also investigated the use of CBCSS by the relevant elderly population. Current chronic conditions prevalent in this elderly population were identified, the majority (90.0%) of the elderly suffering from chronic diseases. Overall, most participants (47.5%) still perceived their health as “very good". Results furthermore showed that patients were generally satisfied with their visit to the pharmacy and that most agreed that the pharmacist was a reliable source of general drug information (4.83?0.39) and information on clinical drug use (4.53?0.88). It was established that only a small number of participants made use of the full spectrum of services offered by their local pharmacy or CBCSS centre. Most of the participants (47.5%) made use of the pharmacy’s immunisation services [yearly (47.5%)] and many also used foot care services (47.5%) [monthly (42.5%)] and blood pressure monitoring services (47.5%) [monthly (42.5%)] at the CBCSS centre. The CBCSS centre also provided some activities for the elderly that were divided into three subsections for the purposes of the study, namely physical, social and cultural activities. Most of the members indicated that they participated in pilates (17.5%), Trimgym (12.5%), the Mooirivier Singing Group (15.0%) and art activities (12.5%) on a weekly basis. Conclusion: In conclusion, this study indicates that participants were generally not aware of the full spectrum of services and/or activities provided by the pharmacy and CBCSS centre, therefore only a few of them made use of these services and participated in the activities on offer. Therefore, pharmacists need to focus on promoting these services to the public, especially to vulnerable groups such as the elderly. Participants also indicated that their expectations of the provision of PC were not met. It is vital that pharmacists change their attitudes toward the provision of PC and services other than the mere dispensing of medicine. Pharmacists are in a position to provide the best possible care such as identifying and monitoring health needs to improve health-related quality of life in elderly individuals. Recommendations for future studies were made.