Community-based pharmacy practice is evolving from a focus on product preparation and dispensing to becoming a health care destination within the four walls of the traditional community-based pharmacy. Furthermore, community-based pharmacy practice is expanding beyond the four walls of the traditional community-based pharmacy to provide care to patients where they need it. Pharmacists involved in this transition are community-based pharmacist practitioners who are primarily involved in leading and advancing team-based patient care services in communities to improve the patient health. This paper will review community-based pharmacy practice innovations and the role of the community-based pharmacist practitioner in the United States.

Community-Based Pharmacy Practice Innovation and the Role of the Community-Based Pharmacist Practitioner in the United States.

Ideally situated within the community, pharmacists can be involved in a broad range of health promotion campaigns including prevention of obesity. Limited evidence is available regarding their involvement in weight management in Lebanon, a country with escalating prevalence rate of obesity. To examine the role of community pharmacists in weight management in Lebanon, specifically studying their beliefs, current practices, services, and knowledge. Using a stratified random sampling approach, a cross sectional national survey of community pharmacists was conducted (n = 341, response rate 89%). At the pharmacy, and through a face-to-face interview, pharmacists completed a multi-component questionnaire that addressed, in addition to socio-demographic and work characteristics, their beliefs, practices, knowledge in relation to weight management. Frequencies and proportions were used to describe the data. Simple and multiple linear regression analyses were used to examine the determinants of knowledge in the study population. Over 80% of study participants agreed that they have an important role to play in weight management. However, 50% of pharmacists did not agree that weight loss products are well regulated and 81.1% thought that companies marketing weight loss products are making false promises. The majority of pharmacists always/often sold weight loss products (84.7%) and counseled their patients for diet (86.3%) and physical activity (91.7%). Despite taking weight and height measurements, 50% of pharmacists rarely/never calculated BMI. Among the pharmacists who reported side effects of weight loss products (46.5%), the majority (91.3%) did so to the pharmaceutical company. The knowledge of pharmacists was better for the use of weight loss products as opposed to their side effects and interactions. Significant predictors of knowledge were holding a Masters/ PhD degree in Pharmacy, graduating from a university inside Lebanon, obtaining weight management training within the academic degree, and receiving inquiries about weight management in the pharmacy more than once daily. The results of the study provided important insights on the beliefs, practices and knowledge of community pharmacists in weight management in Lebanon. These findings could be used to inform the development of future evidence-based community pharmacists led weight management service provision nationally and internationally.

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Role of community pharmacists in weight management: results of a national study in Lebanon

Previous qualitative studies exploring the experiences of community pharmacists (CP) in implementing weight management services (WMS) often lack a theoretical underpinning. This study applied the capability, opportunity, motivation, behaviour (COM-B) model to factors associated with WMS implementation among CPs to develop and recommend better intervention strategies.A qualitative study design was used by conducting in-depth, semi-structured interviews with CPs. All the interviews were audio-recorded and duly transcribed. The thematic analysis approach was used to analyse the data, and the themes generated were mapped onto COM-B model components.The themes that emerged were (1) motivation of pharmacists and (2) knowledge and skills, which were identified as both barriers and facilitators, and (3) the barriers to implementation in aspects of social norms and resources. Factors were subsequently categorised into the subcomponents of the model: physical capability (e.g., training), psychological capability (e.g., lack of knowledge), physical opportunity (e.g., product range), social opportunity (e.g., stigma), automatic motivation (e.g., remuneration) and reflective motivation (e.g., CPs extended roles).In conclusion, programs or training For Cps should develop their psychological capability to change their behaviour by being more proactive in promoting and providing weight management services, with a vital educational component. This behavioural change will improve the promotion of this service and will help many customers who were unaware of this service. Learning opportunities will leave CPs to feel more empowered and overcome barriers to implementing and maintaining WMS in primary care. The study findings provided essential insights into the factors that affect this provided service in Malaysia. The results will help to encourage the embedding of nutrition counselling in academic curricula. 

/pdf/using-com-b-model-in-identifying-facilitators-barriers-and-184bli11.pdf

Using COM-B model in identifying facilitators, barriers and needs of community pharmacists in implementing weight management services in Malaysia: a qualitative study

The objective of this practice and research network opinion paper was to identify literature for pharmacist‐led services with obesity management, summarize clinical evidence for this disease state, and describe the role of a clinical pharmacist among patients who are overweight or have obesity. Clinical pharmacists play a critical role in the safe and effective management of obesity in both the inpatient and outpatient settings. In an outpatient setting, the role of the clinical pharmacist includes a comprehensive patient interview to design an individualized therapeutic plan involving nonpharmacological interventions with or without pharmacological interventions or surgical options. A clinical pharmacist conducts a risk‐benefit analysis for pharmacological interventions. Furthermore, the potential of medications to contribute to weight gain or prevent weight loss can be reviewed by a clinical pharmacist when managing comorbid conditions. In an inpatient setting, a clinical pharmacist conducts medication reconciliation, determines appropriate supplements for nutritional deficiencies, and provides medication management for people with obesity who may or may not be undergoing bariatric surgery. In addition, a clinical pharmacist can provide thorough patient education with monitoring for transitions from hospital to the outpatient setting and subsequent follow‐up visits.

Clinical review and role of clinical pharmacists in obesity management: An opinion of the endocrine and metabolism practice and research network of the American College of Clinical Pharmacy

Introduction: Obesity is a consequence of abnormal lifestyle and poor nutrition. The aim of this paper was to show the relation between the way of nutrition and physical activity, and the increased body weight among young women. Material and methods: The survey was conducted between June and October 2014 among 176 women from all parts of Poland, at the age between 16 and 25 years. The survey was conducted on the basis of a survey questionnaire consisting of questions that covered the dietary preferences, the frequency of eating particular dietary products, and physical activity. Women were divided into two age groups, and the results that were drawn from both groups were compared. Results: Every third interviewee did not eat breakfast every day, every fifth ate her last meal too late. Women were characterised by low physical activity. The majority of them spent their free time passively, and only a small percentage of interviewees performed certain physical exercises. A large group of respondents ate highly calorific desserts. On the other hand, desserts based on fruit were eaten only by one third of the researched group. The scant amount of fruit and vegetables that should be eaten was also proven. Seventy percent of the interviewees did make certain ineffective dieting attempts. Conclusions: In the interviewed group of young, obese women we noted a range of abnormalities connected with the way of nutrition and the quality of eating products. It was seen that physical activity reduced along with increasing age. Every second respondent, in spite of their young age, complained about chronic ailments that may appear as a result of obesity. That is why it was concluded that the cause of obesity was inappropriate diet and lifestyle.

https://www.termedia.pl/Journal/-72/pdf-30532-10?filename=nutritional causes.pdf

Nutritional causes of obesity among young women

OBJECTIVES To complete a scoping review of studies of community pharmacy-delivered weight and obesity management services from January 2010 to March 2017. METHODS A scoping review was conducted to obtain an overview of research related to the study objective. The PubMed, EBSCO and CINAHL databases were searched from January 2010 to March 2017 for articles examining obesity/weight management in community pharmacies. Included studies had to contain an obesity/weight management programme delivered primarily by community pharmacies. All non-interventional studies were excluded. KEY FINDINGS Nine articles were eligible for data extraction. Across the nine included studies, 2141 patients were enrolled. The overwhelming majority of patients enrolled in the studies were female, approximately 50 years of age, had a mean weight of 92.8 kg and mean BMI of 33.8 kg/m2 at baseline. Patients in these various programmes lost a mean of 3.8 kg, however, two studies demonstrated that long-term (>6 months) weight loss maintenance was not achieved. The average dropout rate for each study ranged from 8.3% to 79%. CONCLUSIONS Obesity has a significant impact on the health and wellness of adults globally. Recent research has shown that community pharmacies have the potential to positively impact patient weight loss. However, additional research is needed into the specific interventions that bring the most value to patients and can be sustained and spread across community pharmacy practice.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/ijpp.12453

Jason Teng

Papers

Weight management counselling among community pharmacists: a scoping review