CSIRO PUBLISHING
Australian Journal of Primary Health, 2015, 21, 197–204 http://dx.doi.org/10.1071/PY13118
Research
A national mailed survey exploring weight management services across Australian community pharmacies Souhiela Fakih A, Jennifer L. Marriott A and Safeera Y. Hussainy A,B A
Centre for Medicine Use and Safety, Monash University (Parkville Campus), 381 Royal Parade, Parkville, Vic. 3052, Australia. B Corresponding author. Email: [email protected]
Abstract. This study investigated pharmacists’ and pharmacy assistants’ current weight management recommendations to consumers across Australian community pharmacies using a mailed questionnaire. Two questionnaires were developed, one for pharmacists and one for pharmacy assistants, each divided into five sections. One pharmacist and pharmacy assistant questionnaire were mailed in November 2011 to a systematic sample of 3000 pharmacies across Australia for one pharmacist and pharmacy assistant each to complete. A total of 537 pharmacist and 403 pharmacy assistant responses, from 880 different pharmacies, were received. Overall 94.5% (n = 832/880) of associated pharmacies stocked weight loss products and 48.2% (n = 424/880) offered a weight management program. Both pharmacists and pharmacy assistants felt that the development of pharmacy-specific educational resources and additional training would help improve their ability to provide weight management services. Australian pharmacists and pharmacy assistants currently appear to be providing weight management services to consumers; however, not all their recommendations are evidence based. The need for additional training for pharmacy staff in areas identified as lacking and the development of pharmacy weight management educational resources needs to be addressed. Additional keywords: Australia, pharmacy, pharmacists, pharmacists’ aides, weight-reduction programs. Received 21 August 2013, accepted 13 January 2014, published online 5 March 2014
Introduction In developed, high-income countries such as Australia, overweight and obesity are considered to be the third preventable risk factor for non-communicable diseases, preceded by smoking and high blood pressure (Lopez et al. 2006). Currently in Australia, 42% of men and 35% of women are overweight and 28% of both men and women are obese (Australian Bureau of Statistics 2012). The prevalence of overweight and obesity in Australia continues to increase, with a recent study estimating that by 2025 >80% of men and >75% of women aged 20 years and over will be overweight or obese (Haby et al. 2012). Colagiuri et al. (2010) estimated that the annual total direct costs of overweight and obesity in Australia in 2005 was A$21 billion and the total direct and indirect costs of overweight and obesity could have been as high as A$56.6 billion. Due to the increased health risks overweight and obesity pose and their increased prevalence in Australia, obesity was made an Australian national health priority area in 2008 (Australian Institute of Health and Welfare 2008). Furthermore, in 2008 the Australian Government formed the National Preventative Health Taskforce to recommend key actions to help stop and reverse the prevalence of overweight and obesity in Australia. Recommendations to help make Australia ‘the healthiest county by 2020’ were outlined in the Obesity in Australia: A Journal compilation La Trobe University 2015
Need for Urgent Action report (National Preventative Health Taskforce 2008). The need to support and train primary health care providers so they can inform consumers to make healthier decisions was seen as a key priority to help prevent and treat overweight and obesity (National Preventative Health Taskforce 2008). All weight management guidelines currently recommend diet, exercise and behavioural modification therapy to be considered first in the prevention and treatment of overweight and obesity (Ministry of Health 2009; Scottish Intercollegiate Guidelines Network 2010; National Health and Medical Research Council 2013). The National Health and Medical Research Council (NHMRC) weight management guidelines for health care professionals have recently been updated and released (National Health and Medical Research Council 2013). The purpose of these guidelines is to offer primary health care professionals evidence-based weight management recommendations for the assessment and management of overweight and obesity in adults, adolescents and children. The 2013 NHMRC guidelines recommend health care professionals calculate a person’s body mass index (BMI) to determine treatment options. The guidelines also include an overweight and obesity management model for adults based on BMI (National Health and Medical Research Council 2013). It should be noted that pharmacists are not www.publish.csiro.au/journals/py
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S. Fakih et al.
*
What is known about the topic? *
Community pharmacies have become increasingly involved in providing primary care services to consumers. More specifically, there has been a recent growth in pharmacy involvement in providing weight management services.
What does this paper add? *
Australian pharmacies are providing weight management services to consumers in various ways, not all evidence based. Training and development of educational resources are necessary if pharmacies are to offer these services.
mentioned in the NHMRC guidelines, even though they have been identified previously as important primary health care providers to help prevent and treat overweight and obesity in Australia through education, health promotion and the supply of evidence-based medications and non-pharmacological advice (Bereznicki and Peterson 2008). Australia has seen an increase in the number of weight management products and programs being offered in community pharmacies. Currently, information about the number, type and location of community pharmacies offering weight management services is lacking. In addition, a large number of these weight management products and/or programs are available over-thecounter in self-selection areas, and are sold by pharmacy staff members (pharmacy assistants, pharmacy technicians), without pharmacist intervention. In Australia, pharmacy assistants do not need to complete a formal training program to sell over-thecounter products; thus, training and experience varies widely. Nutrition training among pharmacists also varies. Little is known about what nutritional training is provided to practising pharmacists and pharmacy students. A South Australian university research team identified gaps in nutrition knowledge among practicing pharmacists (Pearce and Cross 2013). In an Australian study using semistructured interviews with 20 pharmacists, participants expressed the need for additional training in areas of nutrition and physical activity (Um et al. 2010). In addition, these authors found that pharmacists were happy to provide weight management services for consumers if they had sufficient training in an accredited program that offered up-to-date evidence-based information on products and programs, and contained information regarding suitable weight management recommendations (Um et al. 2010). Although studies of this type have been conducted overseas (Dastani et al. 2004; Bradley 2009; Newlands et al. 2011; Awad and Waheedi 2012), no study has previously investigated weight management recommendations made by pharmacists and pharmacy assistants in Australia. Thus, the aims of the present study were to: determine the current weight management services provided by Australian community pharmacies *
*
determine the knowledge and practices of Australian pharmacy staff (pharmacists and pharmacy assistants*) towards weight loss programs and products gain an insight into pharmacy assistants’ and pharmacists’ current weight management recommendations to help determine whether pharmacists and pharmacy assistants use recommendations outlined in the NHMRC weight loss guidelines for adults (National Health and Medical Research Council 2003) and, if not, what recommendations they make.
Methods Development of the survey questionnaire The questionnaires used in the present study were based on questionnaires used by Bradley (2009) and Newlands et al. (2011), and refined to reflect Australian practice. Two questionnaires were developed, one for pharmacists and one for pharmacy assistants. Section A asked questions regarding the respondent’s demographic characteristics, Section B asked questions regarding weight management services provided at the pharmacy, Section C focused on current weight management recommendations provided by the respondent, Section D focused on future training areas and further support required, and Section E contained one of five case vignettes that explored specific recommendations around common weight management scenarios. This paper reports the results from Sections A–D. The questionnaire was piloted for face and content validity by academics, pharmacists and pharmacy assistants. Changes were made based on their feedback to produce the final questionnaires (available as Supplementary Material for this paper). Sample size and randomisation To ensure that the sample proportion was within 0.05 of the population proportion with a level of 95% confidence, it was calculated that for each pharmacist and pharmacy assistant questionnaire, 357 questionnaires needed to be returned (Krejcie and Morgan 1970). Of the 5000 pharmacies located in Australia, 3000 were randomly selected. Pharmacies were chosen at random from each state and territory from the pharmacy premises list, which was obtained from the pharmacy premises regulatory authorities. A proportional number of pharmacies were chosen from each state and territory (i.e. 60% of pharmacies from each state and territory in Australia were randomly selected). Randomisation was performed using Excel 2010 (Microsoft, Redmond, WA, USA). Each pharmacy was sent two questionnaires, one pharmacist questionnaire and one pharmacy assistant questionnaire, to complete and return. Survey administration Data were collected using an anonymous mailed questionnaire during November 2011. The Dillman protocol was used for questionnaire distribution (Dillman 1991). Data analysis Data were analysed using SPSS version 19.0 (IBM, Armonk, NY, USA) and summarised using descriptive statistics.
*The term ‘pharmacy assistants’ in the present study refers to all non-pharmacist staff members who are employed in a pharmacy and work behind the medicines counter. This includes general pharmacy assistants and pharmacy technicians.
Community pharmacy weight management services
Australian Journal of Primary Health
Pearson’s Chi-squared test was used to determine any significant relationships between two categorical variables. The level of significance was set at P < 0.05. The study was approved by the Monash University Human Research Ethics Committee.
Results The overall response rate was 18% (537/2972) for pharmacists and 13.6% (403/2972) for pharmacy assistants, exceeding the minimum sample size. There were responses from 880 pharmacies across Australia, giving a response rate for pharmacies of 30% (880/2972).
199
Respondent characteristics Respondent characteristics are given in Table 1. Of the 880 different pharmacies, 41.7% (367/880) were part of a buying group and 58.3% (513/880) were operated independently. Most pharmacies (78.9%; 694/880) were classed as highly accessible based on the Pharmacy Access/Remoteness Index of Australia (PhARIA) (Australian Population and Migration Research Centre 2008). Pharmacy services provided Most pharmacists (96%; 515/537) and pharmacy assistants (88.1%; 355/403) believed pharmacies have a role in the management of overweight and obesity in Australia.
Table 1. Characteristics of the pharmacists and pharmacy assistants who responded to the survey Data show the percentage of respondents in each group, with actual numbers in parentheses. PSA, Pharmaceutical Society of Australia Respondent characteristics
Pharmacists (n = 537)
Respondent characteristics
Pharmacy assistants (n = 403)
State/territory New South Wales Victoria Queensland Western Australia South Australia Tasmania Northern Territory Australian Capital Territory
29.4% (158) 28.1% (151) 16.0% (86) 11.4% (61) 8.4% (45) 4.1% (22) 0.4% (2) 2.2% (12)
New South Wales Victoria Queensland Western Australia South Australia Tasmania Northern Territory Australian Capital Territory
28.5% (115) 26.6% (107) 17.6% (71) 11.4% (46) 7.9% (32) 4.7% (19) 0.5% (2) 2.7% (11)
Location of pharmacy based on PhARIA indexA Highly accessible Accessible Moderately accessible Remote and very remote
76.2% (409) 12.7% (68) 3.5% (19) 7.6% (41)
Highly accessible Accessible Moderately accessible Remote and very remote
80.4% (324) 10.9% (44) 3.5% (14) 5.2% (21)
Pharmacy type Part of a group Privately owned
40.2% (216) 59.8% (321)
Part of a group Privately owned
43.4% (175) 56.6% (228)
Age (years) 20–24 25–30 31–40 41–50 51–60 >60
10.8% (58) 34.8% (187) 18.4% (99) 16.6% (89) 14.5% (78) 4.8% (26)
15–19 20–24 25–29 30–39 40–49 >50
5.7% (23) 27.5% (111) 13.9% (56) 15.1% (61) 17.9% (72) 19.9% (80)
Gender Male Female
47.1% (253) 52.9% (284)
Male Female
4.3% (17) 95.7% (386)
Main role Pharmacy owner Pharmacy manager Employee pharmacist
36.3% (195) 27.9% (150) 35.8% (192)
Weight loss consultant Vitamin consultant Retail manager Dispensary technician General pharmacy assistant
14.4% (58) 3% (12) 16.9% (68) 20.1% (81) 45.6% (184)
Previous training in weight management Yes University Pharmaceutical industry (e.g. drug company) Professional organisations (e.g. PSA)
76.4% (410) 27.9% (150) 45% (242) 35.6% (191)
Yes Pharmacist(s) Pharmacy magazines (e.g. Contact) Professional organisations (e.g. PSA)
74.9% (302) 15.6% (63) 65.3% (263) 47.6% (192)
A Pharmacy Access/Remoteness Index of Australia (PhARIA) categories 2 (accessible A) and 3 (accessible B) have been collapsed into one variable called ‘accessible’. PhARIA categories 5 (remote) and 6 (very remote) have similarly been collapsed into ‘remote and very remote’.
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Australian Journal of Primary Health
S. Fakih et al.
Just over 40% (356/880) of pharmacies provided all weight management pharmacy services, including providing literature on healthy eating and exercise (79%; 695/880), displaying posters for weight loss products and/or programs (70.6%; 621/ 880), stocking weight loss products (94.5%; 832/880) and providing a pharmacy weight management program (48.2%; 424/ 880). There were no significant differences between the types of weight management services provided in Australian states and territories. This was also true for the location of the pharmacy, with no significant differences found between the different PhARIA categories and services provided. Weight loss products in pharmacies were sold behind the counter (35.7%; 314/880), in self-selection areas (61.4%), both behind the counter and via self-selection (28.5%; 251/880) or in weight management consulting booths (e.g. Tony Ferguson® Weight Loss Booth; 2.9%; 26/880). Just under 50% (424/880) of pharmacies provided a weight management program. A significantly (P = 0.02) higher number of group pharmacies (52.7%; 193/366) offered a weight management program compared with privately owned pharmacies (44.8%; 230/513). The reasons for pharmacies not offering a pharmacy weight management program included: time (35.4%; 161/456); cost (22.8%; 104/456); lack of staff knowledge (22.6%; 103/456); lack of public interest (44.1%; 201/456); lack of space (7%; 32/456); and other reasons, such as the pharmacy group not offering the service (16%; 73/456). Of the pharmacies that offered a weight management program, most found the programs to be successful in providing overweight and/or obesity treatment in a pharmacy setting (81.8%; 347/424). Women were reported to be the main consumer group for weight loss products and/or programs in over 60% of pharmacies (535/880), with both men and women being considered the main consumer group in 39% of pharmacies (344/880). Across Australia, only 25.7% of pharmacies (226/880) were referring to any guideline(s) when offering weight management advice, with most pharmacies relying on their pharmacy weight management program guideline for information (e.g. Kate Morgan’s weight loss guide; 44.2%; 100/226) or the Australian Pharmaceutical Handbook (APF) Weight Management Guide
Response rate %
Pharmacists
(Sanson 2009) and/or the Pharmaceutical Society of Australia 2006 provision of orlistat (which can also be found in the APF; 25.2%; 57/226). Fig. 1 shows the weight management classifications pharmacists and pharmacy assistants are currently using to determine whether someone needs to lose weight. Compared with pharmacists, pharmacy assistants were significantly more likely to use no measure when classifying a customer’s weight (P < 0.001). Pharmacists were significantly (P < 0.001) more likely to use BMI in combination with waist circumference (WC) when classifying a customer’s weight. Pharmacists were also significantly more likely to identify the correct BMI equation compared with pharmacy assistants (P < 0.001). Current weight management recommendations by pharmacists and pharmacy assistants Most pharmacists (61.6%; 331/537) and pharmacy assistants (64.7%; 261/403) reportedly felt comfortable approaching a customer to discuss weight loss. On average, pharmacists were spending significantly less time during a weight loss consultation with a customer compared with pharmacy assistants, with 87.3% (469/537) of pharmacists stating they would spend under 15 min during a consultation, compared with 64.5% (260/537) of pharmacy assistants (P < 0.001). Many pharmacists (61.7%; 331/ 537) and pharmacy assistants (65.5%; 264/403) stated they would take their customers to a private consultation area when discussing weight management. The reasons for not taking the customer into a private consultation area included lack of space and also the perceived ease of counselling customers on weight management products in front of the weight loss section of the pharmacy. Table 2 outlines history taking and recommendations that pharmacists and pharmacy assistants would make following a customer’s request about weight loss. Pharmacists stated that when counselling customers on medications to treat overweight- and obesity-related conditions, such as hypertension, hyperlipidaemia, type 2 diabetes etc., they would counsel on weight loss and/or maintenance: never (1.7%; 9/537); only when asked by the customer (17.5%; 94/537);
PAs
95.4% 73.7%
46.8%
16.0%
15.5% 5.3% None
19.6%
3.0% Weight
BMI and WC
Correct BMI equation
Weight management classification Fig. 1. Weight management classifications used by pharmacists and pharmacy assistants to classify a customer’s weight. PAs, pharmacy assistants.
Community pharmacy weight management services
Australian Journal of Primary Health
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Table 2. History taking and recommendations made by pharmacists compared with pharmacy assistants following a customer’s request about weight loss Data show the percentage of respondents in each group, with actual numbers in parentheses. BMI, body mass index; N/A, not applicable Pharmacists (n = 537)
Pharmacy assistants (n = 403)
P-value
56.1% (301) 49.3% (265) 82.8% (445) 92.1% (495) 92.9% (499) 89.4% (480) 89.9% (483) 55.5% (298) 9.3% (50)
57.3% (231) 67.2% (271) 86.6% (349) 86.9% (350) 86.9% (350) 88.1% (355) 91.4% (368) 52.4% (211) 9.7% (39)
0.704
Australian Journal of Primary Health, 2015, 21, 197–204 http://dx.doi.org/10.1071/PY13118
Research
A national mailed survey exploring weight management services across Australian community pharmacies Souhiela Fakih A, Jennifer L. Marriott A and Safeera Y. Hussainy A,B A
Centre for Medicine Use and Safety, Monash University (Parkville Campus), 381 Royal Parade, Parkville, Vic. 3052, Australia. B Corresponding author. Email: [email protected]
Abstract. This study investigated pharmacists’ and pharmacy assistants’ current weight management recommendations to consumers across Australian community pharmacies using a mailed questionnaire. Two questionnaires were developed, one for pharmacists and one for pharmacy assistants, each divided into five sections. One pharmacist and pharmacy assistant questionnaire were mailed in November 2011 to a systematic sample of 3000 pharmacies across Australia for one pharmacist and pharmacy assistant each to complete. A total of 537 pharmacist and 403 pharmacy assistant responses, from 880 different pharmacies, were received. Overall 94.5% (n = 832/880) of associated pharmacies stocked weight loss products and 48.2% (n = 424/880) offered a weight management program. Both pharmacists and pharmacy assistants felt that the development of pharmacy-specific educational resources and additional training would help improve their ability to provide weight management services. Australian pharmacists and pharmacy assistants currently appear to be providing weight management services to consumers; however, not all their recommendations are evidence based. The need for additional training for pharmacy staff in areas identified as lacking and the development of pharmacy weight management educational resources needs to be addressed. Additional keywords: Australia, pharmacy, pharmacists, pharmacists’ aides, weight-reduction programs. Received 21 August 2013, accepted 13 January 2014, published online 5 March 2014
Introduction In developed, high-income countries such as Australia, overweight and obesity are considered to be the third preventable risk factor for non-communicable diseases, preceded by smoking and high blood pressure (Lopez et al. 2006). Currently in Australia, 42% of men and 35% of women are overweight and 28% of both men and women are obese (Australian Bureau of Statistics 2012). The prevalence of overweight and obesity in Australia continues to increase, with a recent study estimating that by 2025 >80% of men and >75% of women aged 20 years and over will be overweight or obese (Haby et al. 2012). Colagiuri et al. (2010) estimated that the annual total direct costs of overweight and obesity in Australia in 2005 was A$21 billion and the total direct and indirect costs of overweight and obesity could have been as high as A$56.6 billion. Due to the increased health risks overweight and obesity pose and their increased prevalence in Australia, obesity was made an Australian national health priority area in 2008 (Australian Institute of Health and Welfare 2008). Furthermore, in 2008 the Australian Government formed the National Preventative Health Taskforce to recommend key actions to help stop and reverse the prevalence of overweight and obesity in Australia. Recommendations to help make Australia ‘the healthiest county by 2020’ were outlined in the Obesity in Australia: A Journal compilation La Trobe University 2015
Need for Urgent Action report (National Preventative Health Taskforce 2008). The need to support and train primary health care providers so they can inform consumers to make healthier decisions was seen as a key priority to help prevent and treat overweight and obesity (National Preventative Health Taskforce 2008). All weight management guidelines currently recommend diet, exercise and behavioural modification therapy to be considered first in the prevention and treatment of overweight and obesity (Ministry of Health 2009; Scottish Intercollegiate Guidelines Network 2010; National Health and Medical Research Council 2013). The National Health and Medical Research Council (NHMRC) weight management guidelines for health care professionals have recently been updated and released (National Health and Medical Research Council 2013). The purpose of these guidelines is to offer primary health care professionals evidence-based weight management recommendations for the assessment and management of overweight and obesity in adults, adolescents and children. The 2013 NHMRC guidelines recommend health care professionals calculate a person’s body mass index (BMI) to determine treatment options. The guidelines also include an overweight and obesity management model for adults based on BMI (National Health and Medical Research Council 2013). It should be noted that pharmacists are not www.publish.csiro.au/journals/py
198
Australian Journal of Primary Health
S. Fakih et al.
*
What is known about the topic? *
Community pharmacies have become increasingly involved in providing primary care services to consumers. More specifically, there has been a recent growth in pharmacy involvement in providing weight management services.
What does this paper add? *
Australian pharmacies are providing weight management services to consumers in various ways, not all evidence based. Training and development of educational resources are necessary if pharmacies are to offer these services.
mentioned in the NHMRC guidelines, even though they have been identified previously as important primary health care providers to help prevent and treat overweight and obesity in Australia through education, health promotion and the supply of evidence-based medications and non-pharmacological advice (Bereznicki and Peterson 2008). Australia has seen an increase in the number of weight management products and programs being offered in community pharmacies. Currently, information about the number, type and location of community pharmacies offering weight management services is lacking. In addition, a large number of these weight management products and/or programs are available over-thecounter in self-selection areas, and are sold by pharmacy staff members (pharmacy assistants, pharmacy technicians), without pharmacist intervention. In Australia, pharmacy assistants do not need to complete a formal training program to sell over-thecounter products; thus, training and experience varies widely. Nutrition training among pharmacists also varies. Little is known about what nutritional training is provided to practising pharmacists and pharmacy students. A South Australian university research team identified gaps in nutrition knowledge among practicing pharmacists (Pearce and Cross 2013). In an Australian study using semistructured interviews with 20 pharmacists, participants expressed the need for additional training in areas of nutrition and physical activity (Um et al. 2010). In addition, these authors found that pharmacists were happy to provide weight management services for consumers if they had sufficient training in an accredited program that offered up-to-date evidence-based information on products and programs, and contained information regarding suitable weight management recommendations (Um et al. 2010). Although studies of this type have been conducted overseas (Dastani et al. 2004; Bradley 2009; Newlands et al. 2011; Awad and Waheedi 2012), no study has previously investigated weight management recommendations made by pharmacists and pharmacy assistants in Australia. Thus, the aims of the present study were to: determine the current weight management services provided by Australian community pharmacies *
*
determine the knowledge and practices of Australian pharmacy staff (pharmacists and pharmacy assistants*) towards weight loss programs and products gain an insight into pharmacy assistants’ and pharmacists’ current weight management recommendations to help determine whether pharmacists and pharmacy assistants use recommendations outlined in the NHMRC weight loss guidelines for adults (National Health and Medical Research Council 2003) and, if not, what recommendations they make.
Methods Development of the survey questionnaire The questionnaires used in the present study were based on questionnaires used by Bradley (2009) and Newlands et al. (2011), and refined to reflect Australian practice. Two questionnaires were developed, one for pharmacists and one for pharmacy assistants. Section A asked questions regarding the respondent’s demographic characteristics, Section B asked questions regarding weight management services provided at the pharmacy, Section C focused on current weight management recommendations provided by the respondent, Section D focused on future training areas and further support required, and Section E contained one of five case vignettes that explored specific recommendations around common weight management scenarios. This paper reports the results from Sections A–D. The questionnaire was piloted for face and content validity by academics, pharmacists and pharmacy assistants. Changes were made based on their feedback to produce the final questionnaires (available as Supplementary Material for this paper). Sample size and randomisation To ensure that the sample proportion was within 0.05 of the population proportion with a level of 95% confidence, it was calculated that for each pharmacist and pharmacy assistant questionnaire, 357 questionnaires needed to be returned (Krejcie and Morgan 1970). Of the 5000 pharmacies located in Australia, 3000 were randomly selected. Pharmacies were chosen at random from each state and territory from the pharmacy premises list, which was obtained from the pharmacy premises regulatory authorities. A proportional number of pharmacies were chosen from each state and territory (i.e. 60% of pharmacies from each state and territory in Australia were randomly selected). Randomisation was performed using Excel 2010 (Microsoft, Redmond, WA, USA). Each pharmacy was sent two questionnaires, one pharmacist questionnaire and one pharmacy assistant questionnaire, to complete and return. Survey administration Data were collected using an anonymous mailed questionnaire during November 2011. The Dillman protocol was used for questionnaire distribution (Dillman 1991). Data analysis Data were analysed using SPSS version 19.0 (IBM, Armonk, NY, USA) and summarised using descriptive statistics.
*The term ‘pharmacy assistants’ in the present study refers to all non-pharmacist staff members who are employed in a pharmacy and work behind the medicines counter. This includes general pharmacy assistants and pharmacy technicians.
Community pharmacy weight management services
Australian Journal of Primary Health
Pearson’s Chi-squared test was used to determine any significant relationships between two categorical variables. The level of significance was set at P < 0.05. The study was approved by the Monash University Human Research Ethics Committee.
Results The overall response rate was 18% (537/2972) for pharmacists and 13.6% (403/2972) for pharmacy assistants, exceeding the minimum sample size. There were responses from 880 pharmacies across Australia, giving a response rate for pharmacies of 30% (880/2972).
199
Respondent characteristics Respondent characteristics are given in Table 1. Of the 880 different pharmacies, 41.7% (367/880) were part of a buying group and 58.3% (513/880) were operated independently. Most pharmacies (78.9%; 694/880) were classed as highly accessible based on the Pharmacy Access/Remoteness Index of Australia (PhARIA) (Australian Population and Migration Research Centre 2008). Pharmacy services provided Most pharmacists (96%; 515/537) and pharmacy assistants (88.1%; 355/403) believed pharmacies have a role in the management of overweight and obesity in Australia.
Table 1. Characteristics of the pharmacists and pharmacy assistants who responded to the survey Data show the percentage of respondents in each group, with actual numbers in parentheses. PSA, Pharmaceutical Society of Australia Respondent characteristics
Pharmacists (n = 537)
Respondent characteristics
Pharmacy assistants (n = 403)
State/territory New South Wales Victoria Queensland Western Australia South Australia Tasmania Northern Territory Australian Capital Territory
29.4% (158) 28.1% (151) 16.0% (86) 11.4% (61) 8.4% (45) 4.1% (22) 0.4% (2) 2.2% (12)
New South Wales Victoria Queensland Western Australia South Australia Tasmania Northern Territory Australian Capital Territory
28.5% (115) 26.6% (107) 17.6% (71) 11.4% (46) 7.9% (32) 4.7% (19) 0.5% (2) 2.7% (11)
Location of pharmacy based on PhARIA indexA Highly accessible Accessible Moderately accessible Remote and very remote
76.2% (409) 12.7% (68) 3.5% (19) 7.6% (41)
Highly accessible Accessible Moderately accessible Remote and very remote
80.4% (324) 10.9% (44) 3.5% (14) 5.2% (21)
Pharmacy type Part of a group Privately owned
40.2% (216) 59.8% (321)
Part of a group Privately owned
43.4% (175) 56.6% (228)
Age (years) 20–24 25–30 31–40 41–50 51–60 >60
10.8% (58) 34.8% (187) 18.4% (99) 16.6% (89) 14.5% (78) 4.8% (26)
15–19 20–24 25–29 30–39 40–49 >50
5.7% (23) 27.5% (111) 13.9% (56) 15.1% (61) 17.9% (72) 19.9% (80)
Gender Male Female
47.1% (253) 52.9% (284)
Male Female
4.3% (17) 95.7% (386)
Main role Pharmacy owner Pharmacy manager Employee pharmacist
36.3% (195) 27.9% (150) 35.8% (192)
Weight loss consultant Vitamin consultant Retail manager Dispensary technician General pharmacy assistant
14.4% (58) 3% (12) 16.9% (68) 20.1% (81) 45.6% (184)
Previous training in weight management Yes University Pharmaceutical industry (e.g. drug company) Professional organisations (e.g. PSA)
76.4% (410) 27.9% (150) 45% (242) 35.6% (191)
Yes Pharmacist(s) Pharmacy magazines (e.g. Contact) Professional organisations (e.g. PSA)
74.9% (302) 15.6% (63) 65.3% (263) 47.6% (192)
A Pharmacy Access/Remoteness Index of Australia (PhARIA) categories 2 (accessible A) and 3 (accessible B) have been collapsed into one variable called ‘accessible’. PhARIA categories 5 (remote) and 6 (very remote) have similarly been collapsed into ‘remote and very remote’.
200
Australian Journal of Primary Health
S. Fakih et al.
Just over 40% (356/880) of pharmacies provided all weight management pharmacy services, including providing literature on healthy eating and exercise (79%; 695/880), displaying posters for weight loss products and/or programs (70.6%; 621/ 880), stocking weight loss products (94.5%; 832/880) and providing a pharmacy weight management program (48.2%; 424/ 880). There were no significant differences between the types of weight management services provided in Australian states and territories. This was also true for the location of the pharmacy, with no significant differences found between the different PhARIA categories and services provided. Weight loss products in pharmacies were sold behind the counter (35.7%; 314/880), in self-selection areas (61.4%), both behind the counter and via self-selection (28.5%; 251/880) or in weight management consulting booths (e.g. Tony Ferguson® Weight Loss Booth; 2.9%; 26/880). Just under 50% (424/880) of pharmacies provided a weight management program. A significantly (P = 0.02) higher number of group pharmacies (52.7%; 193/366) offered a weight management program compared with privately owned pharmacies (44.8%; 230/513). The reasons for pharmacies not offering a pharmacy weight management program included: time (35.4%; 161/456); cost (22.8%; 104/456); lack of staff knowledge (22.6%; 103/456); lack of public interest (44.1%; 201/456); lack of space (7%; 32/456); and other reasons, such as the pharmacy group not offering the service (16%; 73/456). Of the pharmacies that offered a weight management program, most found the programs to be successful in providing overweight and/or obesity treatment in a pharmacy setting (81.8%; 347/424). Women were reported to be the main consumer group for weight loss products and/or programs in over 60% of pharmacies (535/880), with both men and women being considered the main consumer group in 39% of pharmacies (344/880). Across Australia, only 25.7% of pharmacies (226/880) were referring to any guideline(s) when offering weight management advice, with most pharmacies relying on their pharmacy weight management program guideline for information (e.g. Kate Morgan’s weight loss guide; 44.2%; 100/226) or the Australian Pharmaceutical Handbook (APF) Weight Management Guide
Response rate %
Pharmacists
(Sanson 2009) and/or the Pharmaceutical Society of Australia 2006 provision of orlistat (which can also be found in the APF; 25.2%; 57/226). Fig. 1 shows the weight management classifications pharmacists and pharmacy assistants are currently using to determine whether someone needs to lose weight. Compared with pharmacists, pharmacy assistants were significantly more likely to use no measure when classifying a customer’s weight (P < 0.001). Pharmacists were significantly (P < 0.001) more likely to use BMI in combination with waist circumference (WC) when classifying a customer’s weight. Pharmacists were also significantly more likely to identify the correct BMI equation compared with pharmacy assistants (P < 0.001). Current weight management recommendations by pharmacists and pharmacy assistants Most pharmacists (61.6%; 331/537) and pharmacy assistants (64.7%; 261/403) reportedly felt comfortable approaching a customer to discuss weight loss. On average, pharmacists were spending significantly less time during a weight loss consultation with a customer compared with pharmacy assistants, with 87.3% (469/537) of pharmacists stating they would spend under 15 min during a consultation, compared with 64.5% (260/537) of pharmacy assistants (P < 0.001). Many pharmacists (61.7%; 331/ 537) and pharmacy assistants (65.5%; 264/403) stated they would take their customers to a private consultation area when discussing weight management. The reasons for not taking the customer into a private consultation area included lack of space and also the perceived ease of counselling customers on weight management products in front of the weight loss section of the pharmacy. Table 2 outlines history taking and recommendations that pharmacists and pharmacy assistants would make following a customer’s request about weight loss. Pharmacists stated that when counselling customers on medications to treat overweight- and obesity-related conditions, such as hypertension, hyperlipidaemia, type 2 diabetes etc., they would counsel on weight loss and/or maintenance: never (1.7%; 9/537); only when asked by the customer (17.5%; 94/537);
PAs
95.4% 73.7%
46.8%
16.0%
15.5% 5.3% None
19.6%
3.0% Weight
BMI and WC
Correct BMI equation
Weight management classification Fig. 1. Weight management classifications used by pharmacists and pharmacy assistants to classify a customer’s weight. PAs, pharmacy assistants.
Community pharmacy weight management services
Australian Journal of Primary Health
201
Table 2. History taking and recommendations made by pharmacists compared with pharmacy assistants following a customer’s request about weight loss Data show the percentage of respondents in each group, with actual numbers in parentheses. BMI, body mass index; N/A, not applicable Pharmacists (n = 537)
Pharmacy assistants (n = 403)
P-value
56.1% (301) 49.3% (265) 82.8% (445) 92.1% (495) 92.9% (499) 89.4% (480) 89.9% (483) 55.5% (298) 9.3% (50)
57.3% (231) 67.2% (271) 86.6% (349) 86.9% (350) 86.9% (350) 88.1% (355) 91.4% (368) 52.4% (211) 9.7% (39)
0.704
