Fragmentation of the healthcare system and lack of connectivity between in-hospital and community services, have posed an impact on management of patients with chronic conditions. As self-management is an essential component in chronic disease management model and pharmacists are underutilized in Hong Kong, this study developed a consensus-based policy framework on pharmacist-led self-management using a Delphi panel consisted of medical doctors, pharmacists, Chinese medicine practitioners and dispensers. We had studied a local population survey to understand the use of over-the-counter medication, conducted focus groups and telephone survey to explore the views of the four health professions and the general population, respectively, on pharmacist-led approach in self-management. The find- ings served as the base for developing the self-administered questionnaire in Delphi. A total of 19 experts completed the questionnaires and rated the validity and clarity of each statement in a 9-point scale. The Delphi process was completed in two rounds. Community pharmacists could only play an assisting role in patient self-management. They should focus primarily on drug-related issues and were suggested to work on lifestyle modifications collaboratively with physicians and nurses. The government has to develop supportive measures to enhance pharmacist-led patient self-management in the future.
KeywordsCommunity PharmacistSelf-ManagementConsensus Policy FrameworkDelphi Process
Department of Human Services, “HARP Chronic Disease Management Guidelines,” Department of Human Services, Victoria, 2008.
K. Fiandt, “The Chronic Care Model: Description and Application for Practice,” Advanced Practice Nursing, Vol. 6, No. 4, 2006.
G. Foster, S. J. C. Taylor, S. Eldridge, J. Ramsay and C. J. Griffiths, “Self-Management Education Programmes by Lay Leaders for People with Chronic Conditions,” Cochrane Database of Systematic Reviews, 2007. doi:10.1002/14651858.CD005108.pub2
School of Medicine, “Chronic Disease Self-Management Program,” School of Medicine, Stanford. http://patienteducation.stanford.edu/programs/cdsmp.html
A. M. H. Siu, C. C. H. Chan, P. K. K. Poon, D. Y. Chui, and S. C. Chan, “Evaluation of the Chronic Disease SelfManagement Program in a Chinese Population,” Patient Education and Counseling, Vol. 65, No. 1, 2007, pp. 4250. doi:10.1016/j.pec.2006.04.013
The Pharmaceutical Society of Hong Kong & the Society of Hospital Pharmacist of Hong Kong, “The Consultation Document on Health Care Reform ‘Lifelong Investment in Health’,” Hong Kong Special Administrative Region, Health and Welfare Bureau, 2011.
V. C. H. Chung, C. H. Lau, F. W. K. Chan, J. H. S. You, E. L. Y. Wong, E. K. Yeoh, et al., “Use of Chinese and Western Over-the-Counter Medications in Hong Kong,” Chinese Medicine, Vol. 5, 2010, p. 41. doi:10.1186/1749-8546-5-41
F. Y. Y. Wong, F. W. K. Chan, J. H. S. You, E. L. Y. Wong and E. K. Yeoh, “Patient Self-Management and Pharmacist-Led Patient Self-Management in Hong Kong: A Focus Group Study from Different Healthcare Professionals’ Perspectives,” BMC Health Services Research, Vol. 11, 2011, p. 121. doi:10.1186/1472-6963-11-121
J. H. S. You, F. Y. Y. Wong, F. W. K. Chan, E. L. Y. Wong and E. K. Yeoh, “Self-Medication and Self-Care in Hong Kong,” BMC Clinical Pharmacology, Vol. 11, 2011, p. 19. doi:10.1186/1472-6904-11-19
Census and Statistics Department, “Thematic Household Survey,” Report No. 30, Census and Statistics Department, Hong Kong Special Administrative Region, 2007.
M. K. Murphy, N. A. Black, D. L. Lamping, C. M. McKee, C. F. Sanderson, J. Askham, et al., “Consensus Development Methods, and Their Use in Clinical Guideline Development,” Health Technology Assessment, Vol. 2, No. 3, 1998, pp. 1-88.
R. Holland, L. Brooksby, E. Lenaghan, K. Ashton, L. Hay, R. Smith, et al., “Effectiveness of Visits from Community Pharmacists for Patients with Heart Failure: Heart-Med Randomized Controlled Trial,” British Medical Journal, Vol. 334, No. 7603, 2007, pp. 1098-2004. doi:10.1136/bmj.39164.568183.AE
R. L. Rothman, R. Malone, B. Bryant, A. K. Shintani, B. Crigler, D. A. Dewalt, et al., “A Randomized Trial of a Primary Care-Based Disease Management Program to Improve Cardiovascular Risk Factors and Glycated Hemoglobin Levels in Patients with Diabetes,” American Journal of Medicine, Vol. 118, No. 3, 2005, pp. 276-284. doi:10.1016/j.amjmed.2004.09.017
D. Barbanel, S. Eldridge and C. Griffiths, “Can a Self-Management Programme Delivered by a Community Pharmacist Improve Asthma Control? A Randomised Trial,” Thorax, Vol. 58, No. 10, 2003, pp. 851-854. doi:10.1136/thorax.58.10.851
E. A. Coast-Senior, B. A. Kroner, C. L. Kelley and L. E. Trilli, “Management of Patients with Type 2 Diabetes by Pharmacists in Primary Care Clinics,” The Annals of Pharmacotherapy, Vol. 32, 1998, pp. 636-641. doi:10.1345/aph.17095
G. Foster, S. J. C. Taylor, S. Eldridge, J. Ramsay and C. J. Griffiths, “Self-Management Education Programmes by Lay Leaders for People with Chronic Conditions,” Cochrane Database of Systematic Reviews, 2007. doi:10.1002/14651858.CD005108.pub2
Census and Statistics Department, “Thematic Report: Household Income Distribution in Hong Kong. 2006 Population By-Census,” Census and Statistics Department, Hong Kong Special Administrative Region, 2007.
“Ontario Women Live Longer but Don’t Prosper,” Daily Exchange, 2009. http://www.exchangemagazine.com/morningpost/2009/week26/Wednesday/062419.htm
C. M. Deibert, S. Maliski, L. Kwan, A. Fink, S. E. Connor and M. S. Litwin, “Prostate Cancer Knowledge among Low Income Minority Men,” Journal of Urology, Vol. 177, No. 5, 2007, pp. 1851-1855. doi:10.1016/j.juro.2007.01.062
Q. T. Zhang, D. Y. Hu, J. G. Yang, S. Y. Zhang, X. Q. Zhang and S. S. Liu, “Public Knowledge of Heart Attack Symptoms in Beijing Residents,” Chinese Medical Journal, Vol. 120, No. 18, 2007, pp. 1587-1591.
P. Andersson and J. Leppert, “Men of Low-Socio-Economic and Educational Level Possess Pronounced Deficient Knowledge about the Risk Factors Related to Coronary Heart Disease,” Journal of Cardiovascular Risk, Vol. 8, No. 6, 2001, pp. 371-377. doi:10.1097/00043798-200112000-00006
D. S. Kenkel, “Health Behavior, Health Knowledge, and Schooling,” Journal of Political Economy, Vol. 99, No.2, 2001, pp.287-305. doi:10.1086/261751
P. L. Ranelli and J. Biss, “Physicians’ Perceptions of Communication with and Responsibilities of Pharmacists,” Journal of the American Pharmaceutical Association, Vol. 40, No. 5, 2000; pp. 625-630.
J. Edmunds and M. W. Calnan, “The Reprofessionalisation of Community Pharmacy? An Exploration of Attitudes to Extend Roles for Community Pharmacists amongst Pharmacists and General Practitioners in the United Kingdom,” Social Science & Medicine, Vol. 53, No. 7, 2001, pp. 943-955. doi:10.1016/S0277-9536(00)00393-2
The Pharmaceutical Society of Hong Kong & the Society of Hospital Pharmacist of Hong Kong, “The Consultation Document on Health Care Reform “Lifelong Investment in Health,” Hong Kong Special Administrative Region, Health and Welfare Bureau, 2001.
J. A. Prvu Bettger and M. G. Stineman, “Effectiveness of Multidisciplinary Rehabilitation Services in Postacute Care: State-of-the-Science. A Review,” Archives of Physical Medicine and Rehabilitation, Vol. 88, No. 11, 2007, pp. 15261534. doi:10.1016/j.apmr.2007.06.768
WHO Collaborating Centre for Hospitals and Health Promotion, “Feasibility, Effectiveness, Quality and Sustainability of Health Promoting Hospital Projects,” Proceedings of the 5th International Conference on Health Promoting Hospitals, Vienna, 16-19 April 1997.
F. Y. Wong, F. W. Chan, E. L. Wong and E. K. Yeoh, “Do Medical Students Agree with Pharmacist-Led Patient Self-Management in Hong Kong?” Medical Teacher, Vol. 32, No. 12, 2010. doi:10.3109/0142159X.2010.519076
S. Pong, “Improving Hong Kong Health Care System: The Pharmacist Perspective. Topical Issues,” Legislative Council, Hong Kong Special Administrative Region, CB(2) 2521/98-99(01). http://www.legco.gov.hk/yr98-99/english/panels/hs/pape rs/2521e01.pdf