How to make the most of your visit to the pharmacist

Pharmacists are the country’s most accessible, frontline, health professionals – available for free advice, often at a moment’s notice. And almost half of us live within a kilometre of the nearest pharmacy.

Yet the 3,800 pharmacists working in the community around Ireland are still, it could be argued, an under-used resource. These highly-trained professionals are far more than “bag packers” of medications on the direction of doctors – as vital as their “watchdog” role is in that process.

The average adult in Ireland visits a pharmacy 41 times a year, according to last year's Pharmacy Usage and Attitudes Survey conducted for the Irish Pharmacy Union (IPU). Despite this frequency, the range of services available behind some, or all, of the doors of local pharmacies might surprise you.

From one-on-one consultations and blood pressure monitoring to cholesterol testing and travel vaccinations, many pharmacies offer both responsive and preventative health strategies to consumers – in amongst, of course, the over-the-counter medications and other health and beauty products that help to keep these businesses viable. (And nearly one in three also stocks veterinary medicines).

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Every pharmacy must be registered and inspected by the sector's regulator the Pharmaceutical Society of Ireland (PSI). At the beginning of February there were 1,877 pharmacies operating in the community and another 75 inside hospitals.

Ireland has the fifth highest number of community pharmacists per head of population behind Spain, Japan, Belgium and South Korea, according to the OECD. There is a much freer market here for opening a pharmacy compared with, say, the UK where distance and population criteria are taken into account before permission is granted.

While the professional representative body, the IPU, wants regulation changes that would allow pharmacies to broaden their primary-care services, consumers could, arguably, make greater use of what is already there. This might not only save you money, time and improve your health, but also help to reduce demands being made on other parts of our overburdened health services.

Here are some ways to make better use of pharmacies:

1) Avail of a one-on-one private consultation

All pharmacies are obliged to have a private consultation area where you can discuss a health concern with a pharmacist without being overheard. This can be done on a “drop in” basis and there should be no need for an appointment – unless you are looking for a service such as a flu vaccine (see below).

Although the legal requirement for a private space has been in place since 2010, just one in four of people who have visited a pharmacy has ever made use of it, according to last year’s Pharmacy Usage and Attitudes Survey conducted for the IPU by Behaviour & Attitudes Marketing Research.

Pharmacist Kathy Maher of Duleek, Co Meath, says that examples of being in the consultation room with patients in the past week would include "assessing rashes – one was shingles and needed prompt referral to GP; counselling on prescription medicines; blood pressure measurements; vaccinations; mental health crisis – I phoned a crisis line to get urgent support for the patient; talking about baby and infant health concerns, and a significant injury that required me to call urgent secondary care."

In their pharmacy they have also been called on to administer life-saving care – an adrenaline injection to a toddler with peanut anaphylaxis and the use of a defibrillator to a patient in cardiac arrest.

2) Use pharmacy as a “triage” service

The next time you are in two minds whether or not a health concern warrants booking a GP appointment or even a visit to a hospital emergency department, you could first step into a pharmacy for a word with the pharmacist. Some 70 per cent of people talk to their pharmacist first, ahead of visiting the GP, according to the IPU survey mentioned above.

“Depending on the situation, patients may be able to manage a situation themselves or they may need to see their GP, or often times we need to refer a patient to secondary care such as A&E,” says Maher. “In the current times of Dr Google, patients can have misdiagnosed themselves and either have worried unnecessarily or could be falsely reassured.”

Personally she has had a number of women in for whom she was the first person to be asked about a lump in their breast, to confirm that it needed investigating and they went on to be diagnosed with breast cancer by medical professionals.

3) Ask about generic medication options

Whether you are looking for prescription or over-the-counter medication, always check to see if there is a generic, cheaper alternative.  Since 2013, when “reference pricing” was introduced, pharmacists can swap a branded drug on a doctor’s prescription with a generic version that is on the “inter-changeable” list – unless the doctor has categorically stipulated “no substitution”. This means you – or the State – pays less to have your prescription filled.

The shift towards greater use of generic drugs has encouraged brand manufacturers to reduce the price of their products. Some medicine prices have dropped up to 85 per cent since the introduction of reference pricing.

You will save money on over-the-counter medications too if you request, for example, “paracetamol” or “ibuprofen” as pain relievers, rather than plucking out a brand name imprinted on your brain by the work of advertisers. And if you don’t know what a generic version might be called, just ask.

4) Shop around

Three-quarters of spending on medicines in community pharmacies is paid for by the State through various schemes. The Government sets the cost price of all medicines in agreement with the drug manufacturers – and in fact, as the IPU points out, the State then only pays pharmacists 91.8 per cent of the cost. It is up to pharmacists to negotiate prices with wholesalers and manufacturers. The €2 prescription charge to medical card holders for each item dispensed (€1.50 for those over 70) is due to be reduced by 50 cent in July under Budget 2020.

For private patients, prices are going to vary from pharmacy to pharmacy so it’s worth shopping around for particularly costly or regular medications. Just because a pharmacy is expensive for one drug doesn’t mean it won’t be cheaper for another, as it will all depend on its buying systems.

Price is, of course, not the only reason to shop around. As with any personal service, convenience and the calibre and continuity of staff are big considerations. Getting the chance to develop a one-on-one relationship with a pharmacist could prove invaluable. Not that trust in the profession seems to be a problem, with 94 per cent of people surveyed saying they trust the advice and patient care they receive from the pharmacist.

5) Find out if filling a six-month prescription all at once is possible

The possibility of getting six months’ supply of a medicine depends on various circumstances. For a start, it’s not possible if you’re getting them on the medical card.

After that there are supply and safety issues – a pharmacist may not have enough in stock and in the case of something like sleeping pills, for instance, is unlikely to allow you to walk away with that quantity. However, there is no harm in asking if it’s possible with regular ongoing prescriptions as it may save you both time and money.

6) Consider a pharmacy as an option for vaccinations

One in two pharmacies offers a vaccination service by a pharmacist trained and certified to carry out this function. Most commonly it is the flu vaccine that is administered, which they have been permitted to do since 2011. The seasonal flu campaign is still ongoing, running October to April. Figures from the HSE show that in the 2017/2018 flu season, 115,095 people got their flu vaccine in a pharmacy, up from 78,935 in the previous year, and accounting for approximately one in seven of the total vaccinations performed.

Expect to have to make an appointment for injections as they require a 20-minute slot because a patient cannot leave the shop for at least 15 minutes afterwards to make sure there is no allergic reaction.

In addition to the flu vaccine, some offer other types of vaccinations, such as pneumococcal, shingles (herpes zoster) or travel vaccinations. However, there is a legal difference in that the flu, pneumococcal and shingles vaccines are no longer “prescription-only medicine” if they are administered by a pharmacist, whereas prescriptions are still needed for travel vaccinations. Some pharmacy chain websites direct you to links for online doctors who provide a travel consultation service.

The HSE doesn’t reimburse the cost of the shingles vaccination (available to people over 50 without a prescription), so the cost is significant. In one chain of pharmacies, for example, it costs €199. However, the cost of contracting shingles, in terms of quality of life and medication to treat complications, would far outweigh that price.

7) Go for blood-pressure monitoring

If you have concerns about your blood pressure nearly three-quarters of pharmacies (71 per cent) have facilities for checking it. Some GPs may recommend using a pharmacy to keep an eye on your levels in between visits to the surgery.

Pharmacies may also offer 24-hour blood pressure monitoring – it is the same device, using the same software, as you would get at a GP’s. You can have it fitted and return 24 hours later to go through the readings with the pharmacist and then take that information to your GP or cardiologist.

If you are somebody who has come away from the GP knowing simply that your “blood pressure is a bit up, it would be helpful if you made a note of the relevant numbers so you have a baseline for using the pharmacy facility for regular blood pressure checks.

8) Step up your “self care”

Smoking cessation programmes, weight management options and general health improvement strategies are offered by various pharmacies. Look online or inquire in-store to see what supports are available to help you improve your lifestyle, with knock-on health benefits.

PSI figures indicate that a Body Mass Index (BMI) measurement service is available in 72 per cent of pharmacies, while 26 per cent offer testing of cholesterol levels.

9) If you need emergency contraception, consider this your fastest option

The “morning-after” pill, that can be taken up to five days after unprotected sex is now available without a doctor’s prescription from most pharmacies. A 2011 legislative change first made emergency contraception accessible for private purchasers, but up to July 2017 medical card holders still had to have a prescription to get it free in a pharmacy.

If a pharmacist is unable to supply on moral grounds they must inform their supervising or superintendent pharmacist, who can do it. If this is not possible the patient must be referred to another professional who can supply the emergency contraception, ensuring that patient care is not jeopardised. There may be instances where supply of this drug is not clinically recommended, in which case you will be referred to your GP.

Patients over 16 are legally entitled to consent to their own medical treatment but the legal age of consent for sexual activity is 17. This is why some pharmacies may only deal directly with those who are 17 or over when it comes to emergency contraception. There is a questionnaire protocol that needs to be gone through before it can be supplied and, with the Hickeys Pharmacy group for example, a questionnaire can be filled online and submitted to a particular outlet, which will cut down the time needed when meeting the pharmacist.

10) Be aware of online options

First what is not possible – it is not legal to sell prescription medicines online in this country. If you are tempted to try to source them abroad you need to be aware that many which are seized coming into the country prove to be counterfeit.

Even if you use an online GP service the pharmacy still needs a paper prescription. In an urgent situation a doctor can email the scanned copy of a prescription to a pharmacy to allow an emergency dose to be dispensed but the paper prescription for that must be presented within 72 hours.

Community pharmacists are working under the terms of the 2007 Pharmacy Act, which would need updating to allow online innovations in what is, by necessity, a tightly regulated profession.

Some over-the-counter medicines can be sold online by the 60 pharmacies who are specifically registered with the PSI to conduct such online business.

11) Know what’s reasonable to expect from a pharmacist

A patient charter, entitled You and Your Pharmacist, summarises what patients can expect from their community pharmacist in terms of information, care and service. What patients can do, in turn, to help pharmacists meet these expectations, such as providing accurate and up-to-date information on medical history and other medications being taken, are also outlined. The charter can be seen on the regulator's website, and staff there are available to answer queries emailed to info@psi.ie or tel 01 218 4000.

12) If you’re not happy with a pharmacy service, find out how to make a complaint

The PSI handles complaints where there is concern about the behaviour, practice or health of a pharmacist, or where you are not happy with the treatment received in a pharmacy. However, it suggests that in the first instance it is a good idea to raise your issue directly with the pharmacist or pharmacy involved as the problem can often be resolved that way.

If you still fail to gain satisfaction, a formal complaint to the PSI could be the next step. See the advice on its website about what sort of complaints it can or cannot consider before making yours in writing – either through the post or by email. There is a standardised form to help you structure your complaint, or at least see the essential points that must be included in a free-written account.

A screening committee advises the PSI council whether or not it believes the complaint merits further action. The various options and processes involved if further inquiries are deemed necessary are clearly outlined on the PSI’s website.

Read: How to make the most of a visit to the doctor