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Sociology for Pharmacists Second Edition Also available from Taylor & Francis: Pharmacy Practice Edited by Kevin M.G. Taylor and Geoffrey Harding ISBN 0-415-27158-4 (hardback) 0-415-27159-2 (paperback) Textbook of Drug Design and Discovery (Third Edition) Edited by Povl Krogsgaard-Larsen,...

Sociology for Pharmacists Second Edition Also available from Taylor & Francis: Pharmacy Practice Edited by Kevin M.G. Taylor and Geoffrey Harding ISBN 0-415-27158-4 (hardback) 0-415-27159-2 (paperback) Textbook of Drug Design and Discovery (Third Edition) Edited by Povl Krogsgaard-Larsen, Tommy Liljefors and Ulf Madsen ISBN 0-415-28287-X (hardback) 0-415-28288-8 (paperback) Drug Delivery and Targeting Edited by Anya Hillery, Andrew Lloyd and James Swarbrick ISBN 0-415-27198-3 (hardback) Drug Misuse and Community Pharmacy Edited by Janie Sheridan and John Strang ISBN 0-415-28289-6 (hardback) 0-415-28290-X (paperback) Pharmaceutical Biotechnology Edited by Daan J.A. Crommelin and Robert D. Sindelar ISBN 0-415-28500-3 (hardback) 0-415-28501-1 (paperback) Introduction to Pharmacology By Mannfred Hollinger ISBN 0-415-28033-8 (hardback) 0-415-28034-6 (paperback) Theory and Practice of Contemporary Pharmaceutics Tapash K. Ghosh and Bhaskara R. Jasti ISBN 0-415-28863-0 (hardback) 0-415-28864-9 (paperback)  Sociology for Pharmacists An Introduction Kevin Taylor School of Pharmacy University of London, UK Sarah Nettleton Department of Social Policy and Social Work University of York, UK and Geoffrey Harding St Bartholomew’s and the Royal London School of Medicine and Dentistry, Queen Mary, University of London, UK Second Edition First published 2003 by Taylor & Francis 11 New Fetter Lane, London EC4P 4EE Simultaneously published in the USA and Canada by Taylor & Francis Inc, 29 West 35th Street, New York, NY 10001 Taylor & Francis is an imprint of the Taylor & Francis Group This edition published in the Taylor & Francis e-Library, 2004. © 2003 By Kevin Taylor, Sarah Nettleton, Geoffrey Harding All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Every effort has been made to ensure that the advice and information in this book is true and accurate at the time of going to press. However, neither the publisher nor the authors can accept any legal responsibility or liability for any errors or omissions that may be made. In the case of drug administration, any medical procedure or the use of technical equipment mentioned within this book, you are strongly advised to consult the manufacturer’s guidelines. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data Taylor, Kevin, Ph.D. Sociology for pharmacists : an introduction / Kevin Taylor, Sarah Nettleton, Geoffrey Harding. – 2nd ed. p. ; cm. Rev. ed. of: Sociology for pharmacists / Geoffrey Harding, Sarah Nettleton, Kevin Taylor. 1990. Includes bibliographical references and index. 1. Pharmacy—Social aspects. 2. Social medicine. 3. Sociology. [DNLM: 1. Sociology, Medical. 2. Pharmacy. WA 31 T243k 2003] I. Nettleton, Sarah, 1960– II. Harding, Geoffrey, 1954– III. Title. RS92.T39 2003 362.1'042—dc21 2003002015 ISBN 0-203-38117-3 Master e-book ISBN ISBN 0-203-38813-5 (Adobe eReader Format) ISBN 0-415-27487-7 (HB : alk. paper) ISBN 0-415-27488-5 (PB : alk. paper) To our partners and children Contents Preface ix Acknowledgements xi Why a sociology for pharmacy? 1 1. Sociology: an introduction 5 2. Contemporary practice of pharmacy 19 3. Health and illness: understanding the public’s perspective 37 4. Seeking help and consulting health professionals 55 5. Social factors and health 75 6. Social inequalities and health 91 7. The occupational status of pharmacy 113 8. Maintaining and promoting health 131 9. Social research methods 157 Index 185 Contents vii Preface This is the second edition of Sociology for Pharmacists: An Introduction, the first edition having been published in 1990. The philosophy of this revised book remains unchanged. It is written specifically for those studying or practising pharmacy who are newcomers to sociology; it introduces the key concepts of sociology and demonstrates their importance and application to pharmacy practice in the twenty-first century. Each chapter has been rewritten, updated and reformatted, and two chapters merged into one as we have endeavoured to ensure that this revised text reflects the changes in health care and phar- macy that have taken place in recent years. We have written Sociology for Pharmacists in response to the recognition that sociology can contribute towards equipping pharmacists for their contemporary practice. The topics covered are by no means exhaustive; rather we have addressed those which we consider collectively, as sociologists, pharmacist and health care consumers, to be the most important. The book begins with a short introductory section that highlights the changes and developments in society, pharmacy and pharmacy education which have resulted in the need to include sociology and social aspects of health care into the pharmacy under- graduate curriculum. In Chapter 1 we introduce the subject of sociology, key sociological concepts and theorists and outline the importance of a sociological perspective for effect- ive pharmaceutical service delivery. In Chapter 2 we examine pharmacists’ roles and activities in the context of the Nuffield Report on Pharmacy, the Pharmacy in a New Age (PIANA) initiative and recent and proposed changes in health policy. Sociological per- spectives on the experience of health and illness, and illness behaviour are explored in Chapters 3 and 4, and we note that the presence of a symptom(s) alone does not neces- sarily result in an individual seeking help or treatment from a health professional, includ- ing a pharmacist. Chapters 5 and 6 demonstrate the ways in which health status and the experience of illness are influenced by such factors as gender, ethnicity, social class and employment status. In Chapter 7 we consider the occupational status of pharmacy from a sociological perspective and explore whether the status of pharmacy as a ‘profession’ is threatened or enhanced by actual and proposed changes in their activities. In Chapter 8 we consider the issues of health education and the pharmacists’ role in health promotion and in ensuring that the public uses their medicines appropriately. Chapter 9 provides a brief introduction to methodological issues in sociological research and includes some guidance as to how these issues may be applied to research in the social aspects of phar- macy. Throughout the book reference is made to the sociology, medical and pharmacy literature and where appropriate readers are pointed towards additional reading. We have written Sociology for Pharmacists primarily for pharmacy students, though it will also provide thought-provoking reading for pharmacists in community, hospital and academic practice. We have produced a sociology for, rather than a sociology of phar- macy, and envisage that the book will both inform practice and stimulate informed research into the social aspects of pharmacy practice. Preface ix Acknowledgements We thank all those who have helped in the production of this book. In particular, we thank Maria Shew, Annie Cavanagh and Tess Andaya at the School of Pharmacy, Uni- versity of London, for their expert help in the production of diagrams and tables. We are also very grateful to Linda Lisgarten, Michelle Wake and Mary McNicholl, in the library of the School of Pharmacy, for all their assistance in making sure we could access and appropriately cite many of the references used throughout the book. Acknowledgements xi  Why a sociology for pharmacy? The activities of pharmacists in primary and secondary care are subject to continuous change. Within secondary care, clinical and ward pharmacy have become prominent as concepts, with phar- macists increasingly integrated into the health care team, whilst at the same time pharmacists are able to specialise in, for instance, drug information, oncology, paediatrics and radiopharmacy. In primary care, recent decades have witnessed pharmacists’ daily activities radically altered, so that activities such as compounding and formulating medicines have all but disappeared. As techno- logical advances have made the dispensing of medicines a more routine task, how much of their time pharmacists spend on dis- pensing medicines is being called into question. At the same time the number of highly effective proprietary medicines available for sale from pharmacies, which were previously only available on prescription, has increased and is projected to increase still further. Moreover, in the near future pharmacists will be able to prescribe Prescription Only Medicines as supplementary pre- scribers. Taken together, these developments have led pharma- cists to reassess what they do, and to promote themselves as health professionals, who in addition to being the acknowledged experts in medicines are capable of taking on greater responsi- bilities for patients’ health status and the outcomes of drug treat- ment. The time when pharmacy could be characterised as a lone pharmacist preparing and dispensing medicines, closeted away from the public, in the dispensary at the back of a shop has long gone. With the pharmaceutical manufacturing industry now pro- ducing medicinal products in packages complete with package inserts containing patient information suitable for dispensing direct to the consumer, and the employment of trained technical staff within pharmacies, even those pharmacists with the heaviest dispensing loads have more opportunity for embracing what has been referred to as the pharmacist’s ‘extended role’. This ‘extended role’ involves pharmacists interacting directly with the public, offering a range of services including diagnostic testing, health care advice, information, therapeutic recommendations, directions and instructions, in addition to ensuring that people receive the appropriate medication and understand how to use their medicines correctly. The allied concepts of pharmaceutical care and medicines management have been embraced, even if not wholly understood, by pharmacists and government to emphasise the positive contribution pharmacists, by their input to drug therapy, can make to patients’ quality of life. The undergraduate curriculum taught in UK schools of Sociology for Pharmacists 1  pharmacy, extended by one year since 1997, has traditionally focused on the basic and applied sciences, including pharmaceut- ical chemistry, pharmaceutics, pharmacognosy, and pharmacol- ogy. In the 1970s and 1980s the curriculum in most schools was expanded to introduce the subject area of ‘clinical pharmacy’. Clinical pharmacy draws on the knowledge of drugs and disease, as taught within a framework of the pharmaceutical sciences, and then relates this knowledge directly to the clinical requirements of patients; it includes pharmacokinetics, response to symptoms, disease aetiology and therapeutics. The realisation within the pharmacy profession that its members were being increasingly called upon to respond to symptoms, give medical advice, ‘counsel’ patients and dissemi- nate health education messages has resulted in the concept of ‘pharmacy practice’. Pharmacy practice is an all-embracing term which describes a wide range of activities involved in the provi- sion of pharmaceutical services. Consequently, it incorporates not only clinical pharmacy and the legal aspects of practice, but also various perspectives which assist in our understanding of the wider social context in which pharmaceutical services are deliv- ered. Topics within the academic subject of pharmacy practice now include communication skills, medicines use, health eco- nomics, pharmacoepidemiology and pharmacovigilance. Since pharmacists are increasingly assuming the role of ‘health care professionals’, rather than being solely dispensers of medi- cines and suppliers of medical appliances, pharmacy students require new skills as communicators, problem-solvers, reflexive thinkers, educators and advisers. ‘Social and behavioural science’ has been identified as having a significant contribution to make in the training of pharmacists. In the early 1980s an independent committee of inquiry was established under the aegis of the Nuffield Foundation, to closely examine all areas of the practice of pharmacy at that time. The findings of the Nuffield Inquiry, pub- lished in 1986, were a watershed in the historical development of pharmacy in the UK and were a precursor to many subsequent developments. Among its many recommendations, the so called ‘Nuffield Report’ advocated that behavioural science should be incorporated into the pharmacy undergraduate curriculum. The term ‘behavioural science’ denotes the scientific study of human behaviour and although it is most frequently associated with the discipline of psychology it implicitly includes other disciplines which study people and society, such as sociology and anthro- pology. In this book we are concerned specifically with the appli- cation of sociology to the practice of pharmacy. Sociology explains an individual’s actions as a social phenomenon. That is to say, behaviour is explained and shaped by the society in which we live. For this reason, sociologists prefer to use the term ‘social action’ rather than ‘behaviour’. Other areas included under the 2 Why a Sociology for Pharmacy?  umbrella term ‘behavioural science’, for example social psychol- ogy and interpersonal communication, have been covered ade- quately in other texts and are beyond the remit of this book. There is a fundamental need for pharmacists, and indeed for all health professionals, to have a sociologically informed approach to health care, since: ‘Sociology demystifies the nature of health and illness, highlights the social causes of disease and death, exposes power-factors and ethical dilemmas in the production of health care, and either directly or in- directly helps to create a discerning practitioner who then becomes capable of more focussed and competent decision making’ (Morrall, 2001). The medical profession, earlier than pharmacy, recognised the importance of looking at health and illness from a sociological perspective and ‘sociology as applied to medicine’ has been rou- tinely taught in nursing, medical and dental schools in the UK since the 1970s. The introduction of medical sociology into pre- clinical medical courses was a significant departure from those subjects previously taught in such courses. Prior to that time, teaching had tended to be based almost exclusively on detailed anatomical, histological and physiological studies of the tissues and organs of the body. It could similarly be argued that the teaching of pharmacy has traditionally concentrated on the ‘drug entity’, its derivation from plant and animal sources, its action on the body, its absorption, distribution, metabolism and elimination, its synthesis and chemical properties and formulation into dosage forms. As schools of pharmacy and the Royal Pharmaceutical Society of Great Britain responded to the Nuffield Report, it became apparent that aspects of sociology should be incorporated into the pharmacy undergraduate curriculum in order to adequately prepare pharmacy students for their future practice. A working party of the Royal Pharmaceutical Society’s Education Committee was instituted and its report (Working Party on Social and Behav- ioural Science, 1989) made thirteen recommendations with respect to the pharmacy degree course, the main recommendation being that, ‘all schools of pharmacy should include teaching in the social science aspects of pharmacy, in the undergraduate pharmacy degree course’. Subsequent pharmacy initiatives such as Pharmacy in a New Age (Royal Pharmaceutical Society of Great Britain, 1996), government policy as exemplified by the NHS Plan (Department of Health, 2000a, 2000b), and the evolution of pharmacists’ roles – for instance, the advent of primary care pharmacists and pharma- cist (supplementary) prescribing – mean that the awareness, by pharmacists, of the social dimension of health, illness and health care are more important than ever before. 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