Future collaborative possibilities for community pharmacists and dietitians

Historically, the Australian healthcare system has offered secondary and tertiary prevention services, focusing on treating illnesses when they arise rather than preventing the disease from occurring. Yet with a global ageing population and nationally rising rates of chronic illness, increased attention is being given to primary preventative health care measures.

Community pharmacists are particularly well positioned to be providers of preventive health care services. It is undisputed that pharmacies are one of the most accessible representatives of the Australian healthcare system, with the average Australian visiting a pharmacy 18 times a year. But since the core role of the pharmacist is dispensing medicine, they are frequently undervalued and have not been well integrated into national strategies for primary prevention. But beyond dispensing medications, pharmacists are highly skilled and able to provide clinical preventive services such as education, health screenings and health monitoring.

In order to be integrated into the primary prevention team, pharmacists should consider partnerships with other healthcare professionals who would be most useful to their existing patients’ needs. While it is unsurprising that the majority of Australians visit the pharmacy to have a prescription filled (69%) a study by NAB health found that the second most common reason Australians visit pharmacies is to buy nutritional vitamins and/or supplements (30%). As such, future collaborations between dietitians and pharmacists may be a worthwhile consideration.

What is a Dietitian

A dietitian’s role is to apply the science of food and nutrition to assess, diagnose and treat dietary and nutritional problems. Although by definition, all dietitians are nutritionists, not all nutritionists are dietitians. All accredited dietitians must complete a Bachelor degree in a relevant cognate area (for example: science, health sciences, nutrition, food science, exercise science, biomedical science, allied health or nursing), followed by a postgraduate Masters degree in Dietetics. Maintaining accreditation means adhering to a professional code of conduct and undertaking continuous professional development.

Upskilling Nutrition Knowledge

While prescriptive dietary advice should be left to dietitians, pharmacists should feel empowered to offer basic nutritional counselling to patients who suffer from diet-related illnesses. While most pharmacists agree they are well-positioned within the healthcare setting to be more involved in nutritional counselling; several studies have indicated that inadequate nutritional knowledge is a major barrier.

There is hope that these findings will contribute to the development of future education initiatives that aim to better prepare Australian pharmacy students before entering the workforce. But until then, pharmacists should actively seek to develop their nutrition knowledge, confidence, and skills through reputable channels.

Ultimately, this responsibility to educate health care professionals should fall on dietitians, to ensure the dietary advice is appropriate to their profession and what is delivered is evidence-based.

A Collaborative Career Alongside a Dietitian

The collaboration of pharmacists and dietitians would allow pharmacies to become more integrated and accessible, providing patients with more robust strategies for achieving ideal health outcomes.

In the current system, when a pharmacist is presented with a patient who has a medical nutrition concern outside of their scope of knowledge the pharmacist can recommend that they consult with a dietitian, but it begins an expensive or time-consuming process for that patient.

The first option would be for the patient to seek out and make an appointment with a dietitian without a referral, which they would be expected to pay for out of pocket. Alternatively, they can first schedule an appointment with their GP who can provide them with a referral so they can then make an appointment with a dietitian that would be covered by Medicare. Either way, this process requires the patient in question to be motivated, which unfortunately is a commonly cited barrier preventing patients from engaging in health-promoting behaviours.

Dietitians could be incorporated into the community pharmacy setting either as a permanent fixture to provide nutrition counselling on the fly, or as a contracted professional to provide inpharmacy health education programs for patients and pharmacists as required.In Japan, they have already begun to take the initiative in improving community health by placing dietitians in pharmacies, to provide a combined pharmacological and lifestyle support to patients. While it is still early days, so far they have found that the collaboration notably improved the dietary habits and glycemic control of patients with type 2 diabetes.

Beyond improving patient outcomes, the collaboration has been found to be financially beneficial through increasing the sales of health foods and supplements as well as increasing the number of customers at the pharmacies.

For many diet-related illnesses a collaborative effort between dietitians and pharmacists demonstrates the gold standard of treatment. Such as; SSRIs and the Mediterranean diet; statins and a high fibre diet and NSAIDs and anti-inflammatory diets, just to name a few.