Her leadership encompasses visionary support, development, and advocacy for FIP's 153 member organizations, representing four million members globally. Dr. Duggan's responsibilities include strategic planning and collaboration with international entities like WHO and the UN. Additionally, she chairs the World Professions Health Alliance, which advocates for 31 million health professionals across various disciplines, including medicine, nursing, dentistry, physiotherapy, and pharmacy. In this Q&A, Dr. Duggan will discuss the crucial role pharmacists play in liver health and the evolving landscape of pharmacy practice in this area.
Overview and importance of pharmacists in liver health
Can you elaborate on the specific roles pharmacists can play in the prevention and management of liver diseases?
Community pharmacists are strategically positioned to make a significant contribution to liver health through public education, early detection, vaccination, medication management, lifestyle intervention, and collaborative care. For people who use intravenous drugs, pharmacists can provide clean needles and syringes to reduce the risk of hepatitis C and other blood-borne infections. Through their accessibility, expertise, frequent interactions with the public, and trusted relations with the community, pharmacists can help reduce the burden of liver disease and improve patient outcomes.
How do you see the role of community pharmacists evolving in response to the rising prevalence of liver conditions?
We see this role growing. For example, in tandem with more pharmacies being able to offer vaccination services, more pharmacists could offer hepatitis A vaccines. We can also play a part in promoting more self-care and preventive interventions among those most at risk, such as people who are obese, and people with type two diabetes and cardiovascular disease.
Public education and early detection
What strategies can pharmacists employ to effectively educate the public about liver health?
Pharmacists can provide general information on maintaining liver health, such as the importance of a balanced diet, regular exercise, limiting alcohol consumption, and avoiding risky behaviours that can lead to liver disease (e.g., unsafe drug use or unprotected sex). They can also lead awareness campaigns about liver disease risk factors, symptoms, and the importance of regular check-ups.
How can pharmacists be more involved in the early detection of liver diseases, and what tools or training do they need for this?
Pharmacists can perform initial screenings to identify individuals at high risk of liver disease. This may include assessing risk factors such as alcohol use, obesity, diabetes, and family history. They could also recommend, facilitate and interpret liver function tests, and provide referrals for more comprehensive assessments if necessary. Training pharmacists to recognise early symptoms of liver disease (e.g., fatigue, jaundice, abdominal pain) would enable them to advise patients to seek further medical evaluation.
Vaccination and medication management
What is the role of pharmacists in liver disease vaccination campaigns, particularly for hepatitis?
Pharmacists can administer vaccines for hepatitis A and B — two preventable causes of liver disease. They can also educate patients about the importance of these vaccines.
How can pharmacists improve medication management for patients with liver conditions, and what are some common challenges they face in this area?
Pharmacists counsel patients on the potential hepatotoxic effects of certain medicines, both prescription and non-prescription. They also help manage polypharmacy to minimise the risk of liver damage. Pharmacists monitor patients on medicines that require regular liver function tests (e.g., statins, methotrexate) to ensure early detection of liver-related side effects and promote medication adherence to prevent complications.
Lifestyle interventions and collaborative care
How can pharmacists contribute to lifestyle interventions aimed at preventing liver disease, especially non-alcoholic fatty liver disease (NAFLD)?
Pharmacists can offer advice on weight management and healthy eating, which are crucial in preventing non-alcoholic fatty liver disease (NAFLD). They can also provide counselling and resources for alcohol reduction or cessation, including referral to support groups or addiction services if necessary.
Could you discuss the importance of collaborative care in managing liver disease and the ways pharmacists can work with other healthcare professionals?
Interprofessional collaboration, particularly in the management of chronic diseases, is important for improved patient outcomes. Pharmacists can collaborate with other healthcare professionals, including primary care physicians, hepatologists, and dietitians, to ensure comprehensive care for patients with or at risk of liver disease.
Managing misinformation
What are some common misconceptions about liver disease that you have encountered, and how can pharmacists help in dispelling these myths?
There is some misinformation about over-the-counter (OTC) medicines and liver harm, that pharmacists can correct. Not all OTC painkillers are equally risky for the liver. Conversely, not all herbal supplements are always safe for the liver. Consulting a pharmacist is always good advice for people with preexisting liver conditions.
How can pharmacists stay updated with accurate information to better inform and guide patients?
Pharmacists have an ethical duty to undertake continuing professional development/continuing education in order to stay up-to-date with current knowledge, guidance and scientific evidence. There’s a wealth of training and other resources available, including from FIP — see below.
Addressing stigma and delayed treatment
How can pharmacists help reduce the stigma associated with liver diseases?
No healthcare professional, including pharmacists, should judge patients. There are many kinds of liver disease, and no one chooses to get any of these. We can help reduce stigma by treating patients with dignity and respect, by offering a listening ear and referral to support groups. Changing attitudes begins from within a person or a profession, and spreads when others observe the way we act. Addressing any concerns openly within our pharmacy teams can be helpful to reduce stigma towards patients.
Global and Local Initiatives
Can you share some best practices from around the world where pharmacists have made a significant impact on liver health?
According to recent FIP data, there are at least 19 countries where pharmacists can administer Hepatitis B vaccines, and 11 countries where they can prescribe this vaccine. Other examples of impactful practices in this area include: a pharmacist-led clinic in the UK, where pharmacists support liver specialists in managing patients with chronic hepatitis B,1 a pharmacist active consultation service on management and outcomes in patients with drug-induced liver injury in China, and pharmacist interventions through education, expert consultation, and the monitoring of the immunosuppressant drug serum level in liver transplant patients.
What initiatives is the International Pharmaceutical Federation (FIP) undertaking to support pharmacists in their role in liver disease management globally?
FIP has produced a range of educational videos for pharmacists to support the management of fatty liver disease alongside type 2 diabetes, and a series of videos on the prevention and management of fatty liver disease.
Future directions
What do you see as the future of pharmacy practice in the context of liver health?
We would like to see pharmacists being recognised for their expertise in liver health through dedicated services.
How can policymakers support and enhance the role of pharmacists in combating the liver disease epidemic?
Policymakers can support this role by recognising pharmacists as health professionals and enabling new/more services in liver health, similar to enabling pharmacy services for other chronic conditions, such as diabetes.
Call to action
What is your message to pharmacists around the world regarding their role in liver health?
Liver disease accounts for two million deaths annually and is responsible for 1 in every 25 deaths worldwide. Reflect on your current activities and consider what else you can do to improve health in this area.
How can the public and other stakeholders support pharmacists in this critical role?
They can support their local pharmacy to ensure continued services and increase the likelihood of other health services in future.
