BackgroundAn increased interest is observed in broadening community pharmacists' role in public health. To date, little information has been gathered in Canada on community pharmacists' perceptions of their role in health promotion and prevention; however, such data are essential to the development of public-health programs in community pharmacy. A cross-sectional study was therefore conducted to explore the perceptions of community pharmacists in urban and semi-urban areas regarding their ideal and actual levels of involvement in providing health-promotion and prevention services and the barriers to such involvement.MethodsUsing a five-step modified Dillman's tailored design method, a questionnaire with 28 multiple-choice or open-ended questions (11 pages plus a cover letter) was mailed to a random sample of 1,250 pharmacists out of 1,887 community pharmacists practicing in Montreal (Quebec, Canada) and surrounding areas. It included questions on pharmacists' ideal level of involvement in providing health-promotion and preventive services; which services were actually offered in their pharmacy, the employees involved, the frequency, and duration of the services; the barriers to the provision of these services in community pharmacy; their opinion regarding the most appropriate health professionals to provide them; and the characteristics of pharmacists, pharmacies and their clientele.ResultsIn all, 571 out of 1,234 (46.3%) eligible community pharmacists completed and returned the questionnaire. Most believed they should be very involved in health promotion and prevention, particularly in smoking cessation (84.3%); screening for hypertension (81.8%), diabetes (76.0%) and dyslipidemia (56.9%); and sexual health (61.7% to 89.1%); however, fewer respondents reported actually being very involved in providing such services (5.7% [lifestyle, including smoking cessation], 44.5%, 34.8%, 6.5% and 19.3%, respectively). The main barriers to the provision of these services in current practice were lack of: time (86.1%), coordination with other health care professionals (61.1%), staff or resources (57.2%), financial compensation (50.8%), and clinical tools (45.5%).ConclusionsAlthough community pharmacists think they should play a significant role in health promotion and prevention, they recognize a wide gap between their ideal and actual levels of involvement. The efficient integration of primary-care pharmacists and pharmacies into public health cannot be envisioned without addressing important organizational barriers.

Structured, group-based exercise programs offered by community organizations in natural settings can successfully increase balancing ability among community-dwelling older adults concerned about falls.

Attendance at a primary care physician workshop was associated with higher rates of osteoporosis medical practices for elderly women and high-risk men and women. However, osteoporosis detection and treatment remained sub-optimal, particularly in men.

La construcción de una racionalidad : los médicos y la prescripción de psicotrópicos Una importante proporción de personas de edad consume psicotrópicos y son numerosas las que lo hacen desde hace bastante tiempo. No obstante, un cierto número de estudios epidemiologicos ha demostrado que este consumo está asociado al aumento de riesgos en cuanto a trastornos cognitivos, caídas y hospitalizaciones. No es por lo tanto extraño el creciente interés por este fenómeno y la multiplicación de los estudios centrados en « la utilización racional de los medicamentos », es decir, la utilización definida por las autoridades de salud pública según las primeras indicaciones para las cuales los medicamentos fueron puestos en venta. No obstante, este procedimiento parte del a priori de un comportamiento cientifico y estandartizado de parte de los médicos, las desviaciones de las normas clínicas están consideradas desde un principio como irracionales. Pero esto no toma en cuenta los factores llamados « subjetivos » subyacentes en la relación terapeútica tales como el peso de la demanda expresada por el paciente, la carga simbólica del medicamento y del acto de recetar. Este artículo intenta delimitar las etapas de la construcción de una racionalidad frente a la decisión de recetar, a partir de un estudio sobre las representaciones que tienen los médicos en cuanto a la prescripción de psicotrópicos a las personas de edad.