Farmacia Lagunkoia: Potenciando el rol de prevención comunitaria de las farmacias junto con la comunidad

Farmacia Lagunkoia is a program that was created within the framework of the Euskadi Lagunkoia project. It is an initiative promoted by the Department of Welfare, Youth and Demographic Challenge and implemented by the Matia Institute. Its main objective is to encourage the participation of the elderly and the general public in the improvement of neighborhoods and environments in the municipalities of the Basque Country.

Within the wide range of dimensions that are worked on in the field of age-friendliness, those related to services bring together a combination of aspects whose improvement has an impact on the well-being of ageing people Such is the case of pharmacies, which play an essential role in the daily lives of the elderly. Farmacia Lagunkoia emerged as a response to the need to strengthen the community role of pharmacies, turning them into spaces not only for pharmaceutical care, but also for social support and early detection of needs in collaboration with other agents, such as social or health services and community resources.

Through this program, pharmacies develop their potential as a key resource for identifying the needs/problems of the elderly, for example, situations of loneliness, which has become a phenomenon that is receiving increasing social attention, fostered by the accumulation of evidence that points to the impact that this can have on well-being through various channels.

The aim of the initiative is to integrate pharmacies into a broader support network, linking them closely with other agents: social services, health centers and other community agents, to improve the quality of life of the elderly in the Basque Country.

The Lagunkoia Pharmacy approach: a participatory process to improve the community environment

The first experience involving Farmacia Lagunkoia was promoted between 2015 and 2018 by the City Council of Donostia-San Sebastián and the Gipuzkoa College of Pharmacists

The design of the aforementioned process, which involved the collaboration of pharmacy users, local pharmacists, healthcare and social services professionals, and volunteer organizations, made it possible to investigate the needs of the elderly and gave rise to enriching reflections on how to achieve a service more in line with them.

From there, an analysis was made of the different elements that make up the pharmacy space and other aspects, delving into the following questions: - What is the pharmacy I usually go to like? - What is my relationship like with the professionals who work there? - What makes a pharmacy an age-friendly space? What does it have to have? The analysis identified several key factors, such as the physical accessibility of the establishment, the quality of the relationship between pharmacists and users, and the pharmacy's ability to act as a point of reference in the community.

The result was the participatory creation of a set of commitments that pharmacies had to follow in order to be considered friendly. These commitments ranged from physical aspects, such as the elimination of architectural barriers, to more social issues, such as the promotion of a close and trusting relationship between pharmacists and the elderly.

Delving deeper into needs: A qualitative and quantitative study

Between 2020 and 2021, with the aim of extending the Pharmacies initiative throughout the Basque Country, Euskadi Lagunkoia, in collaboration with the Basque Country Pharmacists' Council, launched an inquiry process through a qualitative and quantitative study involving 38 pharmacies from across the territory. This study focused on two aspects: the impact of the COVID-19 pandemic on the user-friendliness of pharmacies, and the way in which they interact with other local agents according to the size of the habitat (rural or urban). The results obtained pointed to the need to promote the community role of pharmacies in detecting potential problems of the elderly. Therefore, the next step was to design a pilot program taking into account the habitat.

Towards a practical approach: Pilots in three municipalities, three different contexts

In 2023, a series of Farmacia Lagunkoia pilot projects were launched in three municipalities, one municipality for each territory of the Basque Country and with different characteristics: Alegría-Dulantzi, a municipality in the territory of Araba (typically rural, small), Aretxabaleta, a municipality in the territory of Gipuzkoa (rural, intermediate) and Barakaldo, a municipality in the territory of Bizkaia - in the district of Cruces (urban, intermediate-large). These are very different contexts, where social dynamics, community support networks and accessibility to services are very diverse.

The choice of these municipalities therefore responded to two main aspects:

• The differences that occur in the rural/urban dichotomy, for example, the dynamics that occur in a rural area around informal care networks, which generate dynamics of interdependence within the community, develop in a different way to those in an urban area.
• High degree of activity of the Friendliness Promotion Group and town council: A Promotion Group and local council involved in improving the friendliness of their physical and social environment and services provides a boost of interest in the Lagunkoia Pharmacy experience.

From June 2023 to February 2024, the pilot has been carried out through a series of participatory sessions in which the bases and modes of operation are developed. The pilot actions have been carried out in line with the times and rhythms followed by those who participate in each collaboration group in each locality.

In each of the Farmacia Lagunkoia sessions, specific actions are identified that can be implemented after the end of each session. In this way, work is carried out on a roadmap that allows them to clearly define the tasks necessary to develop each of the proposed actions.

This process means that the pilot schemes consist of a series of sessions in which different agents are brought together and questioned, agents who until that moment had not had the opportunity to collaborate in these aspects, always with the focus on exploring and defining the community role that pharmacies can play, while fostering cooperation between the different actors involved. The sessions include a detailed analysis of the needs for future community intervention actions, followed by the identification of specific actions that respond to those needs. In addition, commitments are made by the people involved in the process.

During the final process, the experience is explored in depth for the participants, looking at both the achievements and the challenges they have faced throughout the process. In addition, a brainstorming session is held to define how they want to continue working in the future. This space allows for the sharing of learning, the identification of areas for improvement and the collective assessment of the impact of the collaboration, fostering a participatory approach.

Through this initiative, greater coordination is fostered between these actors, making it easier for pharmacies to act as points of reference to guide older people towards the services they may need. To this end, a Working Commission is created for each municipality (collaborative group) which, on a regular basis, reflects on and generates synergies between the different local agents. Within the framework of this group, problems are identified at an early stage and joint and coordinated actions are developed to address the needs of older people in a comprehensive manner.

The profiles that have participated in the pilot projects have been: The pharmacies in each locality (pharmacy professionals) the municipality's Age-Friendly Promotion Group belonging to the Lagunkoia Network (older people playing a leading role in improving the age-friendliness of their environments), the health centre (Osakidetza: medical and community nursing staff), the town hall (social services, technical figure for older people) and other profiles such as the technical figure for community prevention and the municipal development agency. The initiative is completely open to the participation of any other agent who wants to join.

The results

Alegría Dulantzi (rural)

In this rural municipality, informal support networks, such as family and neighborhood, play an important role. However, access to information flows about community activities can be a challenge, which occurs unevenly in different population groups. For this reason, the pilot project in this municipality focused on improving older people's access to social services and encouraging their participation in community activities, taking advantage of the full potential that people who work in pharmacies have when they know the preferences of the people who frequently visit them. In this type of environment, the pharmacy is seen as a place of trust and the people who work there as figures of reference. In order to provide pharmacies with information to pass on and to enable them to select the relevant information to guide each person, the idea of designing an information poster to be distributed in pharmacies and social centers was proposed, so that older people could easily access the resources available in their municipality.

In addition, it was proposed to organize workshops on the maintenance of home first aid kits and the promotion of healthy habits, with a preventive approach that sought not only to improve physical health, but also to encourage the creation of meeting and socialization spaces, as indicated by studies on active aging and community networks.

Aretxabaleta (intermediate)

In this medium-sized municipality, the focus was on improving communication between pharmacies and social services, as previous work sessions had identified that pharmacies were often unaware of the resources available to older people. Although they tend to detect various needs in these people, they often do not have an agile communication channel to report specific situations. For this reason, a protocol was developed to facilitate this connection and ensure that the needs detected can be communicated effectively to the appropriate services. In addition, value was placed on the previous work carried out by the Friendliness Promotion Group, who had set up dialogue workshops that fostered social interaction between older people and that in some way addressed dimensions potentially linked to experiences of loneliness.

Fotografía tomada durante la sesión de trabajo del pilojate en Aretxabaleta

During the design of the actions, it was proposed that pharmacies participate in the meetings of the Red Mugiment in the Basque Country. This network, which collaborates with various local agents such as town halls, associations, health centers and pharmacies, to promote an active lifestyle and are spread throughout the Basque Country. By being in continuous contact with the community, these networks provide a more complete and enriching view of the reality and needs of inactive people, and can be the basis for organizing future actions.

The idea of incorporating pharmacies into these meetings was a valuable proposal, as they are often unaware of the resources and services available to older people. Thus, if a pharmacy detects an older person interested in improving their physical fitness, it can offer them the appropriate information to access the services offered by the network, facilitating their integration into activities that promote a more active lifestyle.

Barakaldo - Cruces (urban)

In this urban environment, the dynamics of loneliness are more complex because, as Catherine Murray (2018) points out, in cities social networks tend to be more fragmented and informal support is less accessible, something that did not happen in the other two rural pilots. In this context, the pilot focused on improving coordination between pharmacies and the La Paz Health Center, establishing an agile communication protocol for the resolution of urgent and non-urgent incidents.

In addition, the dissemination of cultural, sporting and community activities has been proposed, and strategies have been proposed to make them visible and disseminate them through the pharmacy, and at the same time, in the digital sphere, a community mapping of the resources that exist for the elderly has been created. These actions not only improved access to essential services and meaningful activities, but also helped to strengthen social participation through the link between pharmacies.

These are just a few examples of the wide range of actions that can be developed. It is worth remembering that loneliness is a complex, multidimensional phenomenon that requires a comprehensive approach.

Following Jopling's (2015) approach to the dimensions of interventions aimed at improving situations of loneliness, it is essential to consider such important aspects as points of contact with the people who could benefit from them. In this case, pharmacies could become a key entry point for these interventions, and work has been carried out along these lines throughout the pilot projects developed within the framework of the Lagunkoia Pharmacy program. Lagunkoia Pharmacy program.

Conclusions

The development of each of the pilot schemes has demonstrated the potential of Farmacia Lagunkoia as a model of community care that can be scaled up to other municipalities in the Basque Country. Work is currently underway to evaluate the three experiences and to design a scalability plan to expand the initiative to other friendly municipalities belonging to the Network, adapting the interventions to the specific characteristics and needs of each locality.

In the future, Farmacia Lagunkoia is expected to be present in a greater number of municipalities, consolidating itself as a fundamental community prevention tool. As the population ages, initiatives like this one are increasingly necessary to ensure that older people can live healthy, active lives connected to the services and resources of their community.

As the doctor and humanist Albert Schweitzer said: “Sometimes our light goes out, but it is rekindled by the spark of another person”. This is precisely what Farmacia Lagunkoia seeks to do: to shine a light of support and well-being for the elderly, from a place as close and everyday as the pharmacy which, in connection with other agents, can help make communities more participatory, inclusive and supportive.

Text originally published on the blog Ciudades y comunidades amigables con las personas mayores del Imserso.