The reprofessionalisation of community pharmacy? An exploration of attitudes to extended roles for community pharmacists amongst pharmacists and General Practioners in the United Kingdom

What do pharmacy users think of free pharmacy services? Investigating pharmacy users' perceptions, attitudes and willingness to pay for free healthcare from pharmacies

Background

Evidence exists of pharmacists providing free or partially subsidised clinical services in order to meet patient healthcare needs. Little is known about how patients perceive the quality and importance of such unfunded services to their healthcare.

Objectives

To explore pharmacy user perspectives about unfunded services such as their valuation, why they chose to access these services from the pharmacy as well as their willingness to pay should pharmacies need to start charging for the provision of such services owing to budgetary constraints.

Methods

This study was nested in a larger nationwide study where 51 pharmacies were recruited across fourteen locations across New Zealand . Semi-structured interviews were conducted with patients who had accessed unfunded services in community pharmacies. Patients were followed up to identify their percieved health outcomes resulting from accessing the unfunded service.

Results

A total of 253 patient interviews were conducted on-site across 51 pharmacies in New Zealand. Two main themes were identified pertaining to (1) patient-provider relationship and (2) Willingness to pay. A total of fifteen different considerations were found to influence pharmacy users' decisions to access health services from the pharmacy. It was found that 62.8% of patients were willing to pay for unfunded services and the majority paying NZD$10.

Conclusion

Patients positively rate these services and largely deem them important for their healthcare. Willingness to pay for services were also variable between patients and were dependant on the type of service accessed.

"Reigns but does not govern": A reflection on professionalism and the autonomy of the pharmacist

INTRODUCTION

In recent decades, the professionalization of pharmacy has been debated worldwide. With the advent of industrialization, pharmacist autonomy has weakened, especially in the retail pharmacy market. Manegers and mentors of pharmacy chains serve as links between the profession and drug users. This study sought to understand the perceptions of retail pharmacy stakeholders regarding pharmacist autonomy and how to improve it, and to reflect on theories of professionalism.

METHOD

19 semi-structured interviews were conducted. The interviews were transcribed and analyzed through analyst triangulation and categorical content analysis, using the ATLAS.ti software.

RESULTS

Interviews were conducted with nine mentors and ten managers in retail medicine. They reported aspects related to managerial and technical autonomy regulated by law, and strategies for enhancing professional autonomy in retail pharmacy. Autonomy was considered limited by pharmacists' dependence on employability and self-devaluation; and market control exposed the weaknesses in pharmaceutical professionalism. Entrepreneurship and ownership attitude strategies were feasible only in a retail micro-political context.

CONCLUSION

The retail medicine continues to have business model centered on the product and controlling the pharmaceutical practice model. To ensure autonomy and professional strengthening, it is necessary that pharmacy recognizes itself as a clinical profession and develops a stable professional identity.

The pharmacist as safety net: an interview-based study of the intersecting dependencies between doctors and pharmacists

BACKGROUND

Social science research has demonstrated how health practitioners negotiate and contest professional roles and jurisdictions in practice, and in ways that reflect the power dynamics that permeate medicine. This article further explores these relational dynamics by examining how general practitioners (GPs) in Aotearoa New Zealand frame their working relationships with pharmacists.

METHODS

We conducted semi-structured interviews with 16 GPs from around the country. Interviews had a mean duration of 46 min, and were thematically analysed.

RESULTS

GPs saw and used pharmacists as a key source of information about both medicines and patients; thus it was not only pharmacists' training and expertise, but also their community setting and patient proximity, that made them a useful resource to doctors. Furthermore, GPs framed pharmacists as a critical 'safety net' due to their role in catching errors and checking prescribing details. The pharmacy 'safety net' also came through in participants' comments on discount pharmacies, which have introduced pronounced cost-cutting logics to Aotearoa New Zealand's pharmaceutical landscape; in their reflections on these organisations, prescribers express the importance of robust pharmacy practice to their own work.

CONCLUSIONS

Whilst the literature often foregrounds tensions in how health providers reinscribe their professional roles, this research highlights the interdependence that doctors identify with pharmacists, and their aspirations for working together. Both professional groups navigate a pressed health system that presents a set of common challenges to good medicines practice.

The effectiveness and cost of integrating pharmacists within general practice to optimize prescribing and health outcomes in primary care patients with polypharmacy: a systematic review

BACKGROUND

Polypharmacy and associated potentially inappropriate prescribing (PIP) place a considerable burden on patients and represent a challenge for general practitioners (GPs). Integration of pharmacists within general practice (herein 'pharmacist integration') may improve medications management and patient outcomes. This systematic review assessed the effectiveness and costs of pharmacist integration.

METHODS

A systematic search of ten databases from inception to January 2021 was conducted. Studies that evaluated the effectiveness or cost of pharmacist integration were included. Eligible interventions were those that targeted medications optimization compared to usual GP care without pharmacist integration (herein 'usual care'). Primary outcomes were PIP (as measured by PIP screening tools) and number of prescribed medications. Secondary outcomes included health-related quality of life, health service utilization, clinical outcomes, and costs. Randomised controlled trials (RCTs), non-RCTs, interrupted-time-series, controlled before-after trials and health-economic studies were included. Screening and risk of bias using Cochrane EPOC criteria were conducted by two reviewers independently. A narrative synthesis and meta-analysis of outcomes where possible, were conducted; the certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach.

RESULTS

In total, 23 studies (28 full text articles) met the inclusion criteria. In ten of 11 studies, pharmacist integration probably reduced PIP in comparison to usual care (moderate certainty evidence). A meta-analysis of number of medications in seven studies reported a mean difference of -0.80 [-1.17, -0.43], which indicated pharmacist integration probably reduced number of medicines (moderate certainty evidence). It was uncertain whether pharmacist integration improved health-related quality of life because the certainty of evidence was very low. Twelve health-economic studies were included; three investigated cost effectiveness. The outcome measured differed across studies limiting comparisons and making it difficult to make conclusions on cost effectiveness.

CONCLUSIONS

Pharmacist integration probably reduced PIP and number of medications however, there was no clear effect on other patient outcomes; and while interventions in a small number of studies appeared to be cost-effective, further robust, well-designed cluster RCTs with economic evaluations are required to determine cost-effectiveness of pharmacist integration.

TRIAL REGISTRATION

CRD42019139679.

"It is the future. Clinical pharmaceutical care simply has to be a matter of course." - Community pharmacy clinical service providers' and service developers' views on complex implementation factors

BACKGROUND

While there is a lot of documented evidence about the clinical and cost effectiveness of pharmacists' role extensions there is an inherent gap between service development and implementation.

OBJECTIVE(S)

This study aims to better understand the complex factors that influence the implementation of clinical pharmacy services from both the perspective of the community pharmacy service providers and service developers.

METHODS

A prospective qualitative interview study using purposive sampling of twelve service developers and twelve community pharmacy service providers from across all nine Federal States of Austria. The validated and piloted interview guide contained questions and prompts on role perceptions, attitudes, experience, implementation barriers, training needs and measures identified to strengthen clinical pharmacy provision in community pharmacy. Verbatim quotes were independently mapped to the Framework for the Implementation of Services in Pharmacy (FISpH) by two researchers.

RESULTS

24 Interviews were carried out. Data saturation was achieved. There is a great deal of enthusiasm to develop the remit of clinical pharmacy services. It is seen as important to ensure the future survival of the profession. Service developers are more positive and confident in the implementation success and pharmacists' skills than providers. Clear mandates for politics, academia and individual pharmacists have been discussed to affect change.

CONCLUSIONS

Austrian pharmacists are facing the same well documented challenges as many other healthcare systems only with more urgency. The development of a clinical pharmacy service framework; education accreditation standard and a well-supported continuous professional development system are considered key to bring about the necessary culture shift.

The feasibility and acceptability of a brief psychological intervention for adults with long-term health conditions and subthreshold depression delivered via community pharmacies: a mixed methods evaluation-the Community Pharmacies Mood Intervention Study (CHEMIST)

BACKGROUND

Adults with long-term health conditions (LTCs) are more likely to experience depressive symptoms which can worsen health outcomes and quality of life, and increase healthcare costs. Subthreshold depression may go undetected and/or untreated. The Community Pharmacies Mood Intervention Study (CHEMIST) explored whether community pharmacies represent a suitable setting to offer brief psychological support to people with LTCs and comorbid subthreshold depression.

METHODS

A feasibility intervention study with a nested mixed methods evaluation was employed. Adults with subthreshold depression and a minimum of one LTC were recruited from community pharmacies/local general practices and offered a brief psychological support intervention ('Enhanced Support Intervention' (ESI)), based on behavioural activation within a Collaborative Care framework. The intervention included up to six sessions supported by pharmacy staff ('ESI facilitators') trained to deliver the ESI within the community pharmacy setting. Recruitment, retention rates and engagement with the ESI were assessed. Semi-structured, one-to-one interviews with pharmacy staff and study participants, and a focus group with pharmacy staff, explored experiences and acceptability of the study and the ESI. Themes were mapped onto constructs of the Theoretical Framework of Acceptability.

RESULTS

Recruitment of ESI participants was challenging and slower than anticipated despite the varied methods of recruitment employed; although, this was useful in identifying barriers and enabling factors for participation. Engagament with the ESI was good with n=17 (71%) recruited participants commencing the ESI. The ESI was found to be acceptable to participants and ESI facilitators. Retention rate at 4 months was good n=20 (87.0%). The main barriers to identifying potential participants for pharmacy staff were lack of time, resources and limited experience in research. The ESI training and support manual were acceptable to ESI facilitators. The ESI and supporting patient workbook were acceptable to people with LTCs and subthreshold depression.

CONCLUSIONS

Community pharmacies were viewed as an acceptable setting in which to deliver preventative brief psychological support to people with LTCs at risk of depression. This feasibility study provided important data to inform the design of a pilot randomised controlled trial in this setting and highlighted important considerations for future pharmacy-based research.

TRIAL REGISTRATION

ISRCTN11290592.

Clinical pharmacists in Dutch general practice: an integrated care model to provide optimal pharmaceutical care

Background Medication-related harm is a major problem in healthcare. New models of integrated care are required to guarantee safe and efficient use of medication. Aim To prevent medication-related harm by integrating a clinical pharmacist in the general practice team. This best practice paper provides an overview of 1. the development of this function and the integration process and 2. its impact, measured with quantitative and qualitative analyses. Setting Ten general practices in the Netherlands. Development and implementation of the (pragmatic) experiment We designed a 15-month workplace-based post-graduate learning program to train pharmacists to become clinical pharmacists integrated in general practice teams. In close collaboration with general practitioners, clinical pharmacists conduct clinical medication reviews (CMRs), hold patient consultations for medication-related problems, carry out quality improvement projects and educate the practice staff. As part of the Pharmacotherapy Optimisation through Integration of a Non-dispensing pharmacist in a primary care Team (POINT) intervention study, ten pharmacists worked full-time in general practices for 15 months and concurrently participated in the training program. Evaluation of this integrated care model included both quantitative and qualitative analyses of the training program, professional identity formation and effectiveness on medication safety. Evaluation The integrated care model improved medication safety: less medication-related hospitalisations occurred compared to usual care (rate ratio 0.68 (95% CI: 0.57–0.82)). Essential hereto were the workplace-based training program and full integration in the GP practices: this supported the development of a new professional identity as clinical pharmacist. This new caregiver proved to align well with the general practitioner. Conclusion A clinical pharmacist in general practice proves a feasible integrated care model to improve the quality of drug therapy.

Why do pharmacists leave the profession? A mixed-method exploratory study

Background:

Recent New Zealand policy documents aim for pharmacists to be retained, and promote the provision of extended clinical pharmacy services. However, younger pharmacists have expressed dissatisfaction with the profession on informal social for a.

Objectives:

To explore the characteristics, and perspectives of pharmacy as a career, of recent Bachelor of Pharmacy (BPharm, four-year degree) graduates who have left, or are seriously considering leaving the New Zealand pharmacy profession in the near future and where they have gone, or plan to go.

Methods:

We conducted a cross-sectional study with a mixed-method explanatory sequential design. An anonymous online survey among those who completed their pharmacy undergraduate degree (BPharm or equivalent) in 2003 or later and who had left or who were seriously considering leaving the New Zealand pharmacy profession in the next five years, was open from 1^st December 2018 to 1^st February 2019. Recruitment occurred via University alumni databases, pharmacy professional organisations, pharmaceutical print media, social media and word-of-mouth. Ten semi-structured interviews were then conducted with a purposive sample of survey respondents. Descriptive statistics were generated from the quantitative data and qualitative data were analysed using manifest content analysis.

Results:

We received 327 analysable surveys of which 40.4% (n=132) were from those who had already left the New Zealand pharmacy sector at the time of the data collection and the rest (59.6% n=195) were those working within the sector, but seriously considering leaving the profession. Reasons most commonly reported for studying pharmacy were having an interest in health and wanting to work with people. The most common reasons for leaving, or wanting to leave, were dissatisfaction with the professional environment, including inadequate remuneration, and a perceived lack of career pathways or promotion opportunities. A wide range of career destinations were declared, with medicine being most frequently reported.

Conclusions:

Most of the reasons for leaving/considering leaving the profession reported relate to the values and features of the pharmacy profession such as the professional environment, remuneration and career pathways. These findings are consistent with other studies and may represent a barrier to achieving the aims of recent health policy documents.

How pharmacists perceive their professional identity: a scoping review and discursive analysis

OBJECTIVES

The objectives of this scoping review were to (a) explore how pharmacists perceive their professional roles and identities and (b) describe factors impacting which professional roles or identities pharmacists embody in different pharmacy practice settings.

METHODS

A scoping review using a deductive approach was undertaken for this study. Systematic searches were conducted in five databases: Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, EBSCO Cumulative Index to Nursing and Allied Health and Scopus (Elsevier). Key words searched included pharmacist, identity, professional role and one variations of these. Results were double-blind screened for relevance by two authors. Data extraction was facilitated by the web-based software platform COVIDENCE. Foucauldian critical discourse analysis was used to deconstruct how pharmacists perceive their professional roles and identities.

KEY FINDINGS

In total, 21 701 articles were retrieved in the search. Following de-duplication and screening, 23 studies from 11 different countries were included. Five major identity themes were identified: Clinician, Dispenser, Business Person, Patient Counsellor and Physician Supporter. The dispenser identity was the most widespread, but it was viewed by many pharmacists as undesirable. The clinician identity also had a strong presence but was viewed as an identity that pharmacists aspire to embody.

CONCLUSIONS

This scoping review illustrates that pharmacists do not uniformly perceive themselves to be clinicians. A significant gap exists between the profession's desired identity and that embodied by practicing pharmacists. The resulting dissonance may be a contributing factor to the lack of wide-scale practice change that the profession has been seeking for decades.

A call to action to change the communication skills curriculum for pharmacy undergraduates in Turkey: A comparison with the United Kingdom

INTRODUCTION

Globally, pharmacy undergraduate programs are evolving to reflect a more patient-centered approach to clinical practice. The importance of teaching communication skills in any undergraduate pharmacy curriculum cannot be overstated. This article compares current literature and practices related to pharmacy services and communication skills training (CST) in pharmacy undergraduate education in the United Kingdom (UK) and Turkey and discusses the need for an urgent change in the CST curriculum in Turkey. Additionally, the article provides potential strategies for improving the quality of CST and for expanding pharmacy practice to ensure students and graduates are motivated to use communication skills.

COMMENTARY

The traditionally structured curriculum in Turkey, where the basic sciences components are in the early years and clinical experiences in the later years, should be changed into an integrated environment so that CST could be more effectively incorporated. The CST offered at the University of Nottingham could be considered as a framework.

IMPLICATIONS

To meet patient care and educational needs, the authors have identified three key strategies to develop a change in CST for curriculum planners and policy makers in Turkey.

Community's extent of use and approval of extended pharmacy services in community pharmacies in Southwest Ethiopia

Background

The emergence of chronic diseases as major causes of disability and death has necessitated the introduction of new strategies to effectively address the ever-changing nature of public health problems. As a result, the role of community pharmacies in promoting public health is growing in recent years through the provision of extended pharmacy services. This study was conducted with the aim of assessing community’s extent of use and approval of extended pharmacy services at community pharmacies in Bonga town, Southwest Ethiopia.

Materials and methods

Community based cross-sectional study was conducted in Bonga town, Southwest Ethiopia, on households selected by systematic random sampling. Data was collected using semi-structured questionnaire. Data was collected by personally delivering questionnaires to respondents in selected households. Results of the study were described by frequency, mean and standard deviation (SD). Binary logistic analysis was performed to identify potential associations between dependent and independent variables.

Results

Out of 356 individuals included in the study, 58.4% recalled visiting community pharmacy premises during the previous six months. Out of these, 34.6% visited the community pharmacies to get extended pharmacy services. College educated participants were 19.4 times more likely to have used extended pharmacy services as compared to illiterate individuals whereas those who earn monthly income more than 5000 Ethiopian Birr were 3.6 times more likely than those with monthly income of 2000 Ethiopian Birr or less. Of the total participants, 91.3% approved the provision of extended pharmacy services in community pharmacies.

Conclusion

The extent of community’s use of extended pharmacy services at community pharmacies was found to be low. Nevertheless, majority of the study subjects approved the provision of extended pharmacy services at community pharmacies. Efforts to improve the practice of extended pharmacy service provision at community pharmacies should be made by all stake holders.

Non-dispensing pharmacists' actions and solutions of drug therapy problems among elderly polypharmacy patients in primary care

OBJECTIVE

To evaluate the process of clinical medication review for elderly patients with polypharmacy performed by non-dispensing pharmacists embedded in general practice. The aim was to identify the number and type of drug therapy problems and to assess how and to what extent drug therapy problems were actually solved.

METHOD

An observational cross-sectional study, conducted in nine general practices in the Netherlands between June 2014 and June 2015. On three pre-set dates, the non-dispensing pharmacists completed an online data form about the last 10 patients who completed all stages of clinical medication review. Outcomes were the type and number of drug therapy problems, the extent to which recommendations were implemented and the percentage of drug therapy problems that were eventually solved. Interventions were divided as either preventive (aimed at following prophylactic guidelines) or corrective (aimed at active patient problems).

RESULTS

In total, 1292 drug therapy problems were identified among 270 patients, with a median of 5 (interquartile range 3) drug therapy problems per patient, mainly related to overtreatment (24%) and undertreatment (21%). The non-dispensing pharmacists most frequently recommended to stop medication (32%). Overall, 83% of the proposed recommendations were implemented; 57% were preventive, and 35% were corrective interventions (8% could not be assessed). Almost two-third (64%) of the corrective interventions actually solved the drug therapy problem.

CONCLUSION

Non-dispensing pharmacists integrated in general practice identified a large number of drug therapy problems and successfully implemented a proportionally high number of recommendations that solved the majority of drug therapy problems.

Organisational factors associated with safety climate, patient satisfaction and self-reported medicines adherence in community pharmacies

BACKGROUND

Evidence suggests that community pharmacy service quality varies, and that this may relate to pharmacy ownership. However little is known about wider organisational factors associated with quality.

OBJECTIVE

To investigate organisational factors associated with variation in safety climate, patient satisfaction and self-reported medicines adherence in English community pharmacies.

METHODS

Multivariable regressions were conducted using data from two cross-sectional surveys, of 817 pharmacies and 2124 patients visiting 39 responding pharmacies, across 9 diverse geographical areas. Outcomes measured were safety climate, patient satisfaction and self-reported medicines adherence. Independent variables included service volume (e.g. dispensing volume), pharmacy characteristics (e.g. pharmacy ownership), patient characteristics (e.g. age) and areal-specific demographic, socio-economic and health-needs variables.

RESULTS

Valid response rates were 277/800 (34.6%) and 971/2097 (46.5%) for pharmacy and patient surveys respectively. Safety climate was associated with pharmacy ownership (F_8,225 = 4.36, P < 0.001), organisational culture (F_{4, 225} = 12.44, P < 0.001), pharmacists' working hours (F_{4, 225} = 2.68, P = 0.032) and employment of accuracy checkers (F_{4, 225} = 4.55, P = 0.002). Patients' satisfaction with visit was associated with employment of pharmacy technicians (β = 0.0998, 95%CI = [0.0070,0.1926]), continuity of advice-giver (β = 0.2593, 95%CI = [0.1251,0.3935]) and having more reasons for choosing that pharmacy (β = 0.3943, 95%CI = [0.2644, 0.5242]). Satisfaction with information received was associated with continuity of advice-giver (OR = 1.96, 95%CI = [1.36, 2.82]), weaker belief in medicines overuse (OR = 0.92, 95%CI = [0.88, 0.96]) and age (OR = 1.02, 95%CI = [1.01, 1.03]). Regular deployment of locums by pharmacies was associated with poorer medicines adherence (OR = 0.50, 95%CI = [0.30, 0.84]), as was stronger patient belief in medicines overuse (OR = 0.88, 95%CI=[0.81, 0.95]) and younger age (OR = 1.04, 95%CI = [1.01, 1.07]). No patient outcomes were associated with pharmacy ownership or service volume.

CONCLUSIONS

This study characterised variation in the quality of English community pharmacy services identifying the importance of skill-mix, continuity of care, pharmacy ownership, organisational culture, and patient characteristics. Further research is needed into what constitutes and influences quality, including the development of validated quality measures.

Factors influencing national implementation of innovations within community pharmacy: a systematic review applying the Consolidated Framework for Implementation Research

Background

To meet emergent healthcare needs, innovations need to be implemented into routine clinical practice. Community pharmacy is increasingly considered a setting through which innovations can be implemented to achieve positive service and clinical outcomes. Small-scale pilot programmes often need scaled up nation-wide to affect population level change. This systematic review aims to identify facilitators and barriers to the national implementation of community pharmacy innovations.

Methods

A systematic review exploring pharmacy staff perspectives of the barriers and facilitators to implementing innovations at a national level was conducted. The databases Medline, EMBASE, PsycINFO, CINAHL, and Open Grey were searched and supplemented with additional search mechanisms such as Zetoc alerts. Eligible studies underwent quality assessment, and a directed content analysis approach to data extraction was conducted and aligned to the Consolidated Framework for Implementation Research (CFIR) to facilitate narrative synthesis.

Results

Thirty-nine studies were included: 16 were qualitative, 21 applied a questionnaire design, and 2 were mixed methods. Overarching thematic areas spanning across the CFIR domains were pharmacy staff engagement (e.g. their positive and negative perceptions), operationalisation of innovations (e.g. insufficient resources and training), and external engagement (e.g. the perceptions of patients and other healthcare professionals, and their relationship with the community pharmacy). Study participants commonly suggested improvements in the training offered, in the engagement strategies adopted, and in the design and quality of innovations.

Conclusions

This study’s focus on national innovations resulted in high-level recommendations to facilitate the development of successful national implementation strategies. These include (1) more robust piloting of innovations, (2) improved engagement strategies to increase awareness and acceptance of innovations, (3) promoting whole-team involvement within pharmacies to overcome time constraints, and (4) sufficient pre-implementation evaluation to gauge acceptance and appropriateness of innovations within real-world settings. The findings highlight the international challenge of balancing the professional, clinical, and commercial obligations within community pharmacy practice. A preliminary theory of how salient factors influence national implementation in the community pharmacy setting has been developed, with further research necessary to understand how the influence of these factors may differ within varying contexts.

Trial registration

A protocol for this systematic review was developed and uploaded onto the PROSPERO international prospective register of systematic reviews database (Registration number: CRD42016038876).

Electronic supplementary material

The online version of this article (10.1186/s13012-019-0867-5) contains supplementary material, which is available to authorized users.

Challenges faced with opioid prescriptions in the community setting - Australian pharmacists' perspectives

BACKGROUND

Prescription opioids (POs) are well recognised for their role in pain management. However over recent years, use of POs has become an increasingly complex public health issue, with the emergence of increasing quantities of POs being misused and abused. Pharmacists represent the 'gatekeepers' of medicines, which can be a challenging role, relating in particular to POs.

OBJECTIVE

This study aimed to gain insight into the challenges Australian community pharmacists experience in the dispensation of POs.

SETTING

Sydney Australia.

METHOD

Twenty-five pharmacists were recruited from suburbs in and around Sydney, Australia. Pharmacists were interviewed using an in-depth, semi-structured protocol. All interviews were audio-recorded, transcribed and thematically analysed.

MAIN OUTCOME MEASURE

Identification of issues/factors that may influence the dispensing of POs.

RESULTS

Pharmacists were reportedly confronted with several issues in the dispensing of POs, particularly in relation to the patient and prescriber. Pharmacists reported some individuals becoming increasingly more "creative" in the methods used to obtain POs, rendering detection of potential abuse/misuse increasingly difficult. Poor professional relationships with prescribers-an apparent power dynamic between the two professions, and limited engagement with patients were issues also identified. The majority of participants suggested that an electronic monitoring database would help in the identification of PO abuse/misuse.

CONCLUSION

Education is required to emphasise the importance of inter-professional collaboration between pharmacists and prescribers, as is empathy in the pharmacist-patient relationship. Prescription drug monitoring programs and prescribers sending electronic prescriptions directly to the pharmacist were perceived as helpful initiatives to undertake.

Changing status in health care: community and hospital pharmacists’ perceptions of pharmacy practice

Objectives

This study aimed to explore experienced community and hospital pharmacists’ perceptions of how their pharmacy practice and status in health care are affected by others’ views of them.

Methods

A qualitative collective case study was conducted. The primary data were 20 in-depth semistructured interviews of community and hospital pharmacists in England that were audio-recorded, transcribed and analysed thematically.

Key findings

Thematic analysis of the data identified four themes: (1) ambiguities about being professionals, (2) internal divisions, (3) medicines experts and (4) shopkeepers as healthcare providers.

Conclusions

Pharmacists want to be recognised as medicines experts in health care. They are aware that their status is assessed by the public based on their practice, which is dispensing of medicines, and that the public’s image of all pharmacists is that of ‘a typical community pharmacist’ working in a retail shop while having little experience of pharmacists in other healthcare settings. Pharmacists consider that the public does not view them as registered healthcare professionals. They mainly associate being registered professionals with being controlled from afar by their professional regulator, instead of utilising this as an enabling strategy to support their reprofessionalisation efforts. Pharmacists remain the hidden healthcare profession and need to act in practice as healthcare professionals, so the public is aware of their place and contributions in health care to maintain or enhance their status. Internal divisions between community and hospital pharmacists appear to be due to differences in practice, knowledge and aspirations having the potential to adversely affect the pharmacy profession’s status.

Community pharmacy Medicines Use Review: current challenges

With a growing aging population, the appropriate, effective, and safe use of medicines is a global health policy priority. One concern is patients' non-adherence to medicines, which is estimated to be up to 50%. Policymakers seek to reconfigure medicine management services and consider community pharmacy as especially well-placed to improve medicine use. In England and Wales, a commissioned medication review service called "Medicines Use Reviews (MURs)" was made available in through the National Health Service (NHS) in 2005. This involves a patient-pharmacist consultation to improve patients' knowledge and the use of medicines and to help reduce avoidable waste. However, over a decade since their introduction, questions remain over the extent to which the MUR policy has successfully been embedded in practice and translated into more effective use of medicines. The MUR intervention continues to hold many challenges ranging from poor public awareness and acceptance of MURs, organizational constraints, and issues over interprofessional collaboration. Many of these challenges are not exclusive to the MUR service, or even to the community pharmacy setting. Nevertheless, by identifying and exposing such challenges, an opportunity exists for policymakers and commissioners to seek to improve this service to patients. This narrative review explores the current challenges that face MURs. Damschroder et al's consolidated framework for implementation research is employed to help organize these challenges from patient and professional perspectives across multiple contexts. Over the past decade, MUR policy and practice has continued to evolve, being shaped by research, organizational and professional influences, and policy. Reforms to the service suggest that the MURs are becoming more responsive to patients' need and preferences. It is intended that this review will create impetus and scope for further debate, service reconfiguration, and ultimately service improvement.

'I expected just to walk in, get my tablets and then walk out': on framing new community pharmacy services in the English healthcare system

Reconfiguration of the healthcare division of labour is becoming increasingly attractive in the context of increased patient demand and resource constraints. One example is the introduction of extended roles for pharmacists to provide patients additional support to manage their medicines, while also reducing work pressures experienced by other health professionals. Understanding how such policies are framed by those delivering and receiving care has been under-theorised. Using Goffman's frame theory, we examine one newly introduced community pharmacy service (New Medicines Service (NMS)) to illustrate how a policy intended to support patient medicine-taking through the extended roles of pharmacists is framed and where this deviates from its proposed aims. Three themes emerged: (i) the spatial-material artefacts; (ii) existing discursive culture and practice around medicine-taking; and (iii) the NMS interactions that shape and govern framing and subsequent interpretation of the NMS. Our study offers an explanatory and dynamic view of the framing process with important lessons for reconfiguring medicine management policy and practice. As well as illustrating framing as being variegated, complementary or conflicting, it also shows how this plurality and fragility had consequences for patient engagement and sense-making. The consequences for engagement and recommendations for implementing future initiatives are discussed.

Pharmacist views and pharmacy capacity to deliver professional services in the United Arab Emirates

Background The benefits of professional pharmacy services in improving patient outcomes and reducing health expenditure are well documented. To a large extent, these services are not implemented in many developing countries. Objective To explore pharmacists' perceptions of and willingness to provide professional services in the United Arab Emirates (UAE) and the perceived barriers and facilitators. The current provision of pharmacy-based services and capacity for service delivery were also explored. Setting Community pharmacies in Sharjah and Dubai in the UAE. Methods A 34-item cross-sectional survey was conducted. It assessed community pharmacists' perceptions of and willingness to provide professional services in the future, current service provision and capacity to deliver professional services. A descriptive analysis of responses was undertaken. Main outcome measure Community pharmacists' perceptions of and willingness to provide pharmacy-based professional services in the United Arab Emirates (UAE) and associated barriers and facilitators. Results Overall, 200 community pharmacists completed the survey. Ninety-two percent of participants thought that it is time for community pharmacists to engage in extended services (screening, medication use reviews, and chronic disease management) provided that adequate training and regulatory approvals are given. The current restrictive legislations and negative public perception were perceived as major barriers to providing extended services, but lack of time and support staff were also considered barriers. Conclusions Community pharmacists held strong positive views regarding future engagement in professional services. Given the compelling public health case for expansion of affordable care, it is timely to expand health services in the UAE by using the untapped clinical skills of pharmacists. Transition towards professional pharmacy services requires support from key stakeholders including medical and regulatory organizations, and public acceptance.

Pharmacists in general practice: a qualitative interview case study of stakeholders' experiences in a West London GP federation

Background

Increased patient demand for healthcare services coupled with a shortage of general practitioners necessitates changes in professional roles and service delivery. In 2016, NHS England began a 3-year- pilot study of pharmacists in general practice, however, this is not an entirely new initiative. There is limited, current, evidence-based, UK research to inform the pilot so studies of pre-existing services must suffice until findings from a formal national evaluation are available.

Methods

The aim of this exploratory, descriptive interview study was to explore the experiences of stakeholders in eight general practices in the Ealing GP Federation, West London, where pharmacy services have been provided for several years. Forty-seven participants, including pharmacy team members (pre-registration and clinical pharmacists, independent prescribers and pharmacy technicians), general practitioners, patients, practice managers, practice nurses and receptionists took part in semi-structured, audio-recorded qualitative interviews which were transcribed verbatim, coded and analysed thematically to extract the issues raised by participants and the practicalities of providing pharmacy services in general practice.

Results

Findings are reported under the themes of Complementarity (incorporating roles, skills, education and workloads); Integration (incorporating relationships, trust and communication) and Practicalities (incorporating location and space, access, and costs). Participants reported the need for time to develop and understand the various roles, develop communication processes and build inter-professional trust. Once these were established, however, experiences were positive and included decreased workloads, increased patient safety, improved job satisfaction, improved patient relationships, and enhanced cost savings. Areas for improvement included patients’ awareness of services; pharmacists’ training; and regular, onsite access for practice staff to the pharmacy team.

Conclusions

Recommendations are made for the development of clear role definitions, identification of training needs, dedication of time for team building, production of educational materials for practice staff members and patients, and provision of on-site, full-time pharmacy services. Future work should focus on evaluation of various models of employing pharmacy teams in general practice; integration of pharmacists and pharmacy technicians into multidisciplinary general practice teams; relationships between local community pharmacy and general practice personnel; and patients’ service and information needs. A formal national evaluation of the pilot scheme is overdue.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3056-3) contains supplementary material, which is available to authorized users.

Negotiating inter-professional interaction: playing the general practitioner-pharmacist game

Despite a mutual interest in optimising the benefits of medication for patients, the general practitioner (GP) and community pharmacist (CP) often work in isolation from one another, both physically and figuratively. Sources of tension include pharmacy's 'shopkeeper' image, traditional medical hierarchies and potential encroachment on professional boundaries. This article examines GP and CP perceptions of their interactions and negotiations and, drawing on the works of Stein and Goffman, identifies a set of 'unwritten' rules, termed the 'GP-pharmacist game', which involves the concept of 'face-work'. Qualitative interviews with 20 GPs and 23 CPs located in four geographically and demographically different areas in England were conducted during 2010-11. Key rules of the game include the pharmacist avoiding blaming the GP, using discretion in front of patients, and balancing the necessity and frequency of the communication. This article argues that whilst adhering to the 'GP-pharmacist game' may avoid conflict and 'get the job done', it may also constrain efforts to meet wider health care policy aims of a more collaborative relationship.

The role of community pharmacists in the identification and ongoing management of women at risk for perinatal depression: A qualitative study

BACKGROUND

While pharmacists are among the most accessible primary health professionals within a mother's healthcare team to identify potential cases of perinatal depression (PND), very little in the literature suggests that this role has been explored.

AIM

The aim of this study was to explore community pharmacists' perspectives on their potential roles in perinatal mental health promotion (recognition and health education) and the factors affecting these roles.

METHODS

In total, 20 semi-structured, in-depth interviews were conducted with community pharmacists.

RESULTS

Most pharmacists highlighted their significant roles in recognising PND symptoms and providing medication-related support to perinatal mothers. Barriers to service provision included inter-professional role boundaries, the lack of established referral systems and service remuneration and the lack of adequate training in mental health.

CONCLUSION

Pharmacists could potentially reinforce their involvement in mental health promotion activities.

Barriers to promote cardiovascular health in community pharmacies: a systematic review

Community pharmacists play an important role in the provision of health promotion services, and community pharmacies are considered as a potentially ideal site for cardiovascular health promotion. Information based on a systematic review of barriers to promoting cardiovascular health in community pharmacy is currently lacking. We have sought to identify the most important barriers to cardiovascular health promotion in the community pharmacy. We have systematically searched PubMed and International Pharmaceutical Abstracts for a period of 15 years from 1 April 1998 to 1 April 2013, contacted subject experts and hand-searched bibliographies. We have included peer-reviewed articles, with English abstracts in the analysis, if they reported community pharmacists' perceptions of the barriers to cardiovascular health promotion activities in a community pharmacy setting. Two reviewers have independently extracted study characteristics and data. We identified 24 studies that satisfy the eligibility criteria. The main barriers to cardiovascular health promotion in the community pharmacy included pharmacist-related factors; practice site factors; financial factors; legal factors; and patient-related factors. This review will help to provide reliable evidence for health promotion practitioners of the barriers to promoting cardiovascular health in the community pharmacy setting. This knowledge is valuable for the improvement of cardiovascular health promotion in this setting and guiding future research.

Community health integration through pharmacy process and ergonomics redesign (CHIPPER)

As the expansion and utilisation of community pharmacy systems increases, so does the risk for an adverse drug event to occur. In attempts to mitigate this risk, many community pharmacies implement health information technology (IT); however, there are challenges in integrating the wider systems components necessary for a successful implementation with minimal unintended consequences. The purpose of this paper is to introduce a Community Health Integration through Pharmacy Process and Ergonomics Redesign (CHIPPER) framework, which explores the multiple angles of health IT integration to support medication delivery processes in community pharmacy systems. Specifically, CHIPPER identifies the information flows that occur between different parts of the system (initiation, upstream, midstream and downstream) with varying end-users and tasks related to medication delivery processes. In addition to the justification and presentation of the CHIPPER model, this paper reviews several broad applications for CHIPPER and presents two example studies that demonstrate the CHIPPER framework. Practitioner Summary: Most medication delivery in the US occurs through outpatient-based community pharmacy practice. Community pharmacies are challenged by inconsistent and incomplete information flow and technology integration between providers, pharmacy practitioners and patients. This paper presents a framework for improved healthcare systems engineering analysis of pharmacy practice, with case study examples.

Community pharmacists' opinions on skill-mix and delegation in England

OBJECTIVES

Following the 2005 contractual framework amendment, the expanding role of community pharmacy team members required a shift in entrenched views on roles and duties. This study aimed to report on community pharmacists' opinions on skill mix and explore how they can be addressed so that skill mix may be optimised.

METHODS

An invitation to complete an online questionnaire was distributed via email, marked for the attention of the lead pharmacist. Following a low response, a paper-based questionnaire was sent to all community pharmacies in England (n = 11,816). Questions elicited data about the respondent, the pharmacy (including staffing profile) and opinions on skill mix.

KEY FINDINGS

A total of 1154 returns were received, representing a 10% response rate. Of these, most were pharmacy chains (76%; n = 877), with 5-9 staff (54%; n = 600); commonly open 40-49 hours (42%; n = 487), dispensing <6000 prescriptions per week (41%, n = 533). From 26 statements on skill mix, three factors were identified by principal-components factor analysis: 'working well', 'feeling the pressure' and 'open to development'. Characteristics associated with 'working well': pharmacy owners, single businesses, with pharmacy technician(s), dispensing fewer prescriptions and open shorter hours. Characteristics associated with 'feeling the pressure': pharmacy chains, open longer hours, large numbers of prescriptions and relief pharmacists. Characteristics associated with 'open to development': recently qualified, second pharmacists, working longer hours, chains and dispensing lower numbers of prescriptions.

CONCLUSIONS

Although limited by a low response, results suggest being in a position to influence (more experienced, business owners) may be associated with more positive opinions. Further training (including about legalities and leadership) could contribute to optimising skill mix in community pharmacies.

Positioning pharmacists' roles in primary health care: a discourse analysis of the compensation plan in Alberta, Canada

BACKGROUND

A comprehensive Compensation Plan for pharmacy services delivered by community pharmacists was implemented in Alberta, Canada in July 2012. Services covered by the Compensation Plan include care planning services, prescribing services such as adapting prescriptions, and administering a drug or publicly-funded vaccine by injection. Understanding how the Compensation Plan was framed and communicated provides insight into the roles of pharmacists and the potential influence of language on the implementation of services covered by the Compensation Plan by Albertan pharmacists. The objective of this study is to examine the positioning of pharmacists' roles in documents used to communicate the Compensation Plan to Albertan pharmacists and other audiences.

METHODS

Publicly available documents related to the Compensation Plan, such as news releases or reports, published between January 2012 and December 2015 were obtained from websites such as the Government of Alberta, Alberta Blue Cross, the Alberta College of Pharmacists, the Alberta Pharmacists' Association, and the Blueprint for Pharmacy. Searches of the Canadian Newsstand database and Google identified additional documents. Discourse analysis was performed using social positioning theory to explore how pharmacists' roles were constructed in communications about the Compensation Plan.

RESULTS

In total, 65 publicly available documents were included in the analysis. The Compensation Plan was put forward as a framework for payment for professional services and formal legitimization of pharmacists' changing professional roles. The discourse associated with the Compensation Plan positioned pharmacists' roles as: (1) expanding to include services such as medication management for chronic diseases, (2) contributing to primary health care by providing access to services such as prescription renewals and immunizations, and (3) collaborating with other health care team members. Pharmacists' changing roles were positioned in alignment with the aims of primary health care.

CONCLUSIONS

Social positioning theory provides a useful lens to examine the dynamic and evolving roles of pharmacists. This study provides insight into how communications regarding the Compensation Plan in Alberta, Canada positioned pharmacists' changing roles in the broader context of changes to primary health care delivery. Our findings may be useful for other jurisdictions considering implementation of remunerated clinical services provided by pharmacists.

Moral dilemmas of community pharmacists: a narrative study

Background Pharmacists are increasingly involved in patient care. This new role in a complex healthcare system with demanding patients may lead to moral dilemmas. There has been little research into pharmacy ethics, and existing data are limited by their retrospective nature and small sample sizes. A thematic overview of the moral dilemmas experienced by community pharmacists is still missing. Objective To make a thematic overview of moral dilemmas experienced in daily pharmacy practice. Setting Dutch community pharmacy. Methods Dutch community pharmacists wrote a narrative about a moral dilemma they had experienced in clinical practice. The narratives were analysed using qualitative content analysis to identify underlying themes. Main outcome measure Themes of moral dilemmas. Results Twenty-two themes were identified in 128 narratives. These moral dilemmas arose predominantly during pharmacists’ contact with patients and other health professionals. The relationship between the pharmacist, patient and other health professionals was complicated by other parties, such as legal representatives, health insurance companies, and regulators. Conclusion The moral dilemmas experienced by community pharmacists are more diverse than previously reported. The main dilemmas arose in their professional contacts, frequently when their professional autonomy was challenged by the behaviour of patients and other health professionals.

Conceptions on pharmaceutical services in Brazilian primary health care

OBJECTIVE

To identify and discuss the conceptions of pharmaceutical services in Brazilian Primary Health Care, according to different subjects.

METHODS

This study is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015), which is composed of an information survey in a representative sample of cities, stratified according to Brazilian regions, and a subsample of primary health care services. Municipal secretaries of health, those responsible for pharmaceutical services, and those responsible for medicine delivery in pharmacies/dispensing units of the selected services were interviewed. The questionnaires included one question about the understanding of the interviewee regarding pharmaceutical services. The content analysis technique was used to apprehend, in the statements, the meanings attributed to pharmaceutical services, which were subsequently classified into categories according to their main conceptions.

RESULTS

Among the wide diversity of conceptions on pharmaceutical services (PS), we highlight the ones focused on 1) logistic control of medicines with activities concerning guidance or information on their use and 2) guidance or information to users on the use of medicine. The findings reveal a shifting tendency from a medicine-focused conception to one that considers the users and their needs as the final recipient of these actions. However, the lack of references to conceptions regarding care management and integrality point out the slowness of this change; after all, this is a social and historical process that comprises the production of meanings that transcend legal, logistic, and technical arrangements in pharmaceutical services.

CONCLUSIONS

The diversity of conceptions expresses the several meanings attributed to pharmaceutical services; we also identified, in their reorientation process, a movement that reflects a gradual shift in the technical paradigm, from the focus on medicine logistics to a user-oriented approach of health services.

Patient and public perspectives of community pharmacies in the United Kingdom: A systematic review

Background

The United Kingdom has been at the forefront of enhancing pharmacist roles and community pharmacy services, particularly over the past decade. However, patient and public awareness of community pharmacy services has been limited.

Objective

To identify and synthesize the research literature pertaining to patient and public perspectives on: existing community pharmacy services, extended pharmacist roles and strategies to raise awareness of community pharmacy services.

Search strategy

Systematic search of 8 electronic databases; hand searching of relevant journals, reference lists and conference proceedings.

Inclusion criteria

UK studies investigating patient or public views on community pharmacy services or pharmacist roles from 2005 to 2016.

Data extraction and synthesis

Data were extracted into a grid and subjected to narrative synthesis following thematic analysis.

Main results

From the 3260 unique papers identified, 30 studies were included. Manual searching identified 4 additional studies. Designs using questionnaires (n = 14, 41%), semi‐structured interviews (n = 8, 24%) and focus groups (n = 6, 18%) made up the greatest proportion of studies. Most of the studies (n = 28, 82%) were published from 2010 onwards and covered perceptions of specific community pharmacy services (n = 31). Using a critical appraisal checklist, the overall quality of studies was deemed acceptable. Findings were grouped into 2 main themes “public cognizance” and “attitudes towards services” each with 4 subthemes.

Discussion and conclusions

Patients and the public appeared to view services as beneficial. Successful integration of extended pharmacy services requires pharmacists’ clinical skills to be recognized by patients and physicians. Future research should explore different approaches to increase awareness.

Investigating the organisational factors associated with variation in clinical productivity in community pharmacies: a mixed-methods study

Background

Community pharmacies play a key role in health-care systems, dispensing prescriptions and providing medicine-related services. Service provision varies across community pharmacy organisations and may depend on organisational characteristics, such as ownership, staffing and skill mix.

Objectives

To inform the commissioning of community pharmacy services by (1) exploring variation in clinical productivity (levels of service delivery and service quality) in pharmacies, (2) identifying the organisational factors associated with this variation and (3) developing a toolkit for commissioners.

Design

Mixed-methods study: community pharmacy survey, administrative data analysis, patient survey, stakeholder interviews and toolkit development.

Setting

Nine socioeconomically diverse geographical areas of England.

Participants

Stage 1: community pharmacies in nine study areas. Stage 2: in 39 pharmacies, two consecutive samples of approximately 30 patients each following receipt of (1) dispensing and (2) medicines use review (MUR) services. Pharmacy and commissioning representatives from across all types of pharmacy and study sites.

Main outcome measures

Stage 1: dispensing, MUR, new medicines service volume and safety climate. Stage 2: patient satisfaction, Satisfaction with Information about Medicines Scale (SIMS) and Medication Adherence Report Scale (MARS).

Data sources

Stage 1: (i) community pharmacy activity data; (ii) socioeconomic and health needs data; and (iii) community pharmacy questionnaire (ownership type, organisational culture, staffing and skill mix, working patterns, management structure, safety climate, pharmacy–general practice integration), all linked by pharmacy postcode and organisational ‘F’ code. Stage 2: (i) patient questionnaire (background, patient satisfaction, SIMS, MARS); (ii) semistructured stakeholder interviews (variation in quantity and quality of service provision, opportunities and barriers to clinical productivity, mechanisms by which different organisational characteristics may help or hinder clinical productivity). Quantitative data were analysed by fitting a series of fixed-effects linear, logistic and multilevel logistic regression models in Stata® (version 13; StataCorp LP, College Station, TX, USA). Qualitative data were analysed thematically using a framework approach in NVivo10 (QSR International, Warrington, UK).

Results

In stage 1, 285 out of 817 pharmacy questionnaires were returned [valid response rate 34.6% (277/800)]. In stage 2, 1008 out of 2124 patient questionnaires were returned [valid response rate 46.5% (971/2087)]. Thirty pharmacy and 10 commissioning representatives were interviewed face to face or by telephone. Following integration of stage 1 and 2 findings, clinical productivity was associated with pharmacy ownership type, organisational culture, staffing and skill mix, and pharmacy–general practice relationships. Extra-organisational associations included local area deprivation, age profile and health needs, pharmacy location, public perceptions and expectations, supply chain problems, commissioning structures/processes, levels of remuneration and legal/regulatory constraints. Existing arrangements for monitoring clinical productivity focused primarily on quantity.

Limitations

Non-random selection of study sites and non-participation by four major pharmacy chains limited generalisability. Investigation of the full scope of pharmacy service provision was prevented by a lack of available activity data for locally commissioned services. Quantitative exploration of service quality was limited by available validated measures.

Conclusions

These findings have important implications for community pharmacies and service commissioners, highlighting the importance of ownership type, organisational culture, staffing and skill mix for maximising the delivery of high-quality pharmacy services and informing the development of a commissioners’ toolkit.

Future work

Future studies should (1) develop tools to measure community pharmacy service quality; (2) describe and evaluate different models of skill mix; and (3) explore how services are commissioned locally from community pharmacies and the extent to which local needs are met.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

"Click for Closer Care": A Content Analysis of Community Pharmacy Websites in Four Countries

Background

Combinations of professional and commercial communication are typically very controversial, particularly in health care communication on the Internet. Websites of licensed community pharmacies on the other hand tend to raise remarkably little controversy, although they typically contain controversial combinations of clinical and commercial services previously unprecedented in professional health care communication.

Objective

The aim of this study was to fill the void of knowledge about the combination of clinical and commercial services presented on the websites of licensed community pharmacies.

Methods

A content analysis of clinical and commercial services presented in a random sample of 200 licensed community pharmacy websites from Great Britain, the Netherlands, the Canadian provinces British Columbia and Manitoba, and the Australian states New South Wales and Western Australia was conducted.

Results

The top five specific services mentioned on the community pharmacy websites were cosmetic products (126/200, 63.0%), medication refill request options (124/200, 62.0%), over-the-counter medicine (115/200, 57.5%), complementary and alternative medicine (107/200, 53.5%), and home medical aids (98/200, 49.0%). On average, 72.5% (145/200) of the community pharmacy websites across the 4 countries included a combination of clinical and commercial services. A combination of clinical and commercial services was more often present on chain pharmacy websites (120/147, 82.8%) than single pharmacy websites (25/53, 47%; P<.001), and most often on the Canadian community pharmacy websites, followed by the Australian, British, and Dutch pharmacy websites, respectively (P<.02). Furthermore, more than half of the pharmacies’ homepages contained a combination of clinical and commercial images (107/200, 53.5%), and almost half of the homepage menus contained a combination of clinical and commercial items (99/200, 49.5%). The latter were, again, more common on chain pharmacy than single pharmacy websites (P<.001), with significant differences between countries (P<.001).

Conclusions

A considerable share of websites of licensed community pharmacies in Great Britain, the Netherlands, Canada, and Australia combine clinical services with commercial services. Previous research into the presence of a combination of commercial and professional services suggests that such a combination may lead to increased interest in commercial services that may be unnecessary or inappropriate to patients’ health.

Evaluation of a Hybrid Training Module for Community Pharmacy Staff Providing Hypertension Medication Therapy Management

PURPOSE

The purpose of this research study was to evaluate the impact of web-based training on the knowledge and perceived practice of community pharmacy staff engaged in a hypertension medication therapy management program. Following the recommendations from adult learning end experiential learning theoretical frameworks, the proposed training engaged learners in a series of short online educational videos with preknowledge and postknowledge assessment and patient interactions in a clinical setting to reenforce newly learned skills.

METHODS

The participants in this study were from Community pharmacies who actively participate in medication therapy management and disease management services in the 2 largest towns in North Dakota. The preknowledge and postknowledge tests indicated a statistically significant improvement in hypertension management knowledge for the participating pharmacy staff. The qualitative input from the participants fully complemented these findings by showing a strong positive perception on the implemented instructional process.

RESULTS

Training proved to be both effective and essential for pharmacy staff when initiating clinical services to ensure they have the necessary skills to be able to do their job well, and online training is an easy and efficient way to provide this training.

Implementing an online pharmaceutical service using design science research

BACKGROUND

The rising prevalence of chronic diseases is pressing health systems to introduce reforms. Primary healthcare and multidisciplinary models have been suggested as approaches to deal with this challenge, with new roles for nurses and pharmacists being advocated. More recently, implementing healthcare based on information systems and technologies (e.g. eHealth) has been proposed as a way to improve health services. However, implementing online pharmaceutical services, including their adoption by pharmacists and patients, is still an open research question. In this paper we present ePharmacare, a new online pharmaceutical service implemented using Design Science Research.

METHODS

The Design Science Research Methodology (DSRM) was chosen to implement this online service for chronic diseases management. In the paper, DSRM's different activities are explained, from the definition of the problem to the evaluation of the artifact. During the design and development activities, surveys, observations, focus groups, and eye-tracking glasses were used to validate pharmacists' and patients' requirements. During the demonstration and evaluation activities the new service was used with real-world pharmacists and patients.

RESULTS

The results show the contribution of DSRM in the implementation of online services for pharmacies. We found that pharmacists spend only 50% of their time interacting with patients, uncovering a clear opportunity to implement online pharmaceutical care services. On the other hand, patients that regularly visit the same pharmacy recognize the value in patient follow-up demanding to use channels such as the Internet for their pharmacy interactions. Limitations were identified regarding the high workload of pharmacists, but particularly their lack of know-how and experience in dealing with information systems (IST) for the provision of pharmaceutical services.

CONCLUSIONS

This paper summarizes a research project in which an online pharmaceutical service was proposed, designed, developed, demonstrated and evaluated using DSRM. The main barriers for pharmacists' adoption of online pharmaceutical services provision were the lack of time, time management and information systems usage skills, as well as a precise role definition within pharmacies. These problems can be addressed with proper training and services reorganization, two proposals to be investigated in future works.

Interprofessional spanning and building boundaries when supporting potential embryo donors to stem cell research

When patients undergo fertility treatment, it is likely that a surplus of embryos will be created. The existence of these surplus embryos creates responsibilities for the clinics where they are stored and for the people who own them. Since 2001, the owners of the surplus embryos in the UK have the option to donate them to be used in stem cell research (SCR). This development has generated a new population-potential embryo donors to SCR-who have unique support needs as they are neither fertility patients nor donors. However, little is known how lay and professional stakeholders associated with fertility treatment and SCR have conceptualised the support needs of potential embryo donors to SCR or have responded to the additional task once the option became available. In this article, we draw on Gieryn's concept of boundary-work to explore how the emergence of donating embryos to SCR has provided opportunities for embryologists, counsellors, and scientists to shift, adapt, or confirm their roles, knowledge base, and areas of expertise. We present a thematic analysis of 21 in-depth, semi-structured interviews conducted with UK lay and professional stakeholders associated with fertility treatment and SCR. We conclude with reflections on the implications this boundary-work has for those contemplating donating embryos to SCR and the care they receive when making their decision. Such insights are pertinent given the current policy and practice discussions led by the National Donation Strategy Group to improve the care of donors in the UK.

Self-care of long-term conditions: patients' perspectives and their (limited) use of community pharmacies

Background Self-care support is an 'inseparable' component of quality healthcare for long-term conditions (LTCs). Evidence of how patients view and use community pharmacy (CP) to engage in self-care of LTCs is limited. Objective To explore patients' perspectives of engaging in self-care and use of CP for self-care support. Setting England and Scotland. Method Qualitative design employing semi-structured interviews. LTCs patients were recruited via general practitioners (GPs) and CPs. Interviews were conducted between May 2013 and June 2014; they were audio-recorded, transcribed verbatim and analysed thematically. Results Twenty-four participants were interviewed. Three main themes emerged: engaging in self-care, resources for self-care support and (limited) use of community pharmacy. Participants' LTC 'lived experience' showed that self-care was integral to daily living from being diagnosed to long-term maintenance of health/wellbeing; self-care engagement was very personal and diverse and was based on beliefs and experiences. Healthcare professionals were viewed as providing information which was considered passive and insufficient in helping behavioural change. Non-healthcare sources (family, carers, friends, internet) were important in filling active support gaps, particularly lifestyle management. Participants' use of, and identified need for, community pharmacy as a resource for self-care support of LTCs was limited and primarily focussed on medicines supply. There was low awareness and visibility of CPs' potential roles and capability. Conclusion CP needs to reflect on patients' low awareness of its expertise and services to contribute to self-care support of LTCs. Rethinking how interventions are designed and 'marketed'; incorporation of patients' perspectives and collaboration with others, particularly GPs, could prove beneficial.

Changing perspectives of the role of community pharmacists: 1998 – 2012

ABSTRACT INTRODUCTION In New Zealand, extended medicines management roles proposed for pharmacists include the optimisation and monitoring of medicines in patients with long-term conditions through greater collaboration with general practitioners (GPs). Although some collaborative roles have been successfully implemented in hospitals, barriers for both pharmacists and GPs hinder interprofessional working relationships in the community. AIM To compare data from a 2012 study with two previous studies (1998, 2002) examining perceptions of community pharmacists and GPs of the expanding medicines management roles of community pharmacists. METHODS In 2012, a survey, modelled on the 1998 and 2002 studies, was sent to 600 community pharmacists and 600 GPs. Analyses considered the five-point Likert scale to be a continuous variable. A change of ≥ 10% between any two surveys indicated a relevant change for comparison. RESULTS Increasing agreement, which differed considerably between professions, was apparent for most expanding medicine management roles over the 14 study years. In all three studies, pharmacists were open to expanding their roles to include monitoring, screening, advisory and prescribing roles. GPs were most accepting of the traditional dispensing role with a positive shift towards pharmacists’ involvement in medicines management over time. DISCUSSION Over 14 years, GPs became more accepting of community pharmacists’ involvement in extended medicines management roles, although still had low acceptance of the more clinical roles. Pharmacists considered increased involvement in medicines management as their role, but appeared to lack confidence in their ability to do this role.

A qualitative study exploring physicians' perceptions on the role of community pharmacists in Dubai

Objective:

The aim of this study is to explore the perceptions of physicians operating within the boundaries of Dubai on the role of community pharmacists.

Methods:

Semi-structured interviews were done with 12 physicians working within the boundaries of Dubai Health Authority. Interviews mainly focused on understanding the perceptions of physicians on the role of community pharmacists in addition to willingness to integrating pharmacists in patient care process.

Results:

Key findings show that all interviewees agree that community pharmacists are important healthcare professionals. However, 7 physicians restrict the role of pharmacists to dispensing medicines. Physicians in Dubai are willing to collaborate with pharmacists, but more than half of them (7) think that pharmacists might interfere with their jobs.

Conclusion:

The study concludes that all informants agree that collaboration between community pharmacists and physicians definitely enhances patients’ drug therapy outcomes.

Controversy and consensus on a clinical pharmacist in primary care in the Netherlands

Background Controversy about the introduction of a non-dispensing pharmacist in primary care practice hampers implementation. Objective The aim of this study is to systematically map the debate on this new role for pharmacists amongst all stakeholders to uncover and understand the controversy and consensus. Setting: Primary health care in the Netherlands. Method Q methodology. 163 participants rank-ordered statements on issues concerning the integration of a non-dispensing pharmacist in primary care practice. Main outcome measure: Stakeholder perspectives on the role of the non-dispensing pharmacist and pharmaceutical care in primary care. Results This study identified the consensus on various features of the non-dispensing pharmacist role as well as the financial, organisational and collaborative aspects of integrating a non-dispensing pharmacist in primary care practice. Q factor analysis revealed four perspectives: “the independent community pharmacist”, “the independent clinical pharmacist”, “the dependent clinical pharmacist” and “the medication therapy management specialist”. These four perspectives show controversies to do with the level of professional independency of the non-dispensing pharmacist and the level of innovation of task performance. Conclusion Despite the fact that introducing new professional roles in healthcare can lead to controversy, the results of this Q study show the potential of a non-dispensing pharmacist as a pharmaceutical care provider and the willingness for interprofessional collaboration. The results from the POINT intervention study in the Netherlands will be an important next step in resolving current controversies.

How Do Pharmacists Construct, Facilitate and Consolidate Their Professional Identity?

The pharmacy profession continues to experience change regarding roles and responsibilities. The supply of medicines still remains a central function, but patient-facing, clinical roles are now becoming more commonplace, where pharmacists use their expert knowledge to maximise patient use of medicines. This transitional state from supplier of medicines to medicines expert raises questions over the contemporary professional identity of pharmacists. This literature-informed commentary highlights the current situation regarding how pharmacists’ identity is formed and reinforced. The authors suggest that the profession needs to be clearer in articulating what pharmacy does, and advocate the need for strong branding that the profession, public and other healthcare practitioners understand.

Competency-based pharmacy education in the Eastern Mediterranean Region-A scoping review

BACKGROUND

The International Pharmaceutical Federation (FIP) Global Competency Framework (GbCF) was developed as a mapping tool to provide guidance for foundation level pharmacy practice and professional development. The Eastern Mediterranean Region (EMR) with a deep rooted pharmacy history is yet to adopt an explicit competency framework.

OBJECTIVE

To review the literature for evidence of competency-based pharmacy education in the EMR, including pharmacists' and pharmacy students' perceptions of knowledge and skills acquired during training at undergraduate, post-graduate, and life-long learning levels.

METHODS

Six electronic databases were searched for articles published between 1990 and 2014. Titles and abstracts were screened according to the inclusion criteria. Full articles identified for inclusion were assessed and mapped to a relevant domain of the GbCF.

RESULTS

Totally, 57 studies met the inclusion criteria. The majority of studies portrayed pharmacists' and pharmacy students' opinions regarding educational aspects of their experiences. Participants generally cited the need for more practice-based training, modernization of curriculum, continuing pharmacist education and greater involvement in public health promotion, and research to strengthen professional competency. Interventional studies-enhanced knowledge and skills after training was provided to pharmacists and pharmacy students. No studies pertaining to the organization and management domain of the GbCF were found.

CONCLUSION

Despite paucity of studies that specifically investigated aspects of competency-based pharmacy education in the EMR, results provided impressions of what participants perceived as beneficial, or lacking in their education to attain certain competencies. Results point toward the need to implement a competency framework specific to the EMR.

A conceptual framework toward identifying and analyzing challenges to the advancement of pharmacy

BACKGROUND

Pharmacists and health care professionals are faced with increasing and changing health care needs around the world. To meet these demands, they are required to continuously upgrade and develop their professions. Reprofessionalization is therefore crucial to the successful delivery of health services, but traditional theories might provide little practical guidance to evaluating the overall status of a profession.

OBJECTIVE

This study proposes a new conceptual framework of three interrelated professional sectors: education, regulation and practice, and uses it to identify and analyze challenges facing the pharmacy profession in Jordan.

METHODS

A multiple-method qualitative study comprised of semi-structured interviews and focus groups was conducted in Amman, Jordan. To explore and identify the challenges, a purposively recruited cross-sector sample of 53 key informants, stakeholders and pharmacists were interviewed. Interview transcripts were translated and analyzed using QSR NVivo 10. Thematic analysis identified eight main challenges facing pharmacy in Jordan. The original participants were then invited to participate in focus groups, the purpose of which was to validate the interview findings, map them against the conceptual framework and discuss recommendations for development.

RESULTS

The eight validated challenges span the following areas: graduates preparedness for practice, pharmacy education accreditation and quality assurance, pre-registration requirements, workforce development, workforce planning, remuneration and wage rate, pharmacy assistants, and Pharm.D. pharmacists. Focus group participants used the framework to map each of the challenges to the primary sector-to-sector disconnect that they perceived to explain it. A list of recommendations addressing each of the challenges was also devised.

CONCLUSIONS

The framework was found to offer valuable insight as an explanatory and diagnostic tool in policy-relevant research. By emphasizing the processual and contextual nature of reprofessionalization, the framework presents an alternative approach to traditional theories. This study also raises important questions regarding the status of pharmacy in Jordan and aims to provide guidance for local development and much-needed reprofessionalization drives.

Design of the POINT study: Pharmacotherapy Optimisation through Integration of a Non-dispensing pharmacist in a primary care Team (POINT)

Background

In the Netherlands, 5.6 % of acute hospital admissions are medication-related. Almost half of these admissions are potentially preventable. Reviewing medication in patients at risk in primary care might prevent these hospital admissions. At present, implementation of medication reviews in primary care is suboptimal: pharmacists lack access to patient information, pharmacists are short of clinical knowledge and skills, and working processes of pharmacists (focus on dispensing) and general practitioners (focus on clinical practice) match poorly. Integration of the pharmacist in the primary health care team might improve pharmaceutical care outcomes.

The aim of this study is to evaluate the effect of integration of a non-dispensing pharmacist in general practice on the safety of pharmacotherapy in the Netherlands.

Methods

The POINT study is a non-randomised controlled intervention study with pre-post comparison in an integrated primary care setting. We compare three different models of pharmaceutical care provision in primary care: 1) a non-dispensing pharmacist as an integral member of a primary care team, 2) a pharmacist in a community pharmacy with a predefined training in performing medication reviews and 3) a pharmacist in a community pharmacy (care as usual). In all models, GPs remain accountable for individual medication prescription. In the first model, ten non-dispensing clinical pharmacists are posted in ten primary care practices (including 5 – 10 000 patients each) for a period of 15 months. These non-dispensing pharmacists perform patient consultations, including medication reviews, and share responsibility for the pharmaceutical care provided in the practice. The two other groups consist of ten primary care practices with collaborating pharmacists. The main outcome measurement is the number of medication-related hospital admissions during follow-up. Secondary outcome measurements are potential medication errors, drug burden index and costs. Parallel to this study, a qualitative study is conducted to evaluate the feasibility of introducing a NDP in general practice.

Discussion

As the POINT study is a large-scale intervention study, it should provide evidence as to whether integration of a non-dispensing clinical pharmacist in primary care will result in safer pharmacotherapy. The qualitative study also generates knowledge on the optimal implementation of this model in primary care. Results are expected in 2016.

Trial registration number

NTR4389, The Netherlands National Trial Register, 07-01-2014.

Perception of community pharmacists toward their current professional role in the healthcare system of Dubai, United Arab Emirates

The new paradigm to pharmacy profession has changed the focus of pharmacists from product-centered to patient-oriented. This change has brought new set of beliefs and assumptions on the way services should be delivered to pharmacy clients. The main aim of this study was to explore the perception of community pharmacists on their current professional role in Dubai. Key findings show that community pharmacists are more directed toward business than patients. They almost dispense all categories of medicines over-the-counter without the need of prescriptions. However, a new trend of pharmacists in Dubai is to provide enhanced pharmacy services such as consultation to patients upon request.