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Cook C, Reid L, Elsharkawy AM, Radley A, Smith S, McPherson S, Crockford D, Dillon JF, Wright M, Morris D, Malik H, Keall S, Powell J, Catt J, Hampton H, Boothman H, Shah S, Spear J, Ustianoski A, John P, Stevens H, Khakoo SI, Parkes J, Buchanan RM. The implementation of a hepatitis C testing service in community pharmacies: I-COPTIC consensus statement. Public Health 2024; 232:153-160. [PMID: 38781782 DOI: 10.1016/j.puhe.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/21/2024] [Accepted: 04/09/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES This aimed to develop a blueprint for an effective community pharmacy Hepatitis C virus (HCV) testing service by producing a consensus statement. STUDY DESIGN This was a modified Delphi process. METHODS We recruited a heterogenous panel of experts (who had been involved in the setup or delivery of a community pharmacy HCV testing service) by purposive and chain referral methods. We had three rounds of a modified Delphi process. The first was a series of questions with free text responses and was analysed using thematic analysis, and the second and third were statements for the respondents to rate using a 7-point Likert scale. Consensus was predefined in a published protocol, and the results were reviewed by a public and patient involvement panel before the statement was finalised. RESULTS We had 24 participants, including community and hospital-based pharmacists, local pharmaceutical committee members, charity representatives (Hepatitis C Trust), local clinical service lead, nurse specialists and doctors. The response rate of the first, second and third rounds were 100%, 96% and 88%, respectively. After the third round, we had 60 statements that reached consensus. We discussed the accepted statements with a patient and public involvement group. We used these statements to produce the I-COPTIC statement and a graphical summary. CONCLUSIONS We developed a blueprint for the design of a gold standard community pharmacy HCV testing service. We believe this will support the successful implementation of community pharmacy testing for HCV. Community pharmacy testing is an important service to help achieve and maintain HCV elimination.
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Affiliation(s)
- C Cook
- University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
| | - L Reid
- Hepatitis C Trust, 72 Weston Street, London, SE1 3QG, UK.
| | - A M Elsharkawy
- Liver Unit and NIHR Biomedical Research Centre at University Hospitals Birmingham NHS Trust and University of Birmingham, Edgbaston, Birmingham, B15 2TH, UK.
| | - A Radley
- NHS Tayside/University of Dundee, Nethergate, Dundee, DD1 4HN, UK.
| | - S Smith
- Hepatitis C Trust, 72 Weston Street, London, SE1 3QG, UK.
| | - S McPherson
- Liver Unit and NIHR Biomedical Research Centre, The Newcastle Upon Tyne Hospitals NHS Foundation Trust and Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK.
| | - D Crockford
- Community Pharmacy South Central, Sentinel House, Harvest Crescent, Fleet, Hampshire, GU51 2UZ, UK.
| | - J F Dillon
- University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
| | - M Wright
- University Hospitals Southampton, Tremona Road, Southampton, SO16 6YD, UK.
| | - D Morris
- Hepatitis C Trust, 72 Weston Street, London, SE1 3QG, UK.
| | - H Malik
- Carter's Chemist 114-116 Fowler Street, Southshields, NE33 1PZ, UK.
| | - S Keall
- Community Pharmacy Tees Valley, UK.
| | - J Powell
- Community Pharmacy Surrey and Sussex, PO Box 1061A, Surbiton, KT1 9HJ, UK.
| | - J Catt
- Kings College Hospital, Denmark Hill, London, SE5 9RS, UK.
| | - H Hampton
- Royal Cornwall Hospital, Treliske, Truro, Cornwall, TR1 3LJ, UK.
| | - H Boothman
- St George's NHS Foundation Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK.
| | - S Shah
- Kings College Hospital, Denmark Hill, London, SE5 9RS, UK.
| | - J Spear
- University Hospital of Leicester, University Road, Leicester, LE1 7RH, UK.
| | - A Ustianoski
- Manchester University Foundation Trust & University of Manchester UK, Regional Infectious Diseases Unit, North Manchester General Hospital, Delaunays Road, Manchester, M8 5RB, UK.
| | - P John
- University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.
| | - H Stevens
- University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
| | - S I Khakoo
- University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
| | - J Parkes
- University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
| | - R M Buchanan
- University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
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Karia A, Norman R, Robinson S, Lehnbom E, Laba TL, Durakovic I, Balane C, Joshi R, Webster R. Pharmacist's time spent: Space for Pharmacy-based Interventions and Consultation TimE (SPICE)-an observational time and motion study. BMJ Open 2022; 12:e055597. [PMID: 35236731 PMCID: PMC8896034 DOI: 10.1136/bmjopen-2021-055597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To describe the pharmacists' workflow, including tasks and time spent, to better understand their work capacity. DESIGN Cross-sectional, observational, time and motion study. SETTING Community pharmacies in Western Australia and New South Wales, Australia. PARTICIPANTS Currently registered and practising pharmacists were approached using snowball sampling and selected using purposive techniques to obtain balance representation of metropolitan and rural pharmacies, as well as high and low script volumes where possible. RESULTS Twenty-four pharmacists across 15 pharmacies participated during the 135 sessions totalling over 274 hours of observation. Dispensing (30%), indirect patient services (17%), counselling (15%) and professional management activities (15%) were the top four duties pharmacists performed, while only 2% of time was spent on professional services such as pain clinics and influenza vaccinations. Tasks were frequently interrupted and often performed simultaneously. Breaks and consumer-contact times were limited. More time was spent on professional service activities in non-metropolitan pharmacies, in pharmacies with greater daily prescription volumes and those with one or more support pharmacists. CONCLUSIONS This is the first study to quantify the pharmacists' tasks in Australian community pharmacies. Much time is being spent on dispensing, supply and management activities with little time for providing additional professional services. An extra supporting pharmacist is likely necessary to increase professional services. These findings could support future research around barriers and enablers of conducive workflows and of extended professional services.
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Affiliation(s)
- Ajay Karia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Richard Norman
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Faculty of Health Sciences, Curtin enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Suzanne Robinson
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Faculty of Health Sciences, Curtin enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Elin Lehnbom
- Department of Pharmacy, Faculty of Health Sciences, University of Tromsø-The Arctic University of Norway, Tromsø, Norway
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Tracey-Lea Laba
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Iva Durakovic
- Interior Architecture, Faculty of Built Environment, UNSW, Sydney, New South Wales, Australia
| | - Christine Balane
- The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Rohina Joshi
- The George Institute for Global Health, Newtown, New South Wales, Australia
- The George Institute for Global Health India, New Delhi, India
| | - Ruth Webster
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
- The George Institute for Global Health, Newtown, New South Wales, Australia
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Aspden T, Marowa M, Ponton R, Scahill S. Why are we still waiting? Views of future-focused policy and the direction of the profession from dissatisfied recent pharmacy graduates. J Health Organ Manag 2021. [DOI: 10.1108/jhom-04-2020-0162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe New Zealand Pharmacy Action Plan 2016–20 acknowledges the young, highly qualified pharmacist workforce, and seeks to address pharmacist underutilisation in the wider health setting. Anecdotal evidence suggests many recently qualified pharmacists are dissatisfied with the profession. Therefore, those completing BPharm programs after 2002, who had left or were seriously considering leaving the New Zealand pharmacy profession, were invited to comment on future-focused pharmacy documents, and the current direction of pharmacy in New Zealand.Design/methodology/approachAn online questionnaire was open December 2018 to February 2019. Recruitment occurred via e-mail lists of universities and professional organisations, print and social media, and word-of-mouth. Free-text responses were thematically analysed using a general inductive approach.FindingsFrom the 328 analysable surveys received, 172 respondents commented on the documents and/or direction of the pharmacy profession. Views were mixed. Overarching document-related themes were positive direction, but concern over achievability, the lack of funding details, lack of implementation, their benefits for pharmacists and the public, and ability to bring about change and secure a future for the profession. Overall pharmacy was considered an unattractive profession needing to change.Originality/valueThis study highlights dissatisfied recent BPharm graduates agree with the vision in the documents but do not see progress towards achieving the vision occurring, leading to frustration and exit in some cases. Policymakers should be aware of these views as considerable resource goes into their development.
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Tong V, Krass I, Luckie K, Aslani P. The evolving profile of cognitive pharmaceutical services in Australia. Res Social Adm Pharm 2021; 18:2529-2537. [PMID: 33992586 DOI: 10.1016/j.sapharm.2021.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/17/2021] [Indexed: 11/19/2022]
Abstract
Globally, the availability and delivery of cognitive pharmaceutical services (CPS) by pharmacists has expanded over time. Australia has been no exception to this trend, with government funding to support the provision of certain CPS significantly increasing over the last two decades. Whilst medication management services have been consistently funded by the government for more than 15 years, fluctuations in the funding of other CPS have been observed; for example, certain disease state management CPS and introduction of funded MedsChecks. Furthermore, legislative changes have broadened pharmacists' scope of practice and the CPS provided, contributing to an increase in user-pay services. Although the literature to date has highlighted positive impacts associated with CPS on economic, clinical and/or humanistic outcomes, context-specific, real world evidence for the benefits of CPS is much needed to ensure the profession engages in evidence-based practice. The aim of this commentary is to outline the changes in CPS provision and funding within the Australian context, the existing evidence for CPS, and highlight the implications for future research.
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Affiliation(s)
- Vivien Tong
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Ines Krass
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Kate Luckie
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Parisa Aslani
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia.
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Varas-Doval R, Saéz-Benito L, Gastelurrutia MA, Benrimoj SI, Garcia-Cardenas V, Martinez-Martínez F. Systematic review of pragmatic randomised control trials assessing the effectiveness of professional pharmacy services in community pharmacies. BMC Health Serv Res 2021; 21:156. [PMID: 33596906 PMCID: PMC7890900 DOI: 10.1186/s12913-021-06150-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 02/03/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Implementation of Professional Pharmacy Services (PPSs) requires a demonstration of the service's impact (efficacy) and its effectiveness. Several systematic reviews and randomised controlled trials (RCT) have shown the efficacy of PPSs in patient's outcomes in community pharmacy. There is, however, a need to determine the level of evidence on the effectiveness of PPSs in daily practice by means of pragmatic trials. To identify and analyse pragmatic RCTs that measure the effectiveness of PPSs in clinical, economic and humanistic outcomes in the community pharmacy setting. METHODS A systematic search was undertaken in MEDLINE, EMBASE, the Cochrane Library and SCIELO. The search was performed on January 31, 2020. Papers were assessed against the following inclusion criteria (1) The intervention could be defined as a PPS; (2) Undertaken in a community pharmacy setting; (3) Was an original paper; (4) Reported quantitative measures of at least one health outcome indicator (ECHO model); (5) The design was considered as a pragmatic RCT, that is, it fulfilled 3 predefined attributes. External validity was analyzed with PRECIS- 2 tool. RESULTS The search strategy retrieved 1,587 papers. A total of 12 pragmatic RCTs assessing 5 different types of PPSs were included. Nine out of the 12 papers showed positive statistically significant differences in one or more of the primary outcomes (clinical, economic or humanistic) that could be associated with the following PPS: Smoking cessation, Dispensing/Adherence service, Independent prescribing and MTM. No paper reported on cost-effectiveness outcomes. CONCLUSIONS There is limited available evidence on the effectiveness of community-based PPS. Pragmatic RCTs to evaluate clinical, humanistic and economic outcomes of PPS are needed.
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Affiliation(s)
- R Varas-Doval
- Spanish General Pharmaceutical Council, Villanueva 11, 28001, Madrid, Spain.
| | - L Saéz-Benito
- Faculty of Health Sciences, San Jorge University, Villanueva de Gállego, Zaragoza, Spain.,Pharmaceutical Research Group of the University of Granada, Faculty of Pharmacy, Granada University, Granada, Spain
| | - M A Gastelurrutia
- Pharmaceutical Research Group of the University of Granada, Faculty of Pharmacy, Granada University, Granada, Spain
| | - S I Benrimoj
- Pharmaceutical Research Group of the University of Granada, Faculty of Pharmacy, Granada University, Granada, Spain
| | - V Garcia-Cardenas
- Pharmaceutical Research Group of the University of Granada, Faculty of Pharmacy, Granada University, Granada, Spain.,Graduate School of Health, Discipline of Pharmacy, University of Technology Sydney, Sydney, NSW, Australia
| | - F Martinez-Martínez
- Pharmaceutical Research Group of the University of Granada, Faculty of Pharmacy, Granada University, Granada, Spain
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Silva RDOS, Macêdo LA, Santos GAD, Aguiar PM, de Lyra DP. Pharmacist-participated medication review in different practice settings: Service or intervention? An overview of systematic reviews. PLoS One 2019; 14:e0210312. [PMID: 30629654 PMCID: PMC6328162 DOI: 10.1371/journal.pone.0210312] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 12/20/2018] [Indexed: 01/08/2023] Open
Abstract
Introduction Medication review (MR) is a pharmacy practice conducted in different settings that has a positive impact on patient health outcomes. In this context, systematic reviews on MR have restricted the assessment of this practice using criteria such as methodological quality, practice settings, and patient outcomes. Therefore, expanding research on this subject is necessary to facilitate the understanding of the effectiveness of MR and the comparison of its results. Aim To examine the panorama of systematic reviews on pharmacist-participated MR in different practice settings. Methods A literature search was undertaken in Biblioteca Virtual em Saúde (BVS), Embase, PubMed, Scopus, The Cochrane Library, and Web of Science databases through January 2018 using keywords for "medication review", "systematic review", and "pharmacist". Two independents investigators screened titles, abstracts, full texts; assessed methodological quality; and, extracted data from the included reviews. Results Seventeen systematic reviews were included, of which sixteen presented low to moderate methodological quality. Most of reviews were conducted in Europe (n = 7), included controlled primary studies (n = 16), elderly patients (n = 9), and long-term care facilities (n = 8). Seven reviews addressed MR as an intervention and thirteen reviews cited collaboration between physicians and pharmacists in the practice of MR. In addition, thirteen terminologies for MR were used and the main objective was to identify and solve drug-related problems and/or optimize the drug use (n = 11). Conclusion There is considerable heterogeneity in practice settings, population, definitions, terminologies, and approach of MR as well as poor description of patient care process in the systematic reviews. These facts may limit the comparison, summarization and understanding of the results of MR. Furthermore, the methodological quality of most systematic reviews was below ideal. Thus, international agreement on the MR process is necessary to assess, compare and optimize the quality of care provided.
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Affiliation(s)
- Rafaella de Oliveira Santos Silva
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Luana Andrade Macêdo
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Genival Araújo Dos Santos
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Patrícia Melo Aguiar
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Divaldo Pereira de Lyra
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
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Role and impact of pharmacists in Spain: a scoping review. Int J Clin Pharm 2018; 40:1430-1442. [PMID: 30367376 DOI: 10.1007/s11096-018-0740-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 10/13/2018] [Indexed: 10/28/2022]
Abstract
Background The role of the pharmacist has evolved greatly over the last decades, expanding to patient-oriented activities, administrative tasks and public health functions. However, considerable differences emerge across regions. Aim of the review To gather evidence in order to describe and highlight the different characteristics of the pharmacists' role and the impact of their activities in Spain. Method A review of the existing literature was conducted. The literature search was undertaken in PubMed between 01/01/2006 and 15/08/2017. Results were screened and reviewed to extract previously established criteria such as author(s), publication year, language, study design, setting, pharmaceutical activity, patient care programs, targeted diseases and intervention description using DEPICT2 tool. Pharmaceutical intervention were classified into eight outcome measures and categorized by types of outcomes reported: descriptive or impact evaluation regarding the effect of the service (positive, neutral or negative). Results The search strategy resulted in 473 articles and 108 articles met the inclusion criteria. The most common design was observational (n = 76, 70%). Most articles were published after 2011 (75%), in English (69%). Studies were conducted in hospitals (60%) and community pharmacies (30%). Of the 24 pharmaceutical activities identified, medication review was the activity most frequently studied (n = 42), followed by patient education (n = 29), risk and prevention (n = 27) and medication reconciliation (n = 19). Only 39 articles (36%) had outcome measures with impact evaluation. Of the 223 impact outcome measures, 48% (107/223) had a positive effect. Conclusion This review shows the substantial scientific production focusing on pharmacy practice in Spain over the last years. The evidence reviewed reflects the pharmacist role at various professional settings, providing a wide variety of activities on diverse targeted diseases and patient care programs, in line with the increasing specialization of clinical pharmacists over the last years.
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Houle SKD, Carter CA, Tsuyuki RT, Grindrod KA. Remunerated patient care services and injections by pharmacists: An international update. J Am Pharm Assoc (2003) 2018; 59:89-107. [PMID: 30195440 DOI: 10.1016/j.japh.2018.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Recognizing pharmacists' increasing roles as primary care providers, programs offering remuneration for patient care services, and the administration of injections by pharmacists continue to be implemented. The objective of this article is to provide an update on remuneration programs available to pharmacists internationally for nondispensing services. DATA SOURCES Systematic searches for relevant articles published from January 2013 to February 2018 across Pubmed (Medline), Embase, International Pharmaceutical Abstracts, Cochrane Library, Econlit, Scopus, and Web of Science. Gray literature searches, including targeted searches of websites of payers and pharmacy associations, were also performed. STUDY SELECTION Programs were included if they were newly introduced or had changes to patient eligibility criteria and fees since previously published reviews and if they were established programs offered by third-party payers for activities separate from dispensing. DATA EXTRACTION Descriptive information on each program was extracted, including the program's jurisdiction (country and state, provincial, or regional level, as applicable), payer, service description, patient eligibility criteria, and fee structure. RESULTS Over the 5-year period studied, 95 new programs for noninjection patient care services and 37 programs for pharmacist-administered injections were introduced. Large ranges in fees offered for similar programs were observed across programs, even within the same country or region, at an average of $US 71 for an initial medication review, $19 for follow-ups to these reviews, $18 for prescription adaptations, and $13 for injection administration. Apart from some smoking cessation programs in England, which offered incentive payments for successful quits, all services were remunerated on a fee-for-service basis, often in the form of a flat fee regardless of the time spent providing the service. CONCLUSION Although funding for pharmacists' activities continues to show growth, concerns identified in previous reviews persist, including the great variability in remunerated activities, patient eligibility, and fees. These issues may limit opportunities for multijurisdictional program and service outcome evaluation.
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Murphy AL, Gardner DM, Jacobs LM. Patient care activities by community pharmacists in a capitation funding model mental health and addictions program. BMC Psychiatry 2018; 18:192. [PMID: 29898682 PMCID: PMC6000927 DOI: 10.1186/s12888-018-1746-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 05/14/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Community pharmacists are autonomous, regulated health care professionals located in urban and rural communities in Canada. The accessibility, knowledge, and skills of community pharmacists can be leveraged to increase mental illness and addictions care in communities. METHODS The Bloom Program was designed, developed, and implemented based on the Behaviour Change Wheel and a program of research in community pharmacy mental healthcare capacity building. We evaluated the Bloom Program as a demonstration project using mixed methods. A retrospective chart audit was conducted to examine outcomes and these are reported in this paper. RESULTS We collected 201 patient charts from 23 pharmacies in Nova Scotia with 182 patients having at least one or more follow-up visits. Anxiety (n = 126, 69%), depression (n = 112, 62%), and sleep disorders (n = 64, 35%) were the most frequent mental health problems. Comorbid physical health problems were documented in 57% (n = 104). The average number of prescribed medications was 5.5 (range 0 to 24). Sixty seven percent (n = 122) were taking multiple psychotropics and 71% (n = 130) reported taking more than one medication for physical health problems. Treatment optimization was the leading reason for enrollment with more than 80% seeking improvements in symptom management and daily functioning. There were a total of 1233 patient-care meetings documented, of which the duration was recorded in 1098. The median time for enrolling, assessing, and providing follow-up care by pharmacists was 142 min (mean 176, SD 128) per patient. The median follow-up encounter duration was 15 min. A total of 146 patient care encounters were 60 min or longer, representing 13.3% of all timed encounters. CONCLUSIONS Pharmacists work with patients with lived experience of mental illness and addictions to improve medication related outcomes including those related to treatment optimization, reducing polytherapy, and facilitating withdrawal from medications. Pharmacists can offer their services frequently and routinely without the need for an appointment while affording patient confidentiality and privacy. Important roles for pharmacists around the deprescribing of various medications (e.g., benzodiazepines) have previously been supported and should be optimized and more broadly implemented. Further research on the best mechanisms to incentivize pharmacists in mental illness and addiction's care should be explored.
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Affiliation(s)
- Andrea L. Murphy
- 0000 0004 1936 8200grid.55602.34College of Pharmacy and Department of Psychiatry, Dalhousie University, 5968 College St, PO Box 15000, Halifax, NS B3H 4R2 Canada
| | - David M. Gardner
- 0000 0004 1936 8200grid.55602.34Department of Psychiatry and College of Pharmacy, Dalhousie University, QEII HSC, AJLB 7517, 5909 Veterans’ Memorial Lane, Halifax, NS B3H 2E2 Canada
| | - Lisa M. Jacobs
- Independent Evaluator, Contact Consulting, Halifax, NS Canada
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Thomas J, Kumar K, Chur-Hansen A. What does learning together mean for pharmacy and medicine students: is it really about from and with? MEDEDPUBLISH 2018; 7:110. [PMID: 38074612 PMCID: PMC10699384 DOI: 10.15694/mep.2018.0000110.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Abstract
This article was migrated. The article was marked as recommended. Healthcare students from different professional backgrounds are often brought together under the banner of Interprofessional Education (IPE) in an effort to improve collaborative practice. Despite the demonstrated positive impact of IPE on students' knowledge, skills and attitudes, it is not clear what students think about learning with students from another health profession. The aim of this study was to explore pharmacy and medicine students' views and experiences of learning together. Participants were Year 3 Pharmacy and Year 4 Medicine students, with qualitative data gathered via a written reflection. Three main themes were identified. Students were accepting of learning with the other professional group. Learning about was evident, particularly in relation to each other's roles and contributions to patient care. Learning from another professional group was the most problematic as students tended to view and treat knowledge as a commodity to be acquired from another rather than something that could be jointly developed. While medicine and pharmacy students' valued learning with and about each other, they were less likely to engage in co-constructing and sharing new meanings and thus learn from one another. To provide a basis for meaningful collaborative practice, IPE needs to challenge students' fundamental assumptions, beliefs and values about learning with, from and about other professions.
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Hashmi FK, Hassali MA, Khalid A, Saleem F, Aljadhey H, Babar ZUD, Bashaar M. A qualitative study exploring perceptions and attitudes of community pharmacists about extended pharmacy services in Lahore, Pakistan. BMC Health Serv Res 2017; 17:500. [PMID: 28724411 PMCID: PMC5518160 DOI: 10.1186/s12913-017-2442-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 07/11/2017] [Indexed: 11/18/2022] Open
Abstract
Background In recent decades, community pharmacies reported a change of business model, whereby a shift from traditional services to the provision of extended roles was observed. However, such delivery of extended pharmacy services (EPS) is reported from the developed world, and there is scarcity of information from the developing nations. Within this context, the present study was aimed to explore knowledge, perception and attitude of community pharmacists (CPs) about EPS and their readiness and acceptance for practice change in the city of Lahore, Pakistan. Methods A qualitative approach was used to gain an in-depth knowledge of the issues. By using a semi-structured interview guide, 12 CPs practicing in the city of Lahore, Pakistan were conveniently selected. All interviews were audio-taped, transcribed verbatim, and were then analyzed for thematic contents by the standard content analysis framework. Results Thematic content analysis yielded five major themes. (1) Familiarity with EPS, (2) current practice of EPS, (3) training needed to provide EPS, (4) acceptance of EPS and (5) barriers toward EPS. Majority of the CPs were unaware of EPS and only a handful had the concept of extended services. Although majority of our study respondents were unaware of pharmaceutical care, they were ready to accept practice change if provided with the required skills and training. Lack of personal knowledge, poor public awareness, inadequate physician-pharmacist collaboration and deprived salary structures were reported as barriers towards the provision of EPS at the practice settings. Conclusion Although the study reported poor awareness towards EPS, the findings indicated a number of key themes that can be used in establishing the concept of EPS in Pakistan. Over all, CPs reported a positive attitude toward practice change provided to the support and facilitation of health and community based agencies in Pakistan. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2442-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Furqan K Hashmi
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | | | | | - Fahad Saleem
- Faculty of Pharmacy & Health Sciences, University of Baluchistan, Quetta, Pakistan
| | - Hisham Aljadhey
- College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Zaheer Ud Din Babar
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, West Yorkshire, England
| | - Mohammad Bashaar
- SMART Afghan International Trainings & Consultancy, Kabul, Afghanistan.
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12
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Introducing Pharmaceutical Care to Primary Care in Iceland-An Action Research Study. PHARMACY 2017; 5:pharmacy5020023. [PMID: 28970435 PMCID: PMC5597148 DOI: 10.3390/pharmacy5020023] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/15/2017] [Accepted: 04/21/2017] [Indexed: 11/17/2022] Open
Abstract
Even though pharmaceutical care is not a new concept in pharmacy, its introduction and development has proved to be challenging. In Iceland, general practitioners are not familiar with pharmaceutical care and additionally no such service is offered in pharmacies or primary care settings. Introducing pharmaceutical care in primary care in Iceland is making great efforts to follow other countries, which are bringing the pharmacist more into patient care. General practitioners are key stakeholders in this endeavor. The aim of this study was to introduce pharmacist-led pharmaceutical care into primary care clinics in Iceland in collaboration with general practitioners by presenting different setting structures. Action research provided the framework for this research. Data was collected from pharmaceutical care interventions, whereby the pharmaceutical care practitioner ensures that each of a patient's medications is assessed to determine if it is appropriate, effective, safe, and that the patient can take medicine as expected. Sources of data included pharmaceutical care notes on patients, researcher's notes, meetings, and interviews with general practitioners over the period of the study. The study ran from September 2013 to October 2015. Three separate semi-structured in-depth interviews were conducted with five general practitioners from one primary health care clinic in Iceland at different time points throughout the study. Pharmaceutical care was provided to elderly patients (n = 125) before and between general practitioners' interviews. The study setting was a primary care clinic in the Reykjavik area and the patients' homes. Results showed that the GPs' knowledge about pharmacist competencies as healthcare providers and their potential in patient care increased. GPs would now like to have access to a pharmacist on a daily basis. Direct contact between the pharmacist and GPs is better when working in the same physical space. Pharmacist's access to medical records is necessary for optimal service. Pharmacist-led clinical service was deemed most needed in dose dispensing polypharmacy patients. This research indicated that it was essential to introduce Icelandic GPs to the potential contribution of pharmacists in patient care and that action research was a useful methodology to promote and develop a relationship between those two health care providers in primary care in Iceland.
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Rosenthal MM, Desai N, Houle SKD. Pharmacists' perceptions of pay for performance versus fee-for-service remuneration for the management of hypertension through pharmacist prescribing. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2017; 25:388-393. [PMID: 28097711 DOI: 10.1111/ijpp.12330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES As pharmacists expand their roles as patient care providers, remuneration must be offered for patient care activities apart from dispensing. Most jurisdictions paying for such services utilize the fee-for-service (FFS) model, while little is known about the role of pay for performance (P4P) within the pharmacy profession. This study aimed to elicit the experience of pharmacists practicing under both models within the Alberta Clinical Trial in Optimizing Hypertension (RxACTION) study in Alberta, Canada. METHODS Pharmacist participants in RxACTION caring for at least one patient under FFS and under P4P were interviewed about their experiences until data saturation was reached. Interviews were conducted in June-July 2015, with responses audio recorded, transcribed and coded to identify key themes. KEY FINDINGS Eight pharmacists were interviewed, with three key themes identified: a perceived comfort with the existing FFS model particularly due to its ease related to business planning, the transformative effect of the study on their practices and a preference for future models to consider a blend of both service count- and performance-driven metrics. The degree of influence pharmacists feel they can have on outcomes achieved by patients, the perceptions of patients and other healthcare professionals on outcome-based payment, and concerns with the impact of variable remuneration on the pharmacy business model are concerns raised with P4P in pharmacy practice. CONCLUSIONS This study reveals a hesitation to radically transform payment for pharmacists' patient care services towards a P4P model. Efforts to implement P4P should therefore be gradual and accompanied with a robust evaluation plan.
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Affiliation(s)
| | - Nimisha Desai
- Faculty of Science, University of Waterloo, Waterloo, ON, Canada
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Perraudin C, Bugnon O, Pelletier-Fleury N. Expanding professional pharmacy services in European community setting: Is it cost-effective? A systematic review for health policy considerations. Health Policy 2016; 120:1350-1362. [DOI: 10.1016/j.healthpol.2016.09.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 08/02/2016] [Accepted: 09/18/2016] [Indexed: 10/20/2022]
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15
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Mc Namara KP, Peterson GM, Hughes J, Krass I, Versace V, Clark RA, Dunbar J. Cardiovascular Disease Risk Assessment in Australian Community Pharmacy. Heart Lung Circ 2016; 26:667-676. [PMID: 28089788 DOI: 10.1016/j.hlc.2016.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 10/19/2016] [Accepted: 10/27/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Population screening and monitoring of cardiovascular risk is suboptimal in Australian primary care. The role of community pharmacy has increased considerably, but without any policy framework for development. The aim of this study was to explore the nature of community pharmacy-based screening models in Australia, capacity to increase delivery of pharmacy screening, and barriers and enablers to increasing capacity. METHODS An online survey weblink was emailed to pharmacy managers at every quality-accredited pharmacy in Australia by the Quality Pharmacy Care Program. The 122-item survey explored the nature of screening services, pharmacy capacity to deliver services, and barriers and enablers to service delivery in considerable detail. Adaptive questioning was used extensively to reduce the participant burden. Pharmacy location details were requested to facilitate geo-coding and removal of duplicate entries. A descriptive analysis of responses was undertaken. RESULTS There were 294 valid responses from 4890 emails, a 6% response rate. Most pharmacies (79%) had private counselling areas. Blood pressure assessment was nearly universal (96%), but other common risk factor assessments were offered by a minority. Most did not charge for assessments, and 59% indicated capacity to provide multiple risk factor assessments. Fewer than one in five (19%) reported any formal arrangements with general practice for care coordination. Financial viability was perceived as a key barrier to service expansion, amid concerns of patient willingness to pay. Support from government and non-governmental organisations for their role was seen as necessary. CONCLUSION There appears to be a critical mass of pharmacies engaging in evidence-based and professional services. Considerable additional support appears required to optimise performance across the profession.
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Affiliation(s)
- Kevin P Mc Namara
- Deakin Rural Health, Faculty of Health, Deakin University, Melbourne, Vic, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Vic, Australia.
| | - Gregory M Peterson
- Unit for Medicines Outcomes Research and Evaluation, Pharmacy, School of Medicine, University of Tasmania, Hobart, Tas, Australia
| | - Josie Hughes
- Unit for Medicines Outcomes Research and Evaluation, Pharmacy, School of Medicine, University of Tasmania, Hobart, Tas, Australia
| | - Ines Krass
- Faculty of Pharmacy, University of Sydney, Sydney, NSW, Australia
| | - Vincent Versace
- Deakin Rural Health, Faculty of Health, Deakin University, Melbourne, Vic, Australia
| | - Robyn A Clark
- School of Nursing and Midwifery, Faculty of Health, Flinders University, Adelaide, SA, Australia
| | - James Dunbar
- Deakin Rural Health, Faculty of Health, Deakin University, Melbourne, Vic, Australia
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16
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Moullin JC, Sabater-Hernández D, Benrimoj SI. Qualitative study on the implementation of professional pharmacy services in Australian community pharmacies using framework analysis. BMC Health Serv Res 2016; 16:439. [PMID: 27562631 PMCID: PMC4997770 DOI: 10.1186/s12913-016-1689-7] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 08/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple studies have explored the implementation process and influences, however it appears there is no study investigating these influences across the stages of implementation. Community pharmacy is attempting to implement professional services (pharmaceutical care and other health services). The use of implementation theory may assist the achievement of widespread provision, support and integration. The objective was to investigate professional service implementation in community pharmacy to contextualise and advance the concepts of a generic implementation framework previously published. METHODS Purposeful sampling was used to investigate implementation across a range of levels of implementation in community pharmacies in Australia. Twenty-five semi-structured interviews were conducted and analysed using a framework methodology. Data was charted using implementation stages as overarching themes and each stage was thematically analysed, to investigate the implementation process, the influences and their relationships. Secondary analyses were performed of the factors (barriers and facilitators) using an adapted version of the Consolidated Framework for Implementation Research (CFIR), and implementation strategies and interventions, using the Expert Recommendations for Implementing Change (ERIC) discrete implementation strategy compilation. RESULTS Six stages emerged, labelled as development or discovery, exploration, preparation, testing, operation and sustainability. Within the stages, a range of implementation activities/steps and five overarching influences (pharmacys' direction and impetus, internal communication, staffing, community fit and support) were identified. The stages and activities were not applied strictly in a linear fashion. There was a trend towards the greater the number of activities considered, the greater the apparent integration into the pharmacy organization. Implementation factors varied over the implementation stages, and additional factors were added to the CFIR list and definitions modified/contextualised for pharmacy. Implementation strategies employed by pharmacies varied widely. Evaluations were lacking. CONCLUSIONS The process of implementation and five overarching influences of professional services implementation in community pharmacy have been outlined. Framework analysis revealed, outside of the five overarching influences, factors influencing implementation varied across the implementation stages. It is proposed at each stage, for each domain, the factors, strategies and evaluations should be considered. The Framework for the Implementation of Services in Pharmacy incorporates the contextualisation of implementation science for pharmacy.
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Affiliation(s)
- Joanna C. Moullin
- Graduate School of Health, University of Technology Sydney, Level 4, Building 7, 67 Thomas St Ultimo, (PO Box 123 Broadway), Ultimo, 2007 NSW Australia
| | - Daniel Sabater-Hernández
- Graduate School of Health, University of Technology Sydney, Level 4, Building 7, 67 Thomas St Ultimo, (PO Box 123 Broadway), Ultimo, 2007 NSW Australia
- Academic Centre in Pharmaceutical Care, Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja s/n. C.P. 18071, Granada, Spain
| | - Shalom I. Benrimoj
- Graduate School of Health, University of Technology Sydney, Level 4, Building 7, 67 Thomas St Ultimo, (PO Box 123 Broadway), Ultimo, 2007 NSW Australia
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Jokanovic N, Tan EC, van den Bosch D, Kirkpatrick CM, Dooley MJ, Bell JS. Clinical medication review in Australia: A systematic review. Res Social Adm Pharm 2016; 12:384-418. [DOI: 10.1016/j.sapharm.2015.06.007] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 06/26/2015] [Accepted: 06/26/2015] [Indexed: 10/23/2022]
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18
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Kinsey H, Scahill S, Bye L, Harrison J. Funding for change: New Zealand pharmacists’ views on, and experiences of, the community pharmacy services agreement. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2016; 24:379-389. [DOI: 10.1111/ijpp.12266] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 03/18/2016] [Indexed: 11/30/2022]
Abstract
Abstract
Objective
To explore pharmacist’s views on the shift in ethos, funding and service delivery model introduced through the New Zealand’s Community Pharmacy Services Agreement (CPSA).
Methods
A purposive sampling approach drew pharmacists from a matrix who were then contacted via telephone and invited to be interviewed. Semistructured interviews were conducted face-to-face with community pharmacists (n = 17) across urban and rural New Zealand. An interview schedule exploring 12 subject areas was used to facilitate discussion and determine pharmacist’s views and understanding of the CPSA. The interviews were recorded and transcribed verbatim and a general inductive approach was taken to identifying emergent themes.
Key findings
Key themes that emerged were: pharmacists supported the philosophy behind the CPSA, pharmacists understanding of the CPSA, implementing CPSA-related services, perceived impact on patient outcomes and future sustainability of the CPSA. Overall, pharmacists supported the alignment of funding with patient-centred services, but pharmacy owners reported difficulty understanding the funding model, resulting in uncertainty over income. Several pharmacists believed the quality of care offered had not changed, while others found their attitudes towards care had evolved. All pharmacists communicated an increase in their workload and many perceived the sustainability of the CPSA to be linked to its ability to financially sustain community pharmacies.
Conclusions
The majority of pharmacists believed in the philosophy of the CPSA, but expressed concerns over funding, workload and benefits for patients. Future research is required to determine generalisability of these findings, investigate patient perspectives and assess the effect of the CPSA on patient outcomes.
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Affiliation(s)
- Hannah Kinsey
- School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Shane Scahill
- School of Management, Massey University, Albany, Auckland, New Zealand
| | - Lynne Bye
- School of Pharmacy, University of Auckland, Auckland, New Zealand
| | - Jeff Harrison
- School of Pharmacy, University of Auckland, Auckland, New Zealand
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Law MR, Cheng L, Kratzer J, Morgan SG, Marra C, Lynd LD, Majumdar SR. Impact of allowing pharmacists to independently renew prescriptions: A population-based study. J Am Pharm Assoc (2003) 2016; 55:398-404. [PMID: 26115380 DOI: 10.1331/japha.2015.14262] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To study the impact of a 2009 policy change in British Columbia (BC) that allowed pharmacists to independently renew certain prescriptions for chronic conditions. DESIGN Population-based analysis. SETTING BC, Canada. PARTICIPANTS All residents of BC (more than 3.9 million). INTERVENTION Prescription drug use data were collected from the PharmaNet database. This database contains a record of all ambulatory prescription drug dispensations in BC including a variable indicating whether a pharmacist renewed the prescription. MAIN OUTCOME MEASURES We studied pharmaceutical and physician insurance claims datasets for all BC residents for 2 years following the 2009 policy change. We assessed the number and types of drugs renewed by pharmacists, and whether these complied with the policy. Further, we matched pharmacist-renewed prescriptions to equivalent potentially renewable prescriptions and assessed the impact on ambulatory physician visits. RESULTS Over the first 2 years, pharmacists renewed 150,950 prescriptions in BC. Almost one-half of these renewals did not appear to match the conditions set out in the new regulatory policy (n = 69,970, 47%). Those that did match the conditions (n = 80,980, 53%) represented a very small proportion of the 47 million prescriptions that pharmacists could have renewed (0.17%). The most frequently renewed medications were treatments for dyslipidemias, hypertension, diabetes, and gastroesophageal reflux disease. Pharmacist-renewed prescriptions were preceded by a 30% relative decrease in ambulatory physician visits in the week before dispensing, but there was also a 17% relative increase in visits in the week following the pharmacist-renewed prescription. CONCLUSION Overall, the use of pharmacist renewals was very low and one-half of the renewals were not policy-concordant. Pharmacist renewals were associated with the intended reductions in physician visits before dispensing, but there was also an unintended increase in visits after dispensing. These findings suggest that future policies such as this one need to be differently designed and closely monitored.
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The organizational framework of community pharmacies in Europe. Int J Clin Pharm 2015; 37:896-905. [PMID: 26017399 DOI: 10.1007/s11096-015-0140-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 05/19/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The role of the pharmacist has undergone profound changes over the recent years. In most European countries, the tendency seems to be that pharmacists are moving from being product-oriented to service-oriented. An interesting series of papers describing care related services of pharmacy in various countries has been published in 2006, but much has changed since then. This paper aims to provide an updated view on the overall health care sector in Europe, with a special focus on services in community pharmacy. OBJECTIVE To list and compare health care and community pharmacy structure in Europe; and to discuss the facilitators and barriers that can be found in health care systems and may promote or hinder the implementation of new community pharmacy services. SETTING European community pharmacy practice. METHODS A cross-sectional study was undertaken where data were collected using an online survey sent to a purposive sample of representatives from 27 European countries. Main outcome measure variation in professional community pharmacy services across Europe. RESULTS Data were obtained from 22 respondents in 19 countries (70.4%). Health care is mainly provided by a form of public National Health Services in 17 of the 19 countries. Demographic criteria for founding new pharmacies were present in 17 countries. Medicines are exclusively available in pharmacies in approximately one third of the countries. Smoking cessation (93.8%), drug waste management (81.3%) and pharmaceutical care programmes for specific diseases (77.8%) were reported as the most widely disseminated services in European pharmacies. CONCLUSIONS There are still major differences between community pharmacy practice in Europe. Differences are mostly due to the legal framework and remuneration issues, which impact on the range of services available from pharmacies to the community of each country.
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Changes are required to help community pharmacists become more involved in reporting medication safety issues. DRUGS & THERAPY PERSPECTIVES 2015. [DOI: 10.1007/s40267-015-0186-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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22
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Pharmacists in pharmacovigilance: can increased diagnostic opportunity in community settings translate to better vigilance? Drug Saf 2015; 37:465-9. [PMID: 24951945 DOI: 10.1007/s40264-014-0191-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The pharmacy profession has undergone substantial change over the last two to three decades. Whilst medicine supply still remains a central function, pharmacist's roles and responsibilities have become more clinic and patient focused. In the community (primary care), pharmacists have become important providers of healthcare as Western healthcare policy advocates patient self-care. This has resulted in pharmacists taking on greater responsibility in managing minor illness and the delivery of public health interventions. These roles require pharmacists to more fully use their clinical skills, and often involve diagnosis and therapeutic management. Community pharmacists are now, more than ever before, in a position to identify, record and report medication safety incidents. However, current research suggests that diagnostic ability of community pharmacists is questionable and they infrequently report to local or national schemes. The aim of this paper is to highlight current practice and suggest ways in which community pharmacy can more fully contribute to patient safety.
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Zolezzi M, Bye L, Harrison J, Tsuyuki RT, Shaw JP. Provision of health /disease screening and medication monitoring /management in New Zealand community pharmacies. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2014. [DOI: 10.1002/jppr.1032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | - Lynne Bye
- School of Pharmacy; University of Auckland; Auckland New Zealand
| | - Jeff Harrison
- School of Pharmacy; University of Auckland; Auckland New Zealand
| | - Ross T. Tsuyuki
- EPICORE Centre, Department of Medicine, Faculty of Medicine and Dentistry; University of Alberta; Edmonton Canada
| | - John P. Shaw
- School of Pharmacy; University of Auckland; Auckland New Zealand
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Rubio-Valera M, Chen TF, O'Reilly CL. New roles for pharmacists in community mental health care: a narrative review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:10967-90. [PMID: 25337943 PMCID: PMC4211017 DOI: 10.3390/ijerph111010967] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/30/2014] [Accepted: 10/07/2014] [Indexed: 02/05/2023]
Abstract
Medicines are a major treatment modality for many mental illnesses, and with the growing burden of mental disorders worldwide pharmacists are ideally positioned to play a greater role in supporting people with a mental illness. This narrative review aims to describe the evidence for pharmacist-delivered services in mental health care and address the barriers and facilitators to increasing the uptake of pharmacist services as part of the broader mental health care team. This narrative review is divided into three main sections: (1) the role of the pharmacist in mental health care in multidisciplinary teams and in supporting early detection of mental illness; (2) the pharmacists' role in supporting quality use of medicines in medication review, strategies to improve medication adherence and antipsychotic polypharmacy, and shared decision making; and (3) barriers and facilitators to the implementation of mental health pharmacy services with a focus on organizational culture and mental health stigma. In the first section, the review presents new roles for pharmacists within multidisciplinary teams, such as in case conferencing or collaborative drug therapy management; and new roles that would benefit from increased pharmacist involvement, such as the early detection of mental health conditions, development of care plans and follow up of people with mental health problems. The second section describes the impact of medication review services and other pharmacist-led interventions designed to reduce inappropriate use of psychotropic medicines and improve medication adherence. Other new potential roles discussed include the management of antipsychotic polypharmacy and involvement in patient-centered care. Finally, barriers related to pharmacists' attitudes, stigma and skills in the care of patients with mental health problems and barriers affecting pharmacist-physician collaboration are described, along with strategies to reduce mental health stigma.
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Affiliation(s)
- Maria Rubio-Valera
- Research and Development Unit, Fundació Sant Joan de Déu, Department of Pharmacology and Therapeutic Chemistry, School of Pharmacy, Universitat de Barcelona, Barcelona 08830, Spain.
| | - Timothy F Chen
- Faculty of Pharmacy, The University of Sydney, Sydney 2006, Australia.
| | - Claire L O'Reilly
- Faculty of Pharmacy, The University of Sydney, Sydney 2006, Australia.
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Moullin JC, Sabater-Hernández D, Fernandez-Llimos F, Benrimoj SI. Defining professional pharmacy services in community pharmacy. Res Social Adm Pharm 2013; 9:989-95. [DOI: 10.1016/j.sapharm.2013.02.005] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 02/26/2013] [Accepted: 02/26/2013] [Indexed: 11/26/2022]
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26
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Houle SKD, Chuck AW, McAlister FA, Tsuyuki RT. Effect of a pharmacist-managed hypertension program on health system costs: an evaluation of the Study of Cardiovascular Risk Intervention by Pharmacists-Hypertension (SCRIP-HTN). Pharmacotherapy 2012; 32:527-37. [PMID: 22552863 DOI: 10.1002/j.1875-9114.2012.01097.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY OBJECTIVE To quantify the potential cost savings of a community pharmacy-based hypertension management program based on the results of the Study of Cardiovascular Risk Intervention by Pharmacists-Hypertension (SCRIP-HTN) study in terms of avoided cardiovascular events-myocardial infarction, stroke, and heart failure hospitalization, and to compare these cost savings with the cost of the pharmacist intervention program. DESIGN An economic model was developed to estimate the potential cost avoidance in direct health care resources from reduced cardiovascular events over a 1-year period. MEASUREMENTS AND MAIN RESULTS The SCRIP-HTN study found that patients with diabetes mellitus and hypertension who were receiving the pharmacist intervention had a greater mean reduction in systolic blood pressure of 5.6 mm Hg than patients receiving usual care. For our model, published meta-analysis data were used to compute cardiovascular event absolute risk reductions associated with a 5.6-mm Hg reduction in systolic blood pressure over 6 months. Costs/event were obtained from administrative data, and probabilistic sensitivity analyses were performed to assess the robustness of the results. Two program scenarios were evaluated-one with monthly follow-up for a total of 1 year with sustained blood pressure reduction, and the other in which pharmacist care ended after the 6-month program but the effects on systolic blood pressure diminished over time. The cost saving results from the economic model were then compared with the costs of the program. Annual estimated cost savings (in 2011 Canadian dollars) from avoided cardiovascular events were $265/patient (95% confidence interval [CI] $63-467) if the program lasted 1 year or $221/patient (95%CI $72-371) if pharmacist care ceased after 6 months with an assumed loss of effect afterward. Estimated pharmacist costs were $90/patient for 6 months or $150/patient for 1 year, suggesting that pharmacist-managed programs are cost saving, with the annual net total cost savings/patient estimated to be $131 for a program lasting 6 months or $115 for a program lasting 1 year. CONCLUSION Our model found that community pharmacist interventions capable of reducing systolic blood pressure by 5.6 mm Hg within 6 months are cost saving and result in improved patient outcomes. Wider adoption of pharmacist-managed hypertension care for patients with diabetes and hypertension is encouraged.
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Affiliation(s)
- Sherilyn K D Houle
- Epidemiology Coordinating and Research Centre/Centre for Community Pharmacy Research and Interdisciplinary Strategies, University of Alberta, 8215-112 Street NW, Edmonton, Alberta, Canada
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Houle SK, Chuck AW, Tsuyuki RT. Blood pressure kiosks for medication therapy management programs: Business opportunity for pharmacists. J Am Pharm Assoc (2003) 2012; 52:188-94. [DOI: 10.1331/japha.2012.11217] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Al Hamarneh YN, Rosenthal M, McElnay JC, Tsuyuki RT. Pharmacists' perceptions of their practice: a comparison between Alberta and Northern Ireland. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2011; 20:57-64. [PMID: 22236181 DOI: 10.1111/j.2042-7174.2011.00163.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Abstract
Objective
To explore how community pharmacists from Alberta, Canada, and Northern Ireland, UK, describe what a pharmacist does and to compare their responses.
Methods
Two hundred community pharmacists were interviewed using the telephone. The interviewer who introduced himself as a researcher asked two questions about the period over which the participants had been practising pharmacy and the way they describe what a pharmacist does. Responses were categorised into three categories: patient-centred, product-focused and ambiguous. Word-cloud analysis was used to assess the use of patient-care-related terms.
Key findings
Of the responses from community pharmacists in Alberta, 29% were categorised as patient-centred, 45% as product-focused and 26% as ambiguous. In Northern Ireland, 40% of the community pharmacists' responses were categorised as patient-centred, 39% as product-focused and 21% as ambiguous. Community pharmacists in Northern Ireland provided more patient-centred responses than community pharmacists in Alberta (P = 0.013). The word-cloud analysis showed that ‘medicine’ and ‘dispense’ were the most frequently reported terms. It also highlighted a relative lack of patient-care-related terms.
Conclusions
The findings of the present study are suggestive of some movement towards patient-centredness; however, product-focused practice still predominates within the pharmacy profession in Alberta and Northern Ireland. The relative lack of patient-care-related terms suggests that patient care is still not the first priority for pharmacists in both Alberta and Northern Ireland.
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Affiliation(s)
- Yazid N Al Hamarneh
- EPICORE Centre, Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Meagen Rosenthal
- EPICORE Centre, Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - James C McElnay
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, Belfast, UK
| | - Ross T Tsuyuki
- EPICORE Centre, Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
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Charrois TL, McAlister FA, Cooney D, Lewanczuk R, Kolber MR, Campbell NR, Rosenthal M, Houle SK, Tsuyuki RT. Improving hypertension management through pharmacist prescribing; the rural Alberta clinical trial in optimizing hypertension (Rural RxACTION): trial design and methods. Implement Sci 2011; 6:94. [PMID: 21834970 PMCID: PMC3199859 DOI: 10.1186/1748-5908-6-94] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 08/11/2011] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Patients with hypertension continue to have less than optimal blood pressure control, with nearly one in five Canadian adults having hypertension. Pharmacist prescribing is gaining favor as a potential clinically efficacious and cost-effective means to improve both access and quality of care. With Alberta being the first province in Canada to have independent prescribing by pharmacists, it offers a unique opportunity to evaluate outcomes in patients who are prescribed antihypertensive therapy by pharmacists. METHODS The study is a randomized controlled trial of enhanced pharmacist care, with the unit of randomization being the patient. Participants will be randomized to enhanced pharmacist care (patient identification, assessment, education, close follow-up, and prescribing/titration of antihypertensive medications) or usual care. Participants are patients in rural Alberta with undiagnosed/uncontrolled blood pressure, as defined by the Canadian Hypertension Education Program. The primary outcome is the change in systolic blood pressure between baseline and 24 weeks in the enhanced-care versus usual-care arms. There are also three substudies running in conjunction with the project examining different remuneration models, investigating patient knowledge, and assessing health-resource utilization amongst patients in each group. DISCUSSION To date, one-third of the required sample size has been recruited. There are 15 communities and 17 pharmacists actively screening, recruiting, and following patients. This study will provide high-level evidence regarding pharmacist prescribing. TRIAL REGISTRATION Clinicaltrials.gov NCT00878566.
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Affiliation(s)
- Theresa L Charrois
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Robertson J, Walkom E, Pearson S, Hains I, Williamson M, Newby D. The impact of pharmacy computerised clinical decision support on prescribing, clinical and patient outcomes: a systematic review of the literature. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2010. [DOI: 10.1211/ijpp.18.02.0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Jane Robertson
- Discipline of Clinical Pharmacology, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - Emily Walkom
- Discipline of Clinical Pharmacology, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - Sallie‐Anne Pearson
- UNSW Cancer Research Centre, University of New South Wales and Prince of Wales Clinical School, Sydney
| | - Isla Hains
- UNSW Cancer Research Centre, University of New South Wales and Prince of Wales Clinical School, Sydney
| | | | - David Newby
- Discipline of Clinical Pharmacology, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
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A comparative analysis of remuneration models for pharmaceutical professional services. Health Policy 2009; 95:1-9. [PMID: 19945762 DOI: 10.1016/j.healthpol.2009.11.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 10/22/2009] [Accepted: 11/08/2009] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Pharmacists provide a wide range of professional services to support the appropriate use of medicines by patients. This study aims to conduct an international, comparative analysis of remuneration models for pharmaceutical professional services. METHODS Information about remuneration models was derived from a literature review and a semi-structured questionnaire completed by experts. RESULTS Remuneration models differ in the way that pharmacists are paid for professional services beyond dispensing medicines. Also, the scope of services that are remunerated varies. The majority of countries regulate remuneration for services only when the medicine is paid for under the reimbursement scheme. Remuneration of services implies a commitment to assure their quality in some countries. Collaborative practice models have been set up where pharmacists work together with other health care professionals to deliver diagnosis-specific services or services based on the patient's use of medicines. The remuneration of services is influenced by the value of services, budgetary constraints, the payer perspective, and the attitude of physicians, pharmacists and patients. CONCLUSIONS Professional organisations need to formulate a clear strategy for developing and gaining remuneration for pharmaceutical professional services. This implies that pharmacists not only demonstrate the value of services, but also assure their quality.
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Jackson M. Coverage for pharmacist-delivered clinical services—Where do we sit? Can Pharm J (Ott) 2008. [DOI: 10.3821/1913-701x(2008)141[72:cfpcsd]2.0.co;2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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