The provision of pharmaceutical care in Denmark: a cross-sectional survey

Instruments to assess the role of the clinical pharmacist: a systematic review

BACKGROUND

The clinical pharmacist is an essential member of the healthcare team and plays an important role in health care in the primary care and the hospital setting. Knowledge regarding the instruments that evaluate the different activities of the clinical pharmacist, as well as the evaluation of the psychometric properties of these instruments, is necessary.

METHODS

A literature search was performed in the PubMed and Scopus electronic databases without time and language restrictions. For the search strategy, the "pharmaceutical services," "validity studies," and "professional performance" domains were used. To assess the quality of the instruments, the five sources of validity evidence of contemporary psychometry were used, and the Joanna Briggs Institute's standardized instrument was used to assess the methodological quality of the studies. After screening 4096 articles, 32 studies were selected.

RESULTS

A total of 32 studies were included, and 32 instruments were identified to be used by pharmacists acting in various pharmaceutical practice scenarios. It was found that the available instruments were developed or adapted from others, with variation in the methods, constructs, dimensions, and domains, as well as the psychometric properties. Most of the instruments addressed community pharmacies, and evidence of content validity and internal structure was found most frequently. A standardized and validated instrument that comprehensively assessed the performance of the clinical pharmacist, addressing clinical activities, was not identified for all practice environments.

CONCLUSIONS

Without standardized and validated instruments specifics to assess the performance of the clinical pharmacist, it is hard to establish the main clinical activities performed by pharmacists in their pharmaceutical practice environments and to propose training actions to improve professional practice. Despite the large number of instruments available and considered validated by the authors, it is questioned to what extent the validity indicators presented in the different studies really show the validation status.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD 42018099912.

Community pharmacists’ routine provision of drug-related problem-reduction services

Objectives

The present study aimed to assess the degree of the provision of services for drug-related problems (DRPs) and the factors affecting provision within the community pharmacy setting in Irbid, a large city in Northern Jordan.

Methods

A cross-sectional survey was developed and administered to community pharmacists in Irbid, Jordan during the period from January to May 2017. The survey is composed of background and practice characteristics, services provided routinely by the community pharmacists to address DRPs, and barriers and facilitators for DRP-reduction services. A summated score quantifying the degree of DRP-reduction service provision was calculated, which included overall scores and scores for the different scales and domains. Statistical analysis included descriptive statistics and a multivariate linear regression model for factors associated with the high provision of DRP-reduction service.

Results

Two hundred community pharmacists out of 210 pharmacists approached completed the surveys yielding a response rate of 95.2%. The most frequent DRPs encountered within the routine practice in the community pharmacy were economic aspects (76.0%). The mean total score relating to different DRP-reduction services was 32.9 (58.8%) out of 56 as the maximum possible score. It was estimated that 28.2% of the responding pharmacists provided the service overall (scored more than 50% of the scale). For the assessment, intervention, and referral dimensions, similar percentages of providers of the services were achieved: 59.7%, 61.9%, and 49.0%, respectively. Lower rates of providers were achieved on the documentation scale (12.9%). The lack of recognition of the pharmacist role by physicians was the most commonly reported barrier to effective DRP-reduction services among community pharmacists (78.9%). The ability to receive external guidance was indicated by the majority of surveyed pharmacists (94.5%) as a potential facilitator to DRP-reduction services in this study. Predictors associated with high total scores were the presence of medical records for the patients in the pharmacy, patients contact the pharmacy using email, a high satisfaction in professional relationships with physicians, and pharmacists’ age.

Conclusion

Even though community pharmacists in this study have been shown to deliver certain activities to address DRPs to a high degree, the overall rate of DRPs services was suboptimal. Community pharmacists reported several barriers that should be taken into consideration to facilitate the role of community pharmacists in providing adequate DRP reduction services to patients.

Community pharmacists' opinions and practice of pharmaceutical care at chain pharmacy and independent pharmacy in China

Background Whether Chinese community pharmacists in chain pharmacies and independent pharmacies provide the same type and quality of pharmaceutical care has not been fully investigated. Objective This study aimed to investigate community pharmacists' understanding, attitude, practice and perceived barriers of pharmaceutical care at chain pharmacies and independent pharmacies in China. Setting Community pharmacies in China. Method A questionnaire survey was conducted in 27 provinces (autonomous regions) and 4 municipality cities in China. Main outcome measure Chinese community pharmacists' understanding, attitude, practice and perceived barriers of pharmaceutical care. Results The respondent pharmacists' understanding of pharmaceutical care was only moderate, though they showed a positive attitude towards providing the service. The respondent pharmacists from both chain and independent pharmacies provided more basic pharmaceutical service than advanced pharmaceutical care. Regarding barriers to providing pharmaceutical care, the respondent pharmacists identified the main barriers as a lack of physical space, slow introduction of pharmacist law, lack of patient acceptance of pharmaceutical care, and lack of face-to-face communication with patients. Pharmacists at chain pharmacies had a better understanding of and attitude toward pharmaceutical care and practiced more advanced pharmaceutical care than pharmacists at independent pharmacies. Conclusion Chinese community pharmacists' understanding and practice of pharmaceutical care in China needs improvement. Compared with pharmacists at chain pharmacies, pharmacists at independent pharmacies face more challenges in providing pharmaceutical care. Specific efforts should be made to improve pharmacist competence, increase patient acceptance and shape a better operative environment for community pharmacies, especially for independent pharmacies.

Provision of pharmaceutical care by community pharmacists across Europe: Is it developing and spreading?

RATIONALE, AIMS, AND OBJECTIVES

Pharmaceutical care involves patient-centred pharmacist activity to improve medicines management by patients. The implementation of this service in a comprehensive manner, however, requires considerable organisation and effort, and indeed, it is often not fully implemented in care settings. The main objective was to assess how pharmaceutical care provision within community pharmacy has evolved over time in Europe.

METHOD

A cross-sectional questionnaire-based survey of community pharmacies, using a modified version of the Behavioural Pharmaceutical Care Scale (BPCS) was conducted in late 2012/early 2013 within 16 European countries and compared with an earlier assessment conducted in 2006.

RESULTS

The provision of comprehensive pharmaceutical care has slightly improved in all European countries that participated in both editions of this survey (n = 8) with progress being made particularly in Denmark and Switzerland. Moreover, there was a wider country uptake, indicating spread of the concept. However, due to a number of limitations, the results should be interpreted with caution. Using combined data from participating countries, the provision of pharmaceutical care was positively correlated with the participation of the community pharmacists in patient-centred activities, routine use of pharmacy software with access to clinical data, participation in multidisciplinary team meetings, and having specialized education.

CONCLUSIONS

The present study demonstrated a slight evolution in self-reported provision of pharmaceutical care by community pharmacists across Europe, as measured by the BPCS. The slow progress suggests a range of barriers, which are preventing pharmacists moving beyond traditional roles. Support from professional bodies and more patient-centred community pharmacy contracts, including remuneration for pharmaceutical care services, are likely to be required if quicker progress is to be made in the future.

Qatar pharmacists' understanding, attitudes, practice and perceived barriers related to providing pharmaceutical care

BACKGROUND

Pharmaceutical care (PC) is the philosophy of practice that includes identifying and resolving medication therapy problems to improve patient outcomes.

OBJECTIVES

The study objectives were to examine the extent of pharmaceutical care practice and the barriers to pharmaceutical care provision as perceived by Qatar pharmacists and to assess their level of understanding of pharmaceutical care and their attitudes about pharmaceutical care provision. Setting Qatar pharmacies.

METHODS

A cross sectional survey of all pharmacists in Qatar was made. Consenting pharmacists were given the option to complete the survey either online using an online software or as paper by fax or by hand.

MAIN OUTCOME MEASURES

1. Extent of pharmaceutical care practice in Qatar. 2. Barriers to pharmaceutical care provision in Qatar. 3. Qatar pharmacists' level of understanding of pharmaceutical care. 4. Qatar pharmacists' attitudes toward pharmaceutical care provision.

RESULTS

Over 8 weeks, 274 surveys were collected (34 % response rate). More than 80 % of respondents had correct understanding of the aim of PC and of the pharmacist role in PC. However, only 47 % recognized the patient role in PC and only 35 % were aware of the differences between clinical pharmacy and PC. Yet, more than 80 % believed that they could be advocates when it comes to patients' medications and health matters. Concerning their practice, respondents reported spending little time on PC activities. Offering feedback to the physician about the patient progress was always or most of the time performed by 21 % of respondents. The top perceived barriers for PC provision included inconvenient access to patient medical information (78 %) and lack of staff and time (77 and 74 % respectively).

CONCLUSIONS

Although PC is not incorporated into pharmacy practice, Qatar pharmacists showed positive attitudes toward PC provision. Further work should focus on improving their PC understanding and on overcoming all barriers.

The role of pharmacists in smoking cessation in Poland

In Poland, 38.0% of men and 25.6% of women smoke daily. One method for expanding access to smoking cessation services is through community-based pharmacists. Surveys were administered in 2007-2008 to (a) current smokers, (b) members of a pharmacy association, and (c) pharmacy students in their final year of training. Pharmacists were the highest ranked health professionals to whom Polish smokers reported they would turn for information about pharmacological support for smoking cessation. Most pharmacists (79%) reported their knowledge allowed them to provide basic smoking cessation information to their patients. Pharmacy students reported being more able to provide information about the health consequences of tobacco smoking than to help patients quit smoking (85% vs. 61%). In Poland, community-based pharmacists are positioned to provide smoking cessation interventions to all segments of the population. To extend and promote smoking cessation efforts, comprehensive tobacco cessation training should be a required component of the pharmacy school curriculum.

Actual and Perceived Provision of Pharmaceutical Care in Danish Community Pharmacies: The Pharmacists’ Opinions

OBJECTIVE

The study explores characteristics of community pharmacies with respect to implementing pharmaceutical care activities. The article addresses the provision of pharmaceutical care at reality level, perceived level and policy level.

METHOD

A cross-sectional questionnaire was sent to all Danish community pharmacies to investigate the provision of pharmaceutical care (n=288). The respondents were pharmacists. Pharmaceutical care activities were operationalised by detecting and identifying medicine-related problems, setting goals to solve medicine-related problems, and documenting efforts to solve them. A non-respondent analysis was also performed.

MAIN OUTCOME MEASURE

The identification of medicine-related problems (from self-report) was used as a proxy measure of pharmaceutical care activities and compared to pharmacies' self-reported provision of pharmaceutical care.

RESULTS

The survey response rate was 75.7. The characteristics of pharmacies that detected medicine-related problems differed from those of pharmacies with only a perceived provision of pharmaceutical care. Pharmacies that actually detected medicine-related problems focused on external cooperation regarding their pharmacy activities.

CONCLUSION

The profiles of the perceived providers of pharmaceutical care and the respondents that detected medicine- related problems were distinct, thus indicating two separate groups of pharmacies. Pharmaceutical care has only been implemented in Denmark to a limited extent. This may be explained in part by the top-down implementation strategy conceived by the proprietor organisation.