Pharmaceutical care services available in Danish community pharmacies

Council of Europe Resolution on the Implementation of Pharmaceutical Care-A Step Forward in Enhancing the Appropriate Use of Medicines and Patient-Centred Care

Pharmaceutical care was proposed to address morbidity and mortality associated with medicine-related problems. It utilises the pharmacist's expertise in medicines, their relationship with the patient and cooperation with other healthcare professionals to optimise the use of medicines. The European Directorate for the Quality of Medicines & HealthCare (EDQM), part of the Council of Europe, found significant variation in the acceptance of pharmaceutical care and in the implementation of pharmaceutical care in Europe. A multidisciplinary group was established to draft a statement of principles and recommendations concerning pharmaceutical care. Through face-to-face meetings, circulation of draft texts and informal consultation with stakeholders, the group produced a resolution. On 11 March 2020, the resolution was adopted by the Committee of Ministers of the Council of Europe. It explains pharmaceutical care and illustrates pharmacists' contribution to medicine optimisation in different care settings. Pharmaceutical care's value to health services and its place in health policy were emphasised by addressing the risks and harms from suboptimal use of medicines. Pharmaceutical care can improve medicine use, promote rational use of healthcare resources and reduce inequalities in healthcare by realigning the roles and responsibilities of pharmacists and healthcare professionals. EDQM will promote and advocate for the implementation of pharmaceutical care by enacting practice Resolution CM/Res(2020)3.

Evaluating consumer self-medication practices, pharmaceutical care services, and pharmacy selection: a quantitative study

BACKGROUND

The primary objectives of this study were the evaluation of consumer self-medication practices, the assessment of pharmaceutical care provided by pharmacy employees, and the analysis of consumer satisfaction with such care. The research was also aimed at examining the main criteria that consumers consider important when selecting a pharmacy in Armenia.

METHODS

The survey was based on an anonymous questionnaire and carried out between March 2020 and November 2021. It was aimed at providing a comprehensive assessment of pharmaceutical care services and consumer pharmacy choice by investigating two distinct groups: pharmacy consumers and pharmacy employees.

RESULTS

The research reveals that many residents in Armenia engage in self-medication without consulting professional sources, which can lead to potential risks and result in dangerous consequences. This is partly due to a lack of trust in pharmacy employees, which is primarily due to their inability to provide adequate information and advice. This study highlights a significant need for improvement in the quality of service provided by pharmacy employees. Despite these challenges, the majority of consumers reported having a preferred pharmacy, and that employee knowledge is the most important criterion when choosing a pharmacy.

CONCLUSIONS

Consumer distrust, in this context, is based on the incomplete knowledge or incompetency of pharmacy employees. Collective actions should be taken to improve the role of pharmacy employees and consequently improve the public trust in them, which can ensure better control of self-medication and reduce the instances of mistreatment.

Danish community pharmacies supporting self-care for patients

In Denmark, self-care has been a part of the health care professional and health political discourse since the middle of the 1970s particularly in relation to prevention. However, the concept has become more visible in connection with the Danish government's public health programme "Healthy throughout life" from 2002 to 2010, where patients' self-care was highlighted as an important element in preventing disease progression and complications. Self-care in Denmark is seen as a partnership between the patient and the health care professional. Some self-care activities in Danish community pharmacies are mentioned in national and municipal guidelines for better prevention and self-care regarding obesity, sexual health, smoking cessation, teaching patients/relatives and vaccination. This paper describes self-care activities and services delivered by Danish community pharmacies gathered from survey results at 33 community pharmacies, oral communication with the Association of Danish Pharmacies and published papers on Danish community pharmacy services. Self-care activities in Danish community pharmacies include counselling (about health, self-care, prescription medication, and OTC medication), health campaigns, collaborations with other health care professionals and patient associations and community pharmacy services, all with the purpose to support correct medication use, medication safety and to contribute to health promotion and prevention. These cover activities on prevention, detection, minor ailments, and chronic disease. Six of ten future community pharmacy contributions to medication safety and prevention in future health care, described by the Association of Danish Pharmacies, are related to community pharmacies' support of patients towards better self-care. In the future, Danish community pharmacies should consider offering self-care activities by expanding existing counselling, community pharmacy services and collaborations. Remuneration also needs to be aligned for the activities to succeed and become an integrated part of prevention packages and national initiatives that support patient self-care.

What Are the Drug-Related Problems Still Faced by Patients in Daily Life?-A Qualitative Analysis at the Pharmacy Counter

BACKGROUND

Drug-related problems (DRPs) affect many patients. Many activities in general practice, hospitals, and community pharmacies have been initiated to tackle DRPs. However, recent studies exploring what DRP patients are still facing in their daily lives are scarce.

METHODS

Danish pharmacy staff registered DRPs in prescription encounters to understand what DRPs patients are still experiencing in daily life. They noted short descriptions of what happened in the encounter that qualified the incident as a DRP. The descriptions were subjected to an inductive content analysis.

RESULTS

A wide range of DRPs that impacted patients' daily lives practically and healthwise were identified. In total, eighteen percent of patients with prescriptions had a DRP. Three overall stages of DRPs were identified: challenges in receiving the medications, not knowing how or why to take the medications, and not experiencing satisfactory effects. Patients were emotionally affected by these problems.

CONCLUSIONS

DRPs are still widespread in patients' daily lives and influence their well-being. The identified DRPs illustrated the complexity of obtaining medications to work as intended and demonstrate that health professionals must take even the basics of medication intake much more seriously.

Outcomes of Pharmacist-Led Pharmaceutical Care Interventions Within Community Pharmacies: Narrative Review

Pharmaceutical care (PhC) services interventions led by pharmacists within community pharmacies (CPs) are essential in achieving optimal medication use outcomes. PhC is a concept related to medication use goals optimization through the reduction and prevention of drug-related problems (DRPs). This review paper summarized the literature on pharmacist-led PhC interventions within CPs. PubMed and Google Scholar publications were searched, identified, and summarized. Results showed that some studies handled community pharmacists' roles, and some talked about PhC interventions. However, some studies reviewed the use of medicines, adherence, and follow-up, while other groups were on counseling, patient education, and health promotion. Pharmacists integrated some studies concerning diagnosis and disease screening into community pharmacy services. Besides these studies, there were studies on system design and installation of PhC service models. Most of the identified research results showed pharmacist-led intervention benefits for patients. These benefits include reduced DRPs, clinical, economical, humane, education and knowledge, disease prevention and immunization, identification of practice process problems, and the need for current practice redesigning. In conclusion, pharmacists can help patients achieve optimal outcomes through pharmacist-led interventions. Despite mentioned results, We recommend researching comprehensively applied PhC services provision models within CPs for more pharmacists-led interventions and role activation.

Pharmaceutical Care Within Community Pharmacies: Tools Availability and Pharmacists' Views, Wad-Medani, Sudan

Background

Pharmaceutical Care (PhC) services within community pharmacies (CPs) have become a vital issue in many developed countries.

Purpose

This study assessed the availability of PhC tools and pharmacists' views towards PhC services within CPs in Sudan.

Methods

A cross-sectional study was conducted from December 2019 to August 2020 using a pretested self-administered questionnaire. The participants were 120 community pharmacists.

Results

Fifty-eight percent of respondents used to work in pharmacies near homes rather than within the marketplace. The study revealed that the overall tool availability of the assessed components and items was only 25% (Counselling areas 3%, Records 5%, Pharmacist identity 3%, Pharmacy phones 15%, Medical devices 38%, and Staff 29%). The result of pharmacists' views towards the PhC concept, roles, and responsibilities showed a high level of agreement, at 88%, with a statistically insignificant difference between participants.

Conclusion

Tools available within CPs were lower than required. However, pharmacists' views showed a high agreement level towards PhC concept roles and responsibilities. Community pharmacists, academic sectors, and regulatory authorities must start initiatives to improve the provision of PhC tools for better patient care service delivery.

Implementing a newly prescribed cardiovascular medicine in daily routine: The patient perspective at readmission to primary care

BACKGROUND

Readmission to primary care is challenging for patients due to involvement of multiple healthcare providers across different settings and implementing new medicines into their daily routine. Elucidating patients' needs is crucial to tailor counseling support.

OBJECTIVE

To explore the patient perspectives on implementing a newly prescribed cardiovascular medicine into their daily routine at readmission to primary care.

METHODS

A qualitative study was performed within the outpatient pharmacy. Adult patients who were prescribed a new cardiovascular medicine by their treating hospital physician at hospital discharge or during an outpatient clinic visit were eligible to participate. Purposive sampling was applied to equally distribute adherence-influencing factors. Patients were interviewed by telephone and inclusion continued until theoretical data saturation. An adapted Greenhalgh framework for implementation research was used for a thematic content analysis by conceptualizing the new medicine as an innovation that requires implementation by a patient (adopter).

RESULTS

Data saturation was reached at 44 patients of which 19 discontinued their new medicine at the time of the interview. Reasons for discontinuing included: side-effects, insufficient efficacy or negligence. Patients considered a lack of basic knowledge on their newly prescribed cardiovascular medicine as a major barrier for adopting it into their daily routine. They were in need of information on risks and benefits of their new medicine. A noticeable effect and tailored counseling facilitated patients in taking their medicine as prescribed. Patients mentioned personalized organizing tools and routinization of medication intake as important success factors for addressing their practical challenges with their new medicine.

CONCLUSIONS

By applying the adapted Greenhalgh framework, this study provided a unique and structured insight in patients' barriers and facilitators that could influence their ability to implement a new cardiovascular medicine at readmission to primary care. This knowledge enables pharmacists to tailor their patient support and provide individualized patient counseling.

Community Pharmacy Staff's Knowledge, Educational Needs, and Barriers Related to Counseling Cancer Patients and Cancer Survivors in Denmark

OBJECTIVE

The study aimed to determine Danish community pharmacy staff's knowledge, educational needs, and barriers when communicating with cancer patients/survivors. Furthermore, the study investigated whether pharmacy staff was interested in participating in education about cancer.

METHODS

A cross-sectional questionnaire survey was conducted among community pharmacy staff (pharmacists and pharmaconomists) in Denmark. Descriptive and bivariate (t-test and chi-square) statistics were used to analyze the data.

RESULTS

In total, 134 staff members responded to the questionnaire. Their self-reported knowledge of cancer-related topics was between 'very little knowledge' and 'some knowledge'. The most well-known topics concerned risk factors for cancer and side effects from cancer treatments. The importance of learning more about the same topics was rated between 'important' and 'very important'. The largest barriers identified in counseling cancer patients/survivors were a lack of knowledge about cancer, a focus on healthcare problems other than cancer, and a traditional view of community pharmacies as a place to pick up medication. Pharmacy staff expressed interest in participating in educational programs about cancer treatment (91.0%), communication with cancer patients (88.1%), and late effects of cancer (93.3%).

CONCLUSION

Community pharmacy staff show interest in participating in education regarding cancer, but need more knowledge to properly counsel cancer patients and survivors at the community pharmacies. This important barrier should be addressed in future educational programs for community pharmacy staff.

Clinical pharmacy services are reimbursed in Germany: challenges of real world implementation remain

Over the last two decades, community pharmacy has experienced major changes as the role of pharmacists is evolving from a product to a service and a patient focus. As part of this change, new and innovative clinical pharmacy services aimed at improving medicines use and patient outcomes have been designed, both nationally and internationally. Since June 2022, five services are reimbursed by all statutory health insurance funds and private insurance companies in Germany: medication review for patients with polymedication; blood pressure control in hypertension; assuring proper inhalation techniques for patients receiving a new device or a device change; medication review including a follow-up for patients taking oral anticancer drugs or immunosuppressants post-transplantation. Beyond reimbursement, the upscaling and sustainable provision of these professional services are now the main challenges. Implementation research will provide important information for the further development of pharmaceutical care programs.

Developing a pharmacist-led intervention to provide transitional pharmaceutical care for hospital discharged patients: A collaboration between hospital and community pharmacists

Background

Patients who transfer from the hospital back to the community are at risk of experiencing problems related to their medications. Hospital pharmacists (HPs) and community pharmacists (CPs) may play an important role and provide transitional pharmaceutical care in transition of care interventions.

Objective

To describe how a pharmacist-led intervention to provide transitional pharmaceutical care for hospital discharged patients was developed, utilizing already existing pharmacist interventions in the hospital and community pharmacy.

Methods

A mixed-method approach to intervention development was applied. Existing evidence was identified through a literature review of effective transitional care interventions and existing services in the hospital and community pharmacy. Focus group interviews and a workshop were carried out with HPs and CPs to identify their perceived facilitators and uncertainties in relation to intervention development. The final intervention and the expected outcomes were developed in an expert group workshop. Finally, the hospital part of the intervention was tested in a small-scale feasibility study to assess what type of information the HP would transfer to the CP for follow up.

Results

Five components were identified through the 209 systematic reviews: pharmacist-led medication reconciliation, pharmacist-led medication review, collaboration with general practitioners (GPs), post discharge pharmacist follow up and patient counseling or education. HPs and CPs identified uncertainties related to the relevance of the information sent from the HP to the CP, identification of patients at the community pharmacy and communication. The expected outcomes for the patients receiving the intervention were an experience of increased safety and satisfaction and less use of healthcare resources. The feasibility study led to optimization of language and structure of the pharmacist referrals that were used to transfer information from the HP to the CP.

Conclusion

A patient centered intervention to provide transitional pharmaceutical care for hospital discharged patients was developed using existing evidence in transition of care, HPs and CPs, an expert group, and a small-scale feasibility study. A full-scale feasibility test of the intervention should be carried out for it to be further refined.

Effectiveness of inhalation technique assessment service for patients with Respimat® inhaler

OBJECTIVES

The objective of this study was to examine how Inhalation Technique Assessment Service (ITAS) by community pharmacies affect patients' inhalation techniques when using the Respimat® soft mist inhaler. The inhaler was simultaneously updated into a reusable inhaler. The study focused on the Respimat® inhaler because its use is known to be challenging for patients.

METHODS

The study was performed as a pre-post design in 33 community pharmacies (CPs) in Finland. Patients' inhalation technique was assessed before ITAS (baseline) and immediately after ITAS (follow-up 1). Follow-up 2 was performed when the patient came to the pharmacy for a refill (1-3 months after the baseline and the follow-up 1). A Respimat specific twenty item checklist was used to assess inhalation technique. The checklist included 1) preparation steps before the first use of the Respimat® inhaler (8 items) and 2) daily use steps of the Respimat® inhaler (12 items). After ITAS, the patients received a brief questionnaire to assess their asthma/COPD history.

RESULTS

A total of 228 patients were enrolled at the first visit (mean age 67.8 years, 61.0% female, 85.5% had previous Respimat® use experience) and 42 of them attended the follow-up 2, 1-3 months later (mean age 70.1 years, 69.0% female, 92.9% had previous Respimat® use experience. The median number of the steps performed correctly increased from 17/20 at the baseline to all the 20 steps at the follow-up 1 (p < 0.001). At the baseline, 27.6% of the patients (n = 228) performed all preparation steps correctly, while 87.3% at the follow-up 1 and 71.4% at the follow-up 2. The percentage of the patients with acceptable inhalation technique (all critical daily use steps correct) increased from 69.7% at the baseline to 93.0% at the follow-up 1 (p < 0.001). The corresponding figure at the follow-up 2 was 69.0%. At the baseline, 30.3% of patients had optimal inhalation technique (all daily use steps correct). At the follow-up 1 corresponding figure was 85.1%, and 54.8% at the follow-up 2.

CONCLUSIONS

A pharmacist-led intervention significantly improved asthma and COPD patients' inhalation technique with the Respimat® inhaler. Significant improvements were found in the daily use steps and the preparation steps before the first use.

The Danish Network for Community Pharmacy Practice Research and Development

The community pharmacy has a number of attributes that makes it an excellent setting for research and development projects, as it is a highly accessible part of the healthcare system and is staffed by highly trained health care professionals. The big turnover in patients in the community pharmacy makes it possible to reach a great number of patients and collect a lot of data in a relatively short time. However, conducting nation-wide research and development projects can be a rather time-consuming process for the individual community pharmacy, and can thus require collaboration with other community pharmacies and researchers. This will help ensure strong results and better implementation. Thus, the Danish Network for Community Pharmacy Practice for Research and Development (NUAP) was established in Denmark by a number of highly committed community pharmacies and researchers. NUAP consists of 102 member pharmacy owners in addition to a number of researchers. The aim of the network is to strengthen pharmacy practice and pharmacy practice research in Denmark by providing a forum where community pharmacy practitioners and researchers meet and work together. The network is led by a steering committee elected by the members in the network.

Integration of and visions for community pharmacy in primary health care in Denmark

In 2014, the Danish government launched a plan for health entitled: "Healthier lives for everyone - national goals for the health of Danes within the next 10 years". The overall objective is to prolong healthy years of life and to reduce inequality in health. In Denmark, the responsibility for health and social care is shared between the central government, the regions and the municipalities. National and local strategies seek to enhance public health through national and local initiatives initiated by different stakeholders. The Danish community pharmacies also contribute to promoting public health through distribution of and counselling on medication in the entire country and through offering several pharmacy services, six of which are fully or partly remunerated on a national level. Because of greater demands from patients, health care professionals and society and a lack of general practitioners, the Danish community pharmacies now have the opportunity to suggest several new functions and services or to extend existing services. The Danish pharmacy law changed in 2015 with the objective to maintain and develop community pharmacies and to achieve increased patient accessibility. The change in the law made it possible for every community pharmacy owner to open a maximum of seven pharmacy branches (apart from the main pharmacy) in a range of 75 km. This change also increased the competition between community pharmacies and consequently the pharmacies are now under financial pressure. On the other hand, each pharmacy may have been given an incentive to develop their specific pharmacy and become the best pharmacy for the patients. Community pharmacies are working to be seen as partners in the health care system. This role is in Denmark increasingly being supported by the government through the remunerated pharmacy services and through contract with municipalities. Concurrent with the extended tasks for the Danish community pharmacies and utilisation of their excellent competencies in medication the community pharmacies need to focus on their main tasks of supplying medicines and implementing services. This requires efficient management, an increased use of technology for distribution and communication and continuing education and training.

Pharmacy Technicians' Perception About Symptoms and Concerns of Older Patients Visiting Pharmacies: A Cross-Sectional Study

Purpose

Older patients are still not sufficiently integrated into multidisciplinary care concepts including geriatric and palliative care. They do, however, regularly visit pharmacies to fill prescriptions or to buy self-medication. Thus, they have frequent contact with pharmacy technicians (PTs), who are widely involved in counselling in Germany. However, it is not known whether geriatric symptoms are recognized by PTs and to what extent older patients use their pharmacy to address geriatric or palliative concerns. This study aimed to investigate PTs' impression of older patients' symptoms, geriatric and palliative concerns in consultations, as well as multidisciplinary collaboration.

Patients and Methods

We conducted a cross-sectional study in April-May 2019. Using a self-administered questionnaire, PTs were asked about (i) geriatric symptoms, (ii) geriatric and palliative concerns older patients expressed in routine consultations, (iii) supposed reasons for inadequate care, and (iv) PTs' desire for multidisciplinary cooperation.

Results

(i) The 5 most common symptoms the 339 participating PTs recognized in the community pharmacy were pain, insomnia, restricted mobility, eye disorders, and constipation. (ii) The three most frequently addressed non-drug-related geriatric palliative concerns were mental strain, loneliness, and mourning. (iii) As reasons for inadequate patient care, PTs predominantly mentioned patient-related reasons (299 of 518 reasons, 58%). (iv) 85% of the PTs desired closer cooperation with general practitioners, 84% with nursing services and 39% with palliative physicians.

Conclusion

PTs frequently saw older patients visiting the pharmacy who suffer from a variety of symptoms. PTs were additionally confronted with diverse geriatric or palliative concerns. We deduce, first, a need for PT training in geriatric and palliative care. Second, multidisciplinary care concepts and research should include pharmacies because they seem to be a low-threshold contact to older patients, who might need access to adequate care.

Using Real-Life Data to Strengthen the Education of Pharmacy Technician Students: From Student to Research Assistant

This commentary is based on the experience of teaching and observations of how pharmacy technician students can expand their perspective on patient safety by using real-life student-gathered patient data collected from community pharmacies. Pharmacy technicians in Denmark work extensively with counselling on the safe and efficient use of medications. Final-year pharmacy technician students can take the elective course in Clinical Pharmacy in Community Pharmacy, which targets the students who wish to work in depth with patient communication and quality assurance in counselling. One assignment that forms part of the course is for students to collect data about patients’ beliefs about medications. Teachers’ observations suggest that when students gather and work with their own data, they change their perspective on patients’ beliefs about medications. It also strengthens the students’ awareness of their responsibility for ensuring patient safety and contributes valid data to research in pharmacy practice.

Pharmacy Technicians' Contribution to Counselling at Community Pharmacies in Denmark

(1) Background: pharmacy technicians are the largest group of staff at Danish community pharmacies and play a vital role in counselling customers on prescription medication, over-the-counter (OTC) medication and non-medical products. This is the first study carried out to specifically analyse how they contribute to counselling and identification of drug-related problems (DRPs) at Danish community pharmacies. (2) Methods: seventy-six pharmacy technicians from 38 community pharmacies registered data on all of their customer visits for five days, over a four-week period, between January and March 2019. Data were analysed in SPSS version 24. (3) Results: 58.9% of all registered customers (n = 10,417) received counselling. They identified DRPs for 15.8% of all registered customers (n = 2800). Counselling by pharmacy technicians solved, or partially solved, problems for 70.4% of customers with DRPs. Pharmacy technicians estimated that 25.2% of customers receiving counselling (n = 2621) were saved a visit to the general practitioner (GP). (4) Conclusions: as community pharmacists get more involved in complex services, it would be necessary to expand the roles of pharmacy technicians. Pharmacy technicians contribute to medication safety via counselling, and identifying and handling DRPs for all customers. This study documents the role of pharmacy technicians in customer counselling at Danish community pharmacies. It provides evidence to researchers and policy makers to support discussions on the future role of pharmacy technicians at community pharmacies.

Quality of Pharmaceutical Services in Independent Pharmacies and Pharmacy Chains in Poland from the Patient Perspective

INTRODUCTION

Patient satisfaction is a key factor in the evaluation of the quality of healthcare services. Measuring patient satisfaction is common in outpatient, specialist, and hospital healthcare, and is also significant in relation to pharmaceutical services. The pharmacy market in Poland has been undergoing transformations for many years. Legal regulations implemented in 2002 resulted in a rapid growth of pharmacy chains and a decrease in the number of independent pharmacies. This situation may have translated into changes in the quality of pharmaceutical services.

OBJECTIVE

The objective of this study was to evaluate patient satisfaction with services provided in independent pharmacies and pharmacy chains in Poland.

PATIENTS AND METHODS

A total of 163 patients using randomly selected community pharmacies in Poland were enrolled in the study. A modified Community Pharmacy Patient Questionnaire (CPPQ) was used.

RESULTS

The patients highly valued pharmaceutical services provided in Polish pharmacies. The level of service was slightly higher in pharmacy chains. The lowest-rated area was the provision of information on medications, with independent pharmacies higher-rated in this respect. The patients were open to additional services in pharmacies and supported the development of pharmaceutical care.

CONCLUSION

Independent pharmacies and pharmacy chains ensure a similar level of services for patients in Poland. Pharmacy staff should place a special emphasis on providing patients with comprehensive information on medications. The development of pharmaceutical care in Poland will require appropriate legislative preparation.