Determining patient preferences of community pharmacy attributes: A systematic review

Envisioning the Near Future of Community Pharmacy Patient Care Practice: Report of the 2023-2024 AACP Professional Affairs Standing Committee

The 2023-2024 Professional Affairs Committee was charged to (1) Create an action plan in response to the clear urgent need for transformation of community pharmacy practice; and (2) Develop "readiness for change" instrument that addresses multiple pharmacy stakeholder groups that are based on the ACT "community pharmacy enhanced services" definition. Due to the continuous and rapid-paced changes occurring in community pharmacy practice, the committee developed a document that provides the baseline elements that should be considered for community pharmacy practice currently and into the future. This document, Envisioning the Near Future of Community Pharmacy Patient Care Practice: Key Elements of Practice Redesign in Community Pharmacies, contains 8 sections and is recommended to be socialized within the pharmacy profession to ensure that it resonates with current and future community pharmacy practice.

Developing a quality framework for community pharmacy: a systematic review of international literature

OBJECTIVE

To identify the defining features of the quality of community pharmacy (CP) services and synthesise these into an evidence-based quality framework.

DESIGN

Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

DATA SOURCES

International research evidence (2005 onwards) identified from six electronic databases (Embase, PubMed, Scopus, CINAHL, Web of Science and PsycINFO) was reviewed systematically from October 2022 to January 2023. Search terms related to 'community pharmacy' and 'quality'.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Titles and abstracts were screened against inclusion or exclusion criteria, followed by full-text screening by at least two authors. Qualitative, quantitative and mixed-method studies relevant to quality in CP were included.

DATA EXTRACTION AND SYNTHESIS

A narrative synthesis was undertaken. Following narrative synthesis, a patient and public involvement event was held to further refine the quality framework.

RESULTS

Following the title and abstract screening of 11 493 papers, a total of 81 studies (qualitative and quantitative) were included. Of the 81 included studies, 43 investigated quality dimensions and/or factors influencing CP service quality; 21 studies assessed patient satisfaction with and/or preferences for CP, and 17 studies reported the development and assessment of quality indicators, standards and guidelines for CPs, which can help define quality.The quality framework emerging from the global literature consisted of six dimensions: person-centred care, access, environment, safety, competence and integration within local healthcare systems. Quality was defined as having timely and physical access to personalised care in a suitable environment that is safe and effective, with staff competent in the dispensing process and pharmacy professionals possessing clinical knowledge and diagnostic skills to assess and advise patients relative to pharmacists' increasingly clinical roles.

CONCLUSION

The emerging framework could be used to measure and improve the quality of CP services. Further research and feasibility testing are needed to validate the framework according to the local healthcare context.

College student behaviors and preferences in community pharmacies

Objective: The primary goal of conducting this research was to gain insight into what characteristics of a community pharmacy college students may find appealing and how community pharmacies can tailor their services toward college students. Participants: The survey was distributed to 3,000 college students at The University of Mississippi from various schools and majors across campus. A total of 188 students participated by completing questions from the survey. Methods: The research was performed by using a cross-sectional online survey, and basic descriptive statistics, including frequency counts were used to characterize the findings. Statistical analyses, including crosstabs and chi-square analyses, were used to determine if there were any significant (p < 0.05) associations between characteristics such as pharmacy preferences and other variables. Results: Results of this survey indicated that the majority of respondents have used a community pharmacy in the past six months, and a small number of participants are interested in using a pharmacy for more than the sole reason of filling a prescription. Results also showed that insurance and convenience were the two most influential factors in choosing a community pharmacy. Conclusion: The findings presented in this study show a number of opportunities for community pharmacies to improve the health of college students and their communities.

Home delivery of medications: Community pharmacists' perspectives on the pros and cons of the service

Objectives

The main goal of the current study was to investigate pharmacists' perception of home delivery of medications service in Jordan and their willingness to use the service.

Method

This cross-sectional observational study was conducted between March and April 2022. The study targeted community pharmacists working at different community pharmacies across Jordan. The study questionnaire was distributed through Facebook to target Jordanian community pharmacists' groups.

Results

Three hundred and twenty-four community pharmacists participated in the study, 75% (n = 244) of pharmacists reported being willing to use the home delivery and 274 (84.6%) thought it increases the efficiency of their community pharmacies' services. Only 129 (39.8%) pharmacists agreed or strongly agreed that unlike in-store service, home delivery of medications is suitable only for OTC but not for prescriptions medications Nearly half the number of participating pharmacists (n = 153, 47.2%) believe that the service is suitable for refill prescriptions but not for new prescriptions. Pharmacists believe that the foremost pros of the service were to continue life-saving medical treatment (n = 249, 76.9%), serve sick, elderly, and disabled patients (n = 241, 74.4%), and decrease congestion at health facilities (n = 228, 70.4%). On the other hand, the cons of this service, as perceived by pharmacists included failing to build a professional relationship with patients (n = 203, 62.7%), and the contribution to communication errors (n = 147, 45.4%). Logistic regression showed that pharmacists who serve 50 patients or more per day were more willing to use the service than those serving less than 50 patients per day (OR = 2.058, P = 0.032).

Conclusion

The majority of participating pharmacists in this study were willing to use the service at their community pharmacies, especially those serving a large number of patients per day which may indicate the potential of this service in relieving the pressure on community pharmacies and allowing them to serve more patients efficiently.

Tatted not tattered

Tattoos are common practice in underrepresented groups. However, institutional policies often prohibit visible tattoos of health professionals. This affects marginalized groups where tattoos may be the cultural norm. There are conflicting findings on perceptions of tattoos on medical professionals from the perspectives of peers, patients, and learners. Tattoo restriction can be discriminatory against already marginalized persons and sends a message of exclusion. Policies surrounding tattoo restriction should be re-evaluated to create an inclusive environment for all.

Evaluation of Current Community Pharmacist Practice in Saudi Arabia—A Cross-Sectional Study from Pharmacists’ Perspective (Part II)

This study aimed to evaluate the current practice of community pharmacists from patients’ and pharmacists’ perspectives in Saudi Arabia. This paper presents the pharmacist’s perspective. A cross-sectional self-administered online survey was designed to collect responses from community pharmacists in Saudi Arabia from February to April 2021. The questionnaire consisted of several statements related to best practice in community pharmacy. Pharmacists’ responses to each statement were scored using a 5-point Likert scale. Higher scores represented a greater extent to which they adhered to best practice in the community pharmacy setting and vice versa. Data of 164 participants were included in the analysis. The minimum median score was related to the statement: Pharmacist explains the main side effects. The maximum median score was related to the statement: Pharmacist explains dosage regimen. Pharmacists aged 30 years or above and non-Saudi pharmacists had significantly higher median scores compared with pharmacists less than 30 years of age (p = 0.016) and Saudi pharmacists, respectively (p = 0.001). A gap between best practice and current practice of community pharmacists was observed. Policymakers can utilize these findings to provide targeted professional development opportunities for the practicing community pharmacists in order to improve the overall service and care for patients.

Professional tress code: I look like a pharmacist

Hair color, style, and length are facets to a person's self-expression. There is evidence of bias against those who wear natural hair styles in job recruitment settings, which can affect how the candidate is perceived. In addition, there have been discriminatory hair policies that affect minoritized people. In the profession of pharmacy, most definitions of professionalism do not comment on physical appearance as a component but focus on characteristics such as knowledge, respect, communication, and empathy. It is critical to ensure that comments about someone's hair are not microaggressions. To embrace natural hair styles, pharmacists should combat any policies that are discriminatory and provide a safe space for others to feel comfortable wearing their hair in natural styles or with hair coverings. These actions will help create a space for authenticity, self-acceptance, and comfort.

Student Pharmacists' Perceptions of Amazon Pharmacy

Amazon recently launched their online pharmacy in the United States (US). However, no studies have explored student pharmacists’ perceptions of the potential impact of Amazon Pharmacy. This qualitative study used individual semi-structured interviews to examine third- and fourth-year student pharmacists’ perceptions of how Amazon Pharmacy will affect economic, clinical, and humanistic outcomes; the pharmacy experience; and the job market. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed by two independent reviewers until saturation was reached, with differences resolved through discussion with a third researcher. Seventeen students participated in the study. Five themes were identified: perceived economic outcomes for patients, perceived clinical outcomes for patients, perceived humanistic outcomes for patients, perceived impact of the pharmacy experience for patients, and perceived influence of Amazon Pharmacy on the pharmacy market. The majority suggested Amazon Pharmacy would offer lower costs for patients (71%), improved medication adherence (76%), and improved quality of life (65%). There was a consensus that the Amazon Pharmacy experience would be different, with various opinions highlighting potential positive or negative aspects of the service. There were mixed opinions about job opportunities and impact on existing pharmacies. Future studies should evaluate economic, clinical, and humanistic outcomes for patients utilizing Amazon Pharmacy.

Community pharmacists' knowledge, attitudes and practices towards oral healthcare and its management: A systematic review

BACKGROUND

Community pharmacists play a significant part in providing oral healthcare advice as there are significant connections between oral healthcare and body system healthcare.

OBJECTIVE

To systematically review the literature regarding the knowledge, attitudes and practice of community pharmacists in managing oral healthcare problems.

METHODS

A systematic review was conducted through Scopus, PubMed and Google Scholar databases. Studies regarding knowledge, attitudes and practice of management of dental care by community pharmacists between 1990 and 2019 were included.

RESULTS

Forest plot was performed to access knowledge, attitudes and practice of community pharmacist on oral healthcare. The results showed there were 44% of community pharmacists have a lack of knowledge on oral healthcare to provide an appropriate recommendation to patients with dental problems. Eighty-eight per cent of community pharmacists were willing to improve their knowledge of oral healthcare. There were 86% of them recognised that their role was significant in oral health. However, there were 59% of community pharmacists who had poor attitude in providing oral health information.

CONCLUSIONS

Community pharmacists were lacking knowledge on oral health mainly because of paucity in providing appropriate training courses. This has led to poor practices towards oral healthcare as they were unable to provide suitable products recommendations to the patients. This has led the community pharmacists into lack of attitudes in providing oral health information. However, most of the community pharmacists were conscious of their role in the oral healthcare system and were willing to improve their knowledge of oral healthcare.

Medication Abortion With Pharmacist Dispensing of Mifepristone

Medication abortion with pharmacist-dispensed mifepristone is effective, with a low prevalence of adverse events, and patients are satisfied with the model of care.

To estimate effectiveness and acceptability of medication abortion with mifepristone dispensed by pharmacists.

Exploring standardized persons' expectations for practice-readiness among student pharmacists

INTRODUCTION

Although patient expectations and preferences for healthcare selection have been described in the literature, there are no studies exploring what qualities and behaviors standardized persons (SPs) identify for the practice-ready pharmacist. This manuscript explores those qualities and behaviors within an objective structured clinical examination (OSCE) to determine SP interest in having the student as their pharmacy provider.

METHODS

Using open-ended questions via a Qualtrics survey, SPs were asked to provide qualities and behaviors they associated with each of three practice-readiness rating levels. Using a constant comparative approach, the researchers coded the collected data over multiple stages to allow for authentic reflection and interpretation of the data. Coders used both inductive and deductive processes prior to establishing a unified understanding and corresponding codebook.

RESULTS

A total of 55 SPs (61.1% response rate) participated in the survey, with the majority of participants working for the organization no more than two years (58.2%). Through the coding process, several major themes emerged across each of the three ratings including professionalism, patient-centered skills, communication, and preparation. Findings indicated the differences in ratings were influenced by the degree that students demonstrated each theme.

CONCLUSIONS

Overall, these findings provide a better understanding of the qualities and behaviors SPs associate with student pharmacists completing OSCEs acting as practicing pharmacists. However, additional research is needed to determine if the same qualities and behaviors would be viewed as essential with SPs at other academic institutions.

Patient Preferences For Specialty Pharmacy Services: A Stated Preference Discrete-Choice Experiment in China

Objectives: To survey, analyze, and ascertain the preferences for specialty pharmacy services among patients requiring complex care and to provide evidence to support specialty pharmacy service decision-making in China.

Methods: To identify essential service attributes and levels, a review of the literature, discussions with specialty pharmacy managers and a pilot questionnaire were conducted. A D-efficient fractional factorial design was used to generate the discrete-choice experiment (DCE) questionnaire. A face-to-face survey of patients with chronic illness and their families or friends was conducted at three specialty pharmacies in Chengdu and Qingdao, China. A mixed logit model was used for estimation.

Results: Six relevant attributes were identified and incorporated into the DCE questionnaire. A total of 417 participants completed the survey (mean age 43 years, 45.1% males), and 32.1% had lung cancer. The conditional relative importance showed that the most critical attribute was “frequency of telephone follow-up to monitor adverse drug reactions (ADRs), “followed by “mode of drug delivery,” “provider of medication guidance services,” and “availability of medical insurance consultation”; the least important attribute was “business hours.” A 1 min increase in time spent led to a 0.73% decrease in the probability that a service profile would be chosen. Negative preferences were noted for ADR monitoring by telephone follow-up once a year (β = −0.23, p < 0.001) and business hours [8:30–20:00 (Monday to Friday), 8:30–17:30 (weekend)] (β = −0.12, p < 0.001). Compared with women, men had a higher preference for service monitoring ADRs once every 3 months.

Conclusions: Preference measurements showed that “frequency of telephone follow-up to monitor ADRs” had the most critical impact on decisions, followed by “mode of drug delivery.” Specialty pharmacies in China need to take these findings into account to improve their design to increase uptake and patient loyalty.

Public attitudes towards community pharmacy in Arabic speaking Middle Eastern countries: A systematic review

BACKGROUND

Over the last few years, pharmacy practice in the Arab regions of the Middle East has started to change and develop. There have been small but promising steps to recognize the importance of extending community pharmacists' roles to meet the expanding public healthcare demands.

OBJECTIVES

This systematic review aims to identify, synthesize and assess the quality of the literature in the Middle East concerning public attitudes on community pharmacist role and services and in relation to public perceptions on strategies to improve pharmacy services and the image of community pharmacist.

METHODS

A systematic search of 11 electronic databases was conducted to identify all published relevant studies from inception till January 2020. Data was extracted using a designed and tested tool. Studies were assessed for quality using Crowe Critical Appraisal Tool.

RESULTS

The final study results included 36 studies of which 31 adopted a cross-sectional-survey-based design. Included studies were published between 2004 and 2019. Most studies were done in Saudi Arabia (n = 11) or the United Arab Emirates (UAE) (n = 10). We identified four overarching themes across included studies 1) Use of Community Pharmacies; 2) Attitudes towards Community Pharmacist role; 3) Attitudes towards Current Community Pharmacy Services and 4) Strategies to Improve Community Pharmacy Practice. The most common reason for visiting a community pharmacy was to purchase a prescription or over-the counter-medication. The most common factors that affected patients' choice of a particular pharmacy included convenient pharmacy location, availability of a good range of products or medicines, friendliness of the pharmacy staff and convenient pharmacy opening hours. There was a general public perception of community pharmacist as a business oriented person. Expectations of pharmacist duties included treatment of minor health ailments, consultation on over-the-counter medications and parapharmaceutical products, and accuracy checking of dispensed medications. Overall satisfaction with community pharmacy varied between the studies and ranged from 33% to 67.1%. Most commonly reported recommendations to improve pharmacy practice were provision of diagnostic, screening and monitoring services, keeping patient records in the pharmacy, advice on minor illness and provision of a private area for consultation. Seven articles were considered of low quality and 13 articles were considered of high quality.

CONCLUSIONS

While the public in the Middle East has a good understanding of the basic duties of a community pharmacist, there is lack of awareness of advanced pharmaceutical services. Decision makers in Middle Eastern countries should set strategies to improve community pharmacist professional image and competence beyond medication dispensing.

Older adults' understanding of hypothetical community pharmacy quality report cards

BACKGROUND

Quality ratings for health plans and health services have become increasingly available to patients.

OBJECTIVE

We sought to explore older adults' understanding of hypothetical community pharmacy report cards and the information they valued on the report card.

METHODS

We recruited participants aged 50 years or older to complete a 59-question telephone survey. The participants reviewed 3 different pairs of report cards, which represented a hypothetical pharmacy, and each pair contained different quality metrics. The participants identified which pharmacy of the pair they preferred, and this served as the primary outcome. We asked the participants to rate the level of importance (4-point unidirectional scale, not at all to very important) of the star ratings, source of information, and quality metrics. We also gathered information about the participants personal experiences with medications and pharmacy services, their self-reported health, health literacy, health numeracy, and demographics. The frequency that the pharmacy with higher quality metrics was selected was reported. We used logistic regression to examine factors associated with correctly identifying the highest quality pharmacy for all 3 sets of report cards.

RESULTS

Most participants (n = 152) correctly identified all 3 (n = 120, 79.0%) report cards for pharmacies with higher quality metrics. The source of the information, individual quality metrics, and star ratings were all perceived as moderately or very important by most participants. Ratings of importance were strongly correlated (r, 0.70-1.00).

CONCLUSION

More than 75% were able to correctly identify all 3 report cards with higher quality ratings. Most participants believed that the source of the information, the individual quality metrics, and the star rating were all important. Research is needed to explore to what extent patients would use these types of quality metric report cards to make decisions about where to obtain their medications.

Medication Therapy Management: Current Challenges

Medication therapy management (MTM) services have evolved as a means for pharmacists and other providers to assist patients and caregivers in improving therapeutic outcomes and reducing health care expenditures. More than a decade has passed since the Medicare Modernization Act of 2003 provided pharmacists with the opportunity to deliver MTM services to Medicare beneficiaries. MTM continues to offer pharmacists the opportunity to use their knowledge; yet, pharmacists have reported challenges with service delivery. Identifying the challenges that affect MTM services in pharmacy practice is necessary in order to seek improvement to MTM delivery. This narrative review explores the current challenges pharmacists face with MTM delivery, summarizes potential solutions for addressing challenges, and seeks to incite further debate, service reconfiguration, and ultimately service improvement of pharmacist-provided MTM services.