A stakeholder visioning exercise to enhance chronic care and the integration of community pharmacy services

A stakeholders' perspective on enhancing community pharmacists' roles in controlling non-communicable diseases in the United Arab Emirates

Background

There is a global call for upscaling and optimising the role of community pharmacists (CPs) in the control of non-communicable diseases (NCDs). In the United Arab Emirates (UAE), where NCDs are classified as a public health pandemic, upscaling CPs contributions has become more critical. Several contextual, professional, and educational challenges constrain the role of CPs.

Objective

To synthesise the perspectives of key stakeholders in the UAE healthcare system and propose a roadmap for advancing the role of CP s in controlling NCDs in the UAE.

Methods

This research followed a qualitative design using the International Pharmaceutical Federation (FIP) framework for quality assurance of pharmacy profession development. Data were collected using semi-structured interviews with 28 experts and senior leaders, then analysed using the thematic analysis technique with the assistance of NVivo software.

Results

The analysis yielded three main themes that outlined the prospective roadmap: education, work environment, and policy. Some of the generated subthemes were establishing accredited NCD-specialised programmes, building a national framework for interprofessional education and collaboration, and upscaling the engagement of CPs in public health platforms and initiatives.

Conclusion

Improving the role of CPs in controlling the NCD pandemic in the UAE requires coherent and well-structured multidisciplinary endeavours from health policymakers, educational institutions, and all groups of healthcare professionals, including the CPs themselves.

Physical activity promotion in the community pharmacy: An opportunity for an expanded role?

BACKGROUND

Physical inactivity is a major risk factor for the development of chronic diseases, and it is increasingly prevalent in the Portuguese population. Pharmacists' role in promoting physical activity (PA) is still not well established, although health promotion is foreseen by law in Portugal. Competing tasks and location where the pharmacy is embedded can hinder this promotion in their daily practice.

OBJECTIVE

The aim of this study was to identify the main barriers and facilitators of physical activity promotion (PAP) in Portuguese community pharmacies and explore possible pathways for future implementation of physical activity promotion.

METHODS

In-depth, semi-structured interviews were conducted with purposively enrolled community pharmacists. Participant recruitment was aligned with data saturation. Data analysis comprised a mixed model of a deductive theme mapping strategy using the Theoretical Domains Framework (TDF) for the behaviour of promoting physical activity and an inductive approach for any other relevant themes and which might influence PA promotion.

RESULTS

Data saturation was reached at eleven interviews. Barriers and facilitators for the behaviour of promoting PA were identified from 11 out of the 14 TDF domains. Following an inductive approach, other emerging codes were clustered in additional seven major themes. Highlighted barriers focused on domains #1 - Knowledge, #10 - Memory, Attention and Decision Processes and #13 - Environmental Context and Resources. Community mapping, establishment of remuneration models and the use of digital technologies were suggested as additional potential contributors to scale up PAP.

CONCLUSION

Community pharmacists are well placed inside their communities to serve as a focal point for signposting, engagement with other healthcare professionals and community resources and activities organized by the pharmacy itself. Pharmacists should be supported in being knowledgeable, aware, and available when promoting PA in their daily counseling.

Clinical services in community pharmacies: a scoping review of policy and social implications

OBJECTIVES

Clinical services have allowed pharmacists to shift from product-oriented to patient-oriented services. However, the policy and social implications of clinical services in community pharmacies are not well described. The purpose of this scoping review was to identify these implications.

KEY FINDINGS

We searched Pubmed and Embase, from inception to March 2019, as well as grey literature for publications that discussed policy (e.g. pharmacy model and pharmacist status) or social (e.g. role of pharmacists and interprofessional collaboration) implications of clinical services. Publications had to address clinical services provided by pharmacists in community settings that target the global long-term care of patients. We extracted data related to the implications and classified them into themes thereafter. The search process identified 73 relevant publications, of which 13 were included in regard to policy implications and 60 relative to social implications. Two themes emerged from policy implications: implementation and characteristics of policies, and professional status. Pharmacists' independence from distribution, financial coverage of clinical services and innovative models of practice were addressed. Social implications involved three themes: roles and interprofessional collaboration, changes in practice and barriers and model of practices and services. Perceptions of pharmacists' skills, organisational barriers, time constraints, lack of self-confidence and cultural shifts required to implement clinical services were included in these themes.

SUMMARY

Our review demonstrates the changing role of community pharmacists in provision of clinical services within the healthcare system. The range of clinical services varies widely from one setting to another. The context of community pharmacy is not well suited to these changes in practice.

Essential Attributes for the Community Pharmacist as Care Provider

Objective. To identify skills and attributes that pharmacy students need upon graduation if planning to pursue a career path as a community pharmacy practice care provider. Methods. In-depth interviews with community pharmacy stakeholders were conducted, audio-recorded, and transcribed. Interview transcripts were thematically analyzed to identify the skills and attributes pharmacy students need upon graduation to be prepared to practice as a community pharmacy-based care provider. Results. Forty-two participants were interviewed. Identified attributes that were deemed transformative for community pharmacy practice included three behaviors, five skills, and two knowledge areas. Behavioral attributes needed by future community pharmacists were an approach to practice that is forward thinking and patient-centric, and having a provider mentality. The most commonly mentioned skill was the ability to provide direct patient care, with other skills being organizational competence, communication, building relationships, and management and leadership. Critical knowledge areas were treatment guidelines and drug knowledge, and regulatory and payer requirements. Additional skills needed by community pharmacy-based providers included identification and treatment of acute self-limiting illnesses and monitoring activities for chronic health conditions. Conclusion. Essential attributes of community pharmacists that will allow practice transformation to take place include behaving in a forward-thinking, patient-centric manner; displaying a provider mentality through use of effective communication to build relationships with patients and other providers, and learning how to meet regulatory and payer requirements for prescribers. These attributes should be fostered during the student's experiential curriculum.

Collaborative health service planning: A stakeholder analysis with social network analysis to develop a community pharmacy service

BACKGROUND

Stakeholder participation optimizes health planning, fostering the acceptability and integration of new health services. Collaborative approaches may help overcome existing challenges in the development, implementation and evaluation of community pharmacy services (CPSs). Stakeholder analyses lay the foundation for building collaboration in the integrated delivery of health care.

OBJECTIVES

This stakeholder analysis was performed to organize a collaborative initiative to develop a CPS aimed at preventing cardiovascular diseases in Andalucía (Spain). It aimed to identify stakeholders, differentiate/categorize them, and analyze stakeholder relationships.

METHOD

Stakeholders were identified using the snowballing technique. To differentiate/categorize stakeholders and analyze the relationships (i.e., collaboration) an online web-based questionnaire was sent to 186 stakeholders. Stakeholders were asked for: (1) their influence, interest and attitude toward the initiative; (2) stakes/interests; (3) capacity to contribute to the initiative; (4) desire for involvement; (5) concerns; (6) whom they considered a key stakeholder; and (7) the level of collaboration they had with other stakeholders. Data analysis combined descriptive qualitative content analysis, descriptive quantitative analysis and social network analysis.

RESULTS

Of the 186 stakeholders approached, 96 (51.6%) participated. The identification process yielded 217 stakeholders (individuals, organizations or collectives), classified into 10 groups. Fifty-seven stakeholders were considered critical to the intended initiative. Most participant stakeholders supported the initiative and were willing to collaborate in the development of the CPS. Public health and science were the main driving interests. A collaboration network existed between the 96 stakeholders.

CONCLUSION

This study revealed the magnitude of the social system surrounding the development of a CPS aimed at preventing cardiovascular disease. A large array of stakeholders was identified and analyzed, and a group of critical stakeholders selected. Stakeholder characteristics such as attitude toward the initiative, potential contribution, desire for involvement, and the existing collaboration network, provided complementary information that was helpful for planning the process and stakeholder engagement.