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Lake JD, Barnsley J, Lofters A, Austin Z. A Goffmanian analysis of impact of unclear professional identity and role negotiation of pharmacists in primary care: A multiple case study. Res Social Adm Pharm 2024; 20:768-777. [PMID: 38704302 DOI: 10.1016/j.sapharm.2024.04.016] [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: 03/17/2024] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Professional identity and its development is a focus of research, education, and practice. But, there is a lack of how professional identity impacts changes in pharmacists' roles in practice, which are particularly prevalent in primary care teams. OBJECTIVES This research uses Goffmanian theory, micro-sociologic interactional theory, to describe the outcomes of role negotiation in integrated primary care teams. METHODS This is a multiple case study done per Yin, which used interviews and documents to collect data. Interviews used a storytelling format to gather information on the pharmacist's role and negotiation with their team. Four to six interviews were done in each case. Data was analyzed in an iterative manner using the Qualitative approach by Leuven including narrative reports being created for each case. RESULTS Five cases were recruited but three cases were completed. In each case, the pharmacist was passive in role negotiation and allowed other actors to decide what tasks were of value. Likely this passivity was due to their professional identities: supportive and "not a physician". These identities led to a focus on the pharmacists' need to develop. This multi-case study demonstrated that pharmacists' professional identity led to passivity being valued and expected. Whether pharmacists self-limited, which has been previously seen, needs to be better defined. But unclear archetypes reduced tasks identified as unique to the pharmacist. CONCLUSION Goffmanian theory highlighted a key success for future pharmacist role negotiation, a clear professional identity by both pharmacists and society, including team members. Until that occurs, there is a risk of underuse in primary care team settings.
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Affiliation(s)
- Jennifer D Lake
- Leslie Dan Faculty of Pharmacy, University of Toronto, 639 - 144 College Street, Toronto, ON, M5S 3M2, Canada.
| | - Janet Barnsley
- Institute of Health Policy Management and Evaluation, University of Toronto, 4th Floor - 155 College Street, Toronto, ON, M5T 3M6, Canada
| | - Aisha Lofters
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Zubin Austin
- Leslie Dan Faculty of Pharmacy, University of Toronto, 707 - 144 College Street, Toronto, ON, M5S 3M2, Canada
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Thai T, Lancsar E, Spinks J, Freeman C, Chen G. Understanding Australian pharmacy degree holders' job preferences through the lens of motivation-hygiene theory. Soc Sci Med 2024; 348:116832. [PMID: 38569288 DOI: 10.1016/j.socscimed.2024.116832] [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: 10/02/2023] [Revised: 02/27/2024] [Accepted: 03/23/2024] [Indexed: 04/05/2024]
Abstract
Increasing the contribution of pharmacists to primary care has been long discussed, particularly in the context of health workforce shortages and the push to better integrate all providers across primary care. This study examines the employment preferences of Australian pharmacy degree holders (PDHs) elicited through a discrete choice experiment (DCE), to better understand the drivers of current labour force choices. A labelled DCE was developed incorporating the six employment sectors: hospital pharmacy, community pharmacy, primary healthcare settings, pharmaceutical industry, government/academia, and non-pharmacy-related sector. Each alternative was described by five attributes using Herzberg's Two Factor Theory as a conceptual framework. They include motivators - role and career opportunities, and hygiene factors-flexible work schedule, geographic location, and salary. Unforced choice data were analysed using conditional logit and mixed logit models. Based on a sample of 678 PDHs in Australia, our findings indicated pharmaceutical industry is the least preferred sector, followed by non-pharmacy-related sector. Motivators in the form of role and career opportunities are the most important attributes in hospital pharmacy while hygiene factors - geographic location and salary significantly drive the choice of community pharmacy and primary care settings. We provided evidence of a willingness to adopt expanded roles in community pharmacy. This unique interpretation of the key drivers of employment preference in light of motivators and hygiene factors provides policy makers with important information when designing policies to attract and retain PDHs across employment sectors.
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Affiliation(s)
- Thao Thai
- Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Emily Lancsar
- Department of Health Services Research & Policy, Research School of Population Health, College of Health & Medicine, The Australian National University, 63A Eggleston Road, Acton ACT, 2601, Australia
| | - Jean Spinks
- Centre for the Business and Economics of Health, Lev 5, Bld 14, The University of Queensland, St Lucia Campus, Brisbane, QLD, 4072, Australia
| | - Christopher Freeman
- The University of Queensland, School of Pharmacy, Brisbane, QLD, Australia; The University of Queensland, Faculty of Medicine, Brisbane, QLD, Australia; Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Level 5, Building H, Caulfield Campus, 900 Dandenong Road, Caulfield East, VIC, 3145, Australia
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The pharmacist as safety net: an interview-based study of the intersecting dependencies between doctors and pharmacists. J Pharm Policy Pract 2023; 16:40. [PMID: 36894977 PMCID: PMC9999512 DOI: 10.1186/s40545-023-00536-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/11/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Social science research has demonstrated how health practitioners negotiate and contest professional roles and jurisdictions in practice, and in ways that reflect the power dynamics that permeate medicine. This article further explores these relational dynamics by examining how general practitioners (GPs) in Aotearoa New Zealand frame their working relationships with pharmacists. METHODS We conducted semi-structured interviews with 16 GPs from around the country. Interviews had a mean duration of 46 min, and were thematically analysed. RESULTS GPs saw and used pharmacists as a key source of information about both medicines and patients; thus it was not only pharmacists' training and expertise, but also their community setting and patient proximity, that made them a useful resource to doctors. Furthermore, GPs framed pharmacists as a critical 'safety net' due to their role in catching errors and checking prescribing details. The pharmacy 'safety net' also came through in participants' comments on discount pharmacies, which have introduced pronounced cost-cutting logics to Aotearoa New Zealand's pharmaceutical landscape; in their reflections on these organisations, prescribers express the importance of robust pharmacy practice to their own work. CONCLUSIONS Whilst the literature often foregrounds tensions in how health providers reinscribe their professional roles, this research highlights the interdependence that doctors identify with pharmacists, and their aspirations for working together. Both professional groups navigate a pressed health system that presents a set of common challenges to good medicines practice.
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Percival M, McMurray A, Freeman C, Cottrell N. A collaborative pharmacist prescribing model for patients with chronic disease(s) attending Australian general practices: Patient and general practitioner perceptions. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 9:100236. [PMID: 36923064 PMCID: PMC10009526 DOI: 10.1016/j.rcsop.2023.100236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 02/01/2023] [Accepted: 02/11/2023] [Indexed: 02/19/2023] Open
Abstract
A collaborative pharmacist prescribing model for patients with chronic disease(s) attending Australian general practices: patient and general practitioner perceptions. Background Pharmacists working in general practice settings are slowly emerging in Australia, with comprehensive medication reviews forming a large part of their role in optimising pharmaceutical care. In Australia, pharmacists are entirely reliant on general practitioners (GPs) accepting and implementing their recommendations to manage drug related problems (DRPs). The next step is a model where the pharmacist takes on responsibility for implementing some of their recommendations. Aim To investigate patient and general practitioner perceptions of a collaborative model of care where the pharmacist has increased responsibility in assisting the general practitioner manage patients with chronic conditions. Method Semi-structured, phone and face-to-face interviews were conducted with a purposive sample of patients and GPs respectively. Data were transcribed by a professional transcription service, collated using NVivo 12 Plus and analysed using Braun and Clarke's thematic analysis. Provisional codes were generated and clustered into categories, from which themes were identified. Results Eighteen interviews were conducted (12 patients, 6 GPs). Four themes were identified from the patient interview data: pharmacist attributes; acknowledgement of the impact of the pharmacist, understanding of the GP-pharmacist collaborative model; relationships with and attitudes towards medicines and health care providers. Four themes were identified from the general practitioner interview data: pharmacist attributes; relationships with pharmacists; impressions on collaboration; impressions of the pharmacist's recommendations. Patients' and GPs' perceptions of the collaborative model of care overall were positive, acknowledging the advantages of a patient-centred, interdisciplinary approach and the potential benefits to patients. Conclusion The GP-pharmacist collaborative model was viewed favourably by patients and GPs, with some GPs articulating the value in the pharmacist's increased responsibility as they implemented some recommendations to manage DRPs.
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Affiliation(s)
- Matthew Percival
- School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, 20 Cornwall Street, Woolloongabba, Brisbane, QLD 4102, Australia.,Gold Coast Hospital and Health Service, 1 Hospital Boulevard, Southport, QLD 4215, Australia
| | - Anne McMurray
- School of Nursing and Midwifery, Griffith University - Gold Coast Campus, Parklands Dr, Southport, Gold Coast, QLD 4222, Australia.,School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, 90 Sippy Downs Dr, Sippy Downs, QLD 4556, Australia
| | - Christopher Freeman
- School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, 20 Cornwall Street, Woolloongabba, Brisbane, QLD 4102, Australia
| | - Neil Cottrell
- School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, 20 Cornwall Street, Woolloongabba, Brisbane, QLD 4102, Australia
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Lias N, Lindholm T, Pohjanoksa-Mäntylä M, Westerholm A, Airaksinen M. Developing and piloting a self-assessment tool for medication review competence of practicing pharmacists based on nationally set competence criteria. BMC Health Serv Res 2021; 21:1274. [PMID: 34823529 PMCID: PMC8620234 DOI: 10.1186/s12913-021-07291-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND New competence requirements have emerged for pharmacists as a result of changing societal needs towards more patient-centred practices. Today, medication review competence can be considered as basic pharmaceutical competence. Medication review specific competence criteria and tools for self-assessing the competence are essential in building competences and a shared understanding of medication reviews as a collaborative practice. The aim of this study was to develop and pilot a self-assessment tool for medication review competence among practicing pharmacists in Finland. METHODS The development of the self-assessment tool was based on the national medication review competence criteria for pharmacists established in Finland in 2017 and piloting the tool among practicing pharmacists in a national online survey in October 2018. The pharmacists self-assessed their medication review competence with a five-point Likert scale ranging from 1 for "very poor/not at all" to 5 for "very good". RESULTS The internal consistency of the self-assessment tool was high as the range of the competence areas' Cronbach's alpha was 0.953-0.973. The competence areas consisted of prescription review competence (20 items, Cronbach's alpha 0.953), additional statements for medication review competence (11 additional items, Cronbach's alpha 0.963) and medication review as a whole, including both the statements of prescription review and medication review competence (31 items, Cronbach's alpha 0.973). Competence items closely related to routine dispensing were most commonly self-estimated to be mastered by the practicing pharmacists who responded (n = 344), while the more clinical and patient-centred competence items had the lowest self-estimates. This indicates that the self-assessment tool works logically and differentiates pharmacists according to competence. The self-assessed medication review competence was at a very good or good level among more than half (55%) of the respondents (n = 344). CONCLUSION A self-assessment tool for medication review competence was developed and validated. The piloted self-assessment tool can be used for regular evaluation of practicing pharmacists' medication review competence which is becoming an increasingly important basis for their contribution to patient care and society.
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Affiliation(s)
- Noora Lias
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. box 56, 00014, Helsinki, Finland.
| | - Tanja Lindholm
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. box 56, 00014, Helsinki, Finland
| | - Marika Pohjanoksa-Mäntylä
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. box 56, 00014, Helsinki, Finland
| | - Aleksi Westerholm
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. box 56, 00014, Helsinki, Finland
| | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. box 56, 00014, Helsinki, Finland
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Mallinder A, Martini N. Exploring community pharmacists' clinical decision-making using think aloud and protocol analysis. Res Social Adm Pharm 2021; 18:2606-2614. [PMID: 33985891 DOI: 10.1016/j.sapharm.2021.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/30/2021] [Accepted: 05/01/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Clinical decision-making (CDM) is the dynamic process used to gather, interpret and evaluate data to select an evidence-based choice of action. As the role of the pharmacist becomes more patient-focused, effective CDM skills are increasingly vital to achieve patient outcomes centred on quality, safety and efficacy. OBJECTIVE To examine how community pharmacists reason through a clinical problem and what factors assist or hinder decision-making. METHOD Fifteen New Zealand registered community pharmacists in central Auckland were presented with a bacterial conjunctivitis case. Think Aloud and protocol analysis were employed to examine pharmacists' cognitive processes when working through the case. Factors that affect CDM were explored through semi-structured interviews and analyzed using thematic analysis. RESULTS Pharmacists used pattern recognition and analytical reasoning to diagnose and recommend treatment. Three main factors affecting CDM were: 1. community pharmacy environment, where pharmacy size and layout prevented patient privacy; 2. clinical knowledge, which was outdated and limited by poor access to up-to-date resources; and 3. patient factors, where CDM was affected by time, patient's attitudes, and language barriers. When uncertain, pharmacists typically referred patients to their GP to ensure patient safety and believed offering treatment was not within their scope of practice. CONCLUSION Pharmacists used dual processing when encountering a familiar case. Further research is required to explore how pharmacists apply CDM when exposed to less familiar, more complex cases presenting greater ambiguity. Barriers in community pharmacy deter effective CDM skills and could inhibit community pharmacists from fulfilling their expanding role within the modern healthcare system.
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Affiliation(s)
- Alice Mallinder
- School of Pharmacy, University of Nottingham, United Kingdom; School of Pharmacy, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Nataly Martini
- School of Pharmacy, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
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D'Souza N, Scahill S. The need to integrate in primary healthcare: nurse identity constructions of pharmacists as entrepreneurs. J Health Organ Manag 2020; ahead-of-print. [PMID: 33016026 DOI: 10.1108/jhom-01-2020-0009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This study explores nurses' views as to whether they see community pharmacists as "entrepreneurial" and what this might mean for working together in primary care. Pharmacists are expected to fully integrate with their colleagues - particularly nurses - under the New Zealand health policy. Yet, there is scarce literature that examines multidisciplinary teamwork and integration through an entrepreneurial identity lens. This is particularly important since around the world, including New Zealand, community pharmacies are small businesses. DESIGN/METHODOLOGY/APPROACH This was an exploratory qualitative study. A total of 18 semi-structured interviews were conducted with nurses from primary care, nursing professional bodies and academics from nursing schools. Interviews were audio recorded and transcribed verbatim. Coding was undertaken through general inductive thematic analysis. FINDINGS In total three key themes emerged through analysis: the entrepreneurial profile of the community pharmacist, the lack of entrepreneurship across the profession, and the role identity and value that community pharmacists hold, as viewed by nurses. There appeared to be pockets of entrepreneurship in community pharmacy; nurses did not express a blanket label of entrepreneurship across the whole sector. Nurses also discussed several forms of entrepreneurship including commercial-oriented, clinical and social entrepreneurship. The social entrepreneurship identity of community pharmacists sat most comfortably with nurse participants. Overall, nurses appeared to value community pharmacists but felt that they did not fully understand the roles that this profession took on. RESEARCH LIMITATIONS/IMPLICATIONS This paper contributes to the academic literature by identifying three domains of entrepreneurship relevant to community pharmacy as well as multi-level barriers that will need to be jointly tackled by professional bodies and policy-makers. Improving nurses' and other healthcare professionals' knowledge of community pharmacists' role and expertise is also likely to facilitate better inter-professional integration. ORIGINALITY/VALUE There is scarce literature that attempts to understand how entrepreneurial identity plays out in health organisation and management. This study adds to the knowledge base of factors influencing integration in healthcare.
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Affiliation(s)
- Natalia D'Souza
- School of Management, Massey University-Albany Campus, Auckland, New Zealand
| | - Shane Scahill
- School of Pharmacy, University of Auckland, Auckland, New Zealand
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Said A, Hussain N, Abdelaty LN. Physicians' and pharmacists' perception and practice of hospital pharmacist professional role in Egypt. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2020; 28:491-497. [PMID: 32497350 DOI: 10.1111/ijpp.12638] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 04/28/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to investigate physicians' and pharmacists' perceptions of the importance of pharmacists' role in healthcare in Egypt, and actual delivery of these roles in practice. Identifying any differences and inconsistencies between these will inform future strategies that maximize pharmacists' professional contribution to hospital practice. METHODS A self-administered questionnaire using a 5-point Likert scale was distributed to a convenience sample of physicians (500) and pharmacists (500) practicing in selected private or public hospitals in Egypt. The main sections of the questionnaire comprised statements that pertained to physicians'/pharmacists' views on the importance of pharmacists' roles and their actual delivery in practice. KEY FINDINGS In this study, physicians showed low scores for both the importance of and the delivery of advanced patient-facing clinical pharmacy roles such as suggesting prescription medications, and designing treatment plans. In comparison, pharmacists were more positive on both of these aspects of their roles. High mean scores were reported by the physicians for pharmacist's traditional roles such as patient counselling, assessing compliance, preventing medication errors and treating minor illnesses. Both physicians and pharmacists reported poor pharmacists practice as drug information resources despite their high perception of the importance of that role. CONCLUSION This study suggested that in hospitals in Egypt, there are significant differences between physicians' and pharmacists' perception and practice, and pharmacists' clinical skills are underutilized in health care.
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Affiliation(s)
- Amira Said
- Department of Clinical Pharmacy, College of Pharmacy, Al Ain University of Science and Technology, Al Ain, Abu Dhabi, UAE
| | - Nadia Hussain
- Department of Pharmaceutical Sciences, College of Pharmacy, Al Ain University of Science and Technology, Al Ain, Abu Dhabi, UAE
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Lake JD, Rosenberg-Yunger ZRS, Dainty KN, Rolf von den Baumen T, Everall AC, Guilcher SJT. Understanding perceptions of involving community pharmacy within an integrated care model: a qualitative study. BMC Health Serv Res 2020; 20:396. [PMID: 32393239 PMCID: PMC7212674 DOI: 10.1186/s12913-020-05237-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 04/19/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Over the past several years, there has been more emphasis on integration within health care. Community pharmacy is often under-represented within integrated care models. This study explored stakeholder perceptions and enablers of including community pharmacy within an integrated care model. METHODS A qualitative study was undertaken. Participants were recruited through professional networks and social media, as well as snowball recruitment from other participants. They included community pharmacists, clinicians, and decision-makers working in Ontario, Canada. Data were collected using telephone interviews completed with a semi-structured interview guide based on Consolidated Framework for Implementation Research from June to September 2018. Data were analysed inductively and deductively following the Qualitative Analysis Guide of Leuven. An additional theoretical framework (Rainbow Model of Integrated Care) was used to categorize enablers. RESULTS Twenty-two participants were interviewed including nine pharmacists, seven clinicians, and six decision-makers. Three key themes were identified: 1) Positive value of including pharmacy in integrated care models; 2) One model does not fit all; and 3) Conflict of interest. Four key enablers were identified reflecting functional and normative factors: functional - 1) remuneration, 2) technology; normative - 3) engagement, and 4) relationships. While both functional and normative factors were discussed, the latter seemed to be more important to facilitate the inclusion of community pharmacy. Many participants characterized community pharmacists' lack of skills or confidence to provide patient care. CONCLUSIONS This study confirms previously known views about concerns with community pharmacy's conflict of interest. However, discordant perceptions of conflict of interest and negative perceptions about capabilities of community pharmacy need to be addressed for successful integration. Normative enablers, such as culture, are likely important for organizational integration and require additional inquiry.
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Affiliation(s)
- Jennifer D. Lake
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON M5S 3M2 Canada
- Institute of Health, Policy Management and Evaluation, 155 College Street, Toronto, ON M5T 1P8 Canada
- Faculty of Medicine, University of Toronto, 1 Kings College Circle, Toronto, ON M5S 1A8 Canada
| | - Zahava R. S. Rosenberg-Yunger
- Ted Rogers School of Management, School of Health Services Management, Ryerson University, 350 Victoria Street, Toronto, ON M5B2K3 Canada
| | - Katie N. Dainty
- Institute of Health, Policy Management and Evaluation, 155 College Street, Toronto, ON M5T 1P8 Canada
- North York General Hospital, 4001 Leslie St, Toronto, ON M2K 1E1 Canada
| | | | - Amanda C. Everall
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON M5S 3M2 Canada
| | - Sara J. T. Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON M5S 3M2 Canada
- Institute of Health, Policy Management and Evaluation, 155 College Street, Toronto, ON M5T 1P8 Canada
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Vicary D, Hutchison C, Aspden T. Avoiding acute kidney injury in primary care: attitudes and behaviours of general practitioners and community pharmacists in Hawke’s Bay. J Prim Health Care 2020; 12:244-256. [DOI: 10.1071/hc19106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 08/26/2020] [Indexed: 11/23/2022] Open
Abstract
ABSTRACT
INTRODUCTIONAwareness of the effect of acute kidney injury on patient outcomes and health systems is growing internationally. New Zealand’s approach focuses on stopping consumption of ‘at-risk’ medicines when acute kidney injury has been established and raising awareness of the risks associated with the Triple Whammy drug combination.
AIMTo explore current practices and views of Hawke’s Bay general practitioners (GPs) and community pharmacists regarding patient education about medicines with potential for contributing to community-acquired acute kidney injury, with a focus on community pharmacists providing patient education regarding when to temporarily withhold ‘at-risk’ medicines during acute dehydrating illnesses.
METHODSTwo tailored cross-sectional online anonymous surveys of GPs and community pharmacists working in Hawke’s Bay were administered between 2015 and 2016. Descriptive statistics were generated from the closed-question responses and manifest content analysis was applied to the free-text responses.
RESULTSTwenty-two percent (37/167) of GPs and 34% (32/95) of pharmacists responded. Most respondents, GPs (34/37) and pharmacists (25/32), self-reported expertise to educate patients on temporarily withholding ‘at-risk’ medicines during acute dehydrating illnesses. Twenty-nine (78%) GPs had confidence in pharmacists providing this patient education and 20 (54%) welcomed pharmacist contact regarding a Triple Whammy prescription. However, for a variety of reasons, pharmacists did not routinely provide this education or contact GPs.
DISCUSSIONBoth GPs and community pharmacists reported they had expertise to provide useful patient education about ‘at-risk’ medicine use during acute dehydrating illnesses. Dialogue to clarify the role of the two groups would be beneficial to achieve a more coordinated approach to patient care. Relevant strategies and frameworks already exist, but national interprofessional leadership and local application would be beneficial.
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Zhou M, Desborough J, Parkinson A, Douglas K, McDonald D, Boom K. Barriers to pharmacist prescribing: a scoping review comparing the UK, New Zealand, Canadian and Australian experiences. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2019; 27:479-489. [DOI: 10.1111/ijpp.12557] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 05/07/2019] [Accepted: 06/03/2019] [Indexed: 12/01/2022]
Abstract
Abstract
Objectives
Non-medical prescribers, including pharmacists, have been found to achieve comparable clinical outcomes with doctors for certain health conditions. Legislation supporting pharmacist prescribing (PP) has been implemented in the United Kingdom (UK), Canada and New Zealand (NZ); however, to date, Australian pharmacists have not been extended prescribing rights. The purpose of this review was to describe the barriers to PP found in the literature from the UK, Canada, NZ and Australia, and examine the implications of these for the development of PP in Australia.
Methods
We conducted a scoping review, which included peer-reviewed and grey literature, and consultation with stakeholders. Sources – Scopus, PubMed and CINAHL; Google Scholar, OpenGrey and organisational websites from January 2003 to March 2018 in the UK, Canada, NZ and Australia. Inclusion criteria – articles published in English, related to implementation of PP and articulated barriers to PP.
Key findings
Of 863 unique records, 120 were reviewed and 64 articles were eligible for inclusion. Three key themes emerged: (1) Socio-political context, (2) Resourcing issues and (3) Prescriber competence. The most common barriers were inadequate training regarding diagnostic knowledge and skills, inadequate support from authorities and stakeholders, and insufficient funding/reimbursement.
Conclusions
If implementation of PP is to occur, attention needs to be focused on addressing identified barriers to PP implementation, including fostering a favourable socio-political context and prescriber competence. As such, a concerted effort is required to develop clear policy pathways, including targeted training courses, raising stakeholder recognition of PP and identifying specific funding, infrastructure and resourcing needs to ensure the smooth integration of pharmacist prescribers within interprofessional clinical teams.
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Affiliation(s)
- Mingming Zhou
- People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Jane Desborough
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Anne Parkinson
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Kirsty Douglas
- Academic Unit of General Practice, ANU Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - David McDonald
- National Centre for Epidemiology and Population Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Katja Boom
- Independent Consultant/Accredited Australian Pharmacist Working in General Practice, Canberra, ACT, Australia
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Bollen A, Harrison R, Aslani P, van Haastregt JCM. Factors influencing interprofessional collaboration between community pharmacists and general practitioners-A systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e189-e212. [PMID: 30569475 DOI: 10.1111/hsc.12705] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 11/20/2018] [Accepted: 11/22/2018] [Indexed: 06/09/2023]
Abstract
Effective interprofessional collaboration is critical for sustaining high quality care in the context of the increasing burden on primary healthcare services. Despite this, there is limited understanding of the factors contributing to effective collaboration between general practitioners and community pharmacists. The aim of this systematic review was to identify the factors that impact on interprofessional collaboration between general practitioners (GPs) and community pharmacists (CPs). Keywords and synonyms were combined and applied to four databases (EMBASE, CINAHL, SCOPUS, and MEDLINE) to identify articles published between January 2000 to April 2017. Relevant journals and reference lists were also hand-searched. A total of 37 articles met the eligibility criteria. Factors that posed a challenge to effective interprofessional collaboration were the perceived imbalance in hierarchy and power between the professions and a lack of understanding of each other's skills and knowledge. Experience of collaboration with the other party led to greater understanding of each other's capabilities and potential role in co-delivering patient care. The physical environment was also identified as important, with co-location and other resources to facilitate clear and regular communication identified as important facilitators of interprofessional collaboration. The review findings highlight a range of approaches that may positively influence interprofessional collaboration between GPs and CPS such as co-location, co-education to understand the professional capabilities of each group, and utilising compatible technologies to facilitate communication between the two professions.
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Affiliation(s)
- Annelies Bollen
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI Care and Public Health Institute, Maastricht University, Maastricht, The Netherlands
- School of Public Health & Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Reema Harrison
- School of Public Health & Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Parisa Aslani
- School of Public Health & Community Medicine, University of New South Wales, Sydney, NSW, Australia
- Faculty of Pharmacy, The University of Sydney, Camperdown, NSW, Australia
| | - Jolanda C M van Haastregt
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI Care and Public Health Institute, Maastricht University, Maastricht, The Netherlands
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Weir NM, Newham R, Dunlop E, Bennie M. Factors influencing national implementation of innovations within community pharmacy: a systematic review applying the Consolidated Framework for Implementation Research. Implement Sci 2019; 14:21. [PMID: 30832698 PMCID: PMC6398232 DOI: 10.1186/s13012-019-0867-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 02/04/2019] [Indexed: 12/29/2022] Open
Abstract
Background To meet emergent healthcare needs, innovations need to be implemented into routine clinical practice. Community pharmacy is increasingly considered a setting through which innovations can be implemented to achieve positive service and clinical outcomes. Small-scale pilot programmes often need scaled up nation-wide to affect population level change. This systematic review aims to identify facilitators and barriers to the national implementation of community pharmacy innovations. Methods A systematic review exploring pharmacy staff perspectives of the barriers and facilitators to implementing innovations at a national level was conducted. The databases Medline, EMBASE, PsycINFO, CINAHL, and Open Grey were searched and supplemented with additional search mechanisms such as Zetoc alerts. Eligible studies underwent quality assessment, and a directed content analysis approach to data extraction was conducted and aligned to the Consolidated Framework for Implementation Research (CFIR) to facilitate narrative synthesis. Results Thirty-nine studies were included: 16 were qualitative, 21 applied a questionnaire design, and 2 were mixed methods. Overarching thematic areas spanning across the CFIR domains were pharmacy staff engagement (e.g. their positive and negative perceptions), operationalisation of innovations (e.g. insufficient resources and training), and external engagement (e.g. the perceptions of patients and other healthcare professionals, and their relationship with the community pharmacy). Study participants commonly suggested improvements in the training offered, in the engagement strategies adopted, and in the design and quality of innovations. Conclusions This study’s focus on national innovations resulted in high-level recommendations to facilitate the development of successful national implementation strategies. These include (1) more robust piloting of innovations, (2) improved engagement strategies to increase awareness and acceptance of innovations, (3) promoting whole-team involvement within pharmacies to overcome time constraints, and (4) sufficient pre-implementation evaluation to gauge acceptance and appropriateness of innovations within real-world settings. The findings highlight the international challenge of balancing the professional, clinical, and commercial obligations within community pharmacy practice. A preliminary theory of how salient factors influence national implementation in the community pharmacy setting has been developed, with further research necessary to understand how the influence of these factors may differ within varying contexts. Trial registration A protocol for this systematic review was developed and uploaded onto the PROSPERO international prospective register of systematic reviews database (Registration number: CRD42016038876). Electronic supplementary material The online version of this article (10.1186/s13012-019-0867-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Natalie M Weir
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, 40 Taylor Street, Robertson Trust Wing, Glasgow, G4 0RE, UK.
| | - Rosemary Newham
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, 40 Taylor Street, Robertson Trust Wing, Glasgow, G4 0RE, UK
| | - Emma Dunlop
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, 40 Taylor Street, Robertson Trust Wing, Glasgow, G4 0RE, UK
| | - Marion Bennie
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, 40 Taylor Street, Robertson Trust Wing, Glasgow, G4 0RE, UK.,Information Services Division, NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9EB, UK
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