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Gellatly S, Moszczynski A, Fiedeldey L, Houle S, Smith M, Ogbogu U, Rudman D, Minaker L, Shelley J. "No one went into pharmacy … to sell a lot of Coca-Cola. It's just sort of a necessary evil" - Community pharmacists' perceptions of front-of-store sales and ethical tensions in the retail environment. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 11:100312. [PMID: 37576805 PMCID: PMC10415799 DOI: 10.1016/j.rcsop.2023.100312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 08/15/2023] Open
Abstract
Background Community pharmacists are expected to uphold ethical duties to patients and society while maintaining independent businesses or fulfilling expectations of corporate owners. Canadian pharmacy colleges provide only indirect guidance on the retail setting of the profession. Little is known about whether pharmacists identify ethical issues in retail pharmacy or around the sales of non-drug products. Objective This study sought to examine pharmacists' perceptions of their roles in health promotion, the factors that influence the selection of front-of-store products, and ethical issues relating to their dual roles as health care providers and retailers. Methods In 2020, 25 Canadian pharmacists participated in semi-structured phone interviews. Interviews were audio-recorded, anonymized, transcribed verbatim, and thematically analyzed using qualitative methods. Results Almost all participants described their role primarily as a health care provider, though some described themselves as 50-50 health care providers and retailers. Most staff pharmacists reported little control over front-of-store product selection. Where participants reported some control, external factors such as business viability and profitability impacted their choices, though some reported selecting products based on the needs of their patient community or their personal beliefs. The dominant tensions described stemmed from participants' dual roles as health care providers and retailers, though specific issues and situations were varied, ranging corporate targets, to service provision, to the sales of unproven or unhealthy products. Participants suggested solutions to the issues they described, ranging from a complete overhaul of the licensing structure of community pharmacies, down to one-on-one conversations with patients. Conclusion Our findings suggest that the retail setting of community pharmacy produces unique ethical tensions: the imposition of retail sales standards and targets are commonplace, and business viability is a primary driving force in front-of-store product selection. Clear guidance from Canadian pharmacy colleges and legislators to address these tensions and issues may be necessary.
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Affiliation(s)
- Stephanie Gellatly
- Faculty of Law, University of Western Ontario, 1151 Richmond Street, London, ON N6A 3K7, Canada
| | - Alexander Moszczynski
- Faculty of Health Sciences, University of Western Ontario, 1151 Richmond Street, London, ON N6A5B9, Canada
| | - Lean Fiedeldey
- Faculty of Health Sciences, University of Western Ontario, 1151 Richmond Street, London, ON N6A5B9, Canada
| | - Sherilynn Houle
- School of Pharmacy, University of Waterloo, 10A Victoria St S, Kitchener, ON N2G 1C5, Canada
| | - Maxwell Smith
- Faculty of Health Sciences, University of Western Ontario, 1151 Richmond Street, London, ON N6A5B9, Canada
| | - Ubaka Ogbogu
- Faculty of Law, University of Alberta, Edmonton, AB T6G 2H5, Canada
| | - Debbie Rudman
- School of Occupational Therapy, University of Western Ontario, 1151 Richmond Street, London, ON N6A 5B9, Canada
| | - Leia Minaker
- School of Planning, Faculty of Environment, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
| | - Jacob Shelley
- Faculty of Law, University of Western Ontario, 1151 Richmond Street, London, ON N6A 3K7, Canada
- Faculty of Health Sciences, University of Western Ontario, 1151 Richmond Street, London, ON N6A5B9, Canada
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Borralho J, Gregório J. "Each one has their own role": Exploratory study on consumers' perceptions about nutritionists services provided in community pharmacies. Res Social Adm Pharm 2020; 17:475-479. [PMID: 32331986 DOI: 10.1016/j.sapharm.2020.04.008] [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] [Received: 04/04/2020] [Accepted: 04/05/2020] [Indexed: 10/24/2022]
Abstract
Obesity and overweight have grown to epidemic proportions in the past decades. To tackle this rising threat to health systems, lifestyle changes and nutritional education have been promoted through specialized programs and nutritional primary health care services. Community pharmacies adjustment to a new paradigm of pharmacy services means that they are not just a place for buying and selling medicines, but increasingly a space for diverse health care services. One such service addresses the weight problems of community pharmacy users through the provision of nutrition consultation services. In Portugal, these consultations are provided by nutritionists, many times under formal agreements with nutritional supplements commercial brands. METHODS The aim of this exploratory study was to characterize the experience of people attending nutrition consultations at two different pharmacies and to understand their perception of the role community pharmacists may have in weight management. To conduct this study, interviews were performed following an interview guide comprised of sociodemographic characterization questions and open-answer questions. RESULTS Ten people participated in the study, seven females and three males. The average self-reported BMI of the sample was 29.4Kg/m2. The results showed that there is a general satisfaction with nutrition consultations, with all respondents agreeing that community pharmacies are a right place to have these consultations. Accessibility and low cost were found to be the biggest advantages in having nutrition consultations at a pharmacy. On the other hand, these participants felt that the biggest disadvantage was the price of nutritional supplements. Lack of motivation was also seen as a major impediment to continue with the nutrition consultations. When participants were asked about what role community pharmacists may have in weight management, 50% of participants disagreed with the idea of pharmacists providing the service on their own. CONCLUSION the results of this study indicate that the degree of satisfaction of those attending the nutrition consultations is high, especially because of pharmacies' accessibility and proximity, hinting at the idea of efficiency as an important factor driving the demand for new health care services. Pharmacists were viewed as having a gatekeeper role, but the nutrition service provision should be exclusively provided by nutritionists, in an example of successful multidisciplinary practice within the community pharmacy setting. Future studies should focus on the effect these consultations have on the loss or maintenance of weight, including the comparison with service provision in the traditional settings.
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Affiliation(s)
- Joana Borralho
- Farmácia Exposul, Lisboa, Portugal; CBIOS - Research Center for Biosciences and Health Technologies, Universidade Lusófona de Humanidades e Tecnologias, Portugal.
| | - João Gregório
- CBIOS - Research Center for Biosciences and Health Technologies, Universidade Lusófona de Humanidades e Tecnologias, Portugal.
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Hossain LN, Fernandez-Llimos F, Luckett T, Moullin JC, Durks D, Franco-Trigo L, Benrimoj SI, Sabater-Hernández D. Qualitative meta-synthesis of barriers and facilitators that influence the implementation of community pharmacy services: perspectives of patients, nurses and general medical practitioners. BMJ Open 2017; 7:e015471. [PMID: 28877940 PMCID: PMC5588935 DOI: 10.1136/bmjopen-2016-015471] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The integration of community pharmacy services (CPSs) into primary care practice can be enhanced by assessing (and further addressing) the elements that enable (ie, facilitators) or hinder (ie, barriers) the implementation of such CPSs. These elements have been widely researched from the perspective of pharmacists but not from the perspectives of other stakeholders who can interact with and influence the implementation of CPSs. The aim of this study was to synthesise the literature on patients', general practitioners' (GPs) and nurses' perspectives of CPSs to identify barriers and facilitators to their implementation in Australia. METHODS A meta-synthesis of qualitative studies was performed. A systematic search in PubMed, Scopus and Informit was conducted to identify studies that explored patients', GPs' or nurses' views about CPSs in Australia. Thematic synthesis was performed to identify elements influencing CPS implementation, which were further classified using an ecological approach. RESULTS Twenty-nine articles were included in the review, addressing 63 elements influencing CPS implementation. Elements were identified as a barrier, facilitator or both and were related to four ecological levels: individual patient (n=14), interpersonal (n=24), organisational (n=16) and community and healthcare system (n=9). It was found that patients, nurses and GPs identified elements reported in previous pharmacist-informed studies, such as pharmacist's training/education or financial remuneration, but also new elements, such as patients' capability to follow service's procedures, the relationships between GP and pharmacy professional bodies or the availability of multidisciplinary training/education. CONCLUSIONS Patients, GPs and nurses can describe a large number of elements influencing CPS implementation. These elements can be combined with previous findings in pharmacists-informed studies to produce a comprehensive framework to assess barriers and facilitators to CPS implementation. This framework can be used by pharmacy service planners and policy makers to improve the analysis of the contexts in which CPSs are implemented.
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Affiliation(s)
- Lutfun N Hossain
- Graduate School of Health, University of Technology, Sydney, New South Wales, Australia
| | - Fernando Fernandez-Llimos
- Department of Social Pharmacy, Faculty of Pharmacy, Research Institute for Medicines, University of Lisbon, Lisboa, Portugal
| | | | - Joanna C Moullin
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Desire Durks
- Graduate School of Health, University of Technology, Sydney, New South Wales, Australia
| | - Lucia Franco-Trigo
- Graduate School of Health, University of Technology, Sydney, New South Wales, Australia
| | - Shalom I Benrimoj
- Graduate School of Health, University of Technology, Sydney, New South Wales, Australia
| | - Daniel Sabater-Hernández
- Graduate School of Health, University of Technology, Sydney, New South Wales, Australia
- Academic Centre in Pharmaceutical Care, University of Granada, Granada, Spain
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Penny RA, Windsor C. Collaboration: A critical exploration of the care continuum. Nurs Inq 2016; 24. [PMID: 27905162 DOI: 10.1111/nin.12164] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2016] [Indexed: 12/21/2022]
Abstract
The purpose of this research was to explore the concept of collaboration within a specific healthcare context and to include the perspectives of healthcare users, a position largely lacking in previous studies. In applying a critical theoretical approach, the focus was on, as an exemplar, mothers with newborn babies who had spent more than 48 hr in a special care nursery. Semistructured interviews were undertaken with child health nurses, midwives and mothers. The three key theoretical findings on collaboration generated in the study point to layers of meanings around identity, knowledge and institutions of care. Findings from the interview data analysis were further examined through the lens of key policy documents. The research outcomes indicate that the concept of collaboration serves an important function in healthcare in obscuring the complexities and ambiguities that characterise the care continuum. The study concludes the need for a more critical approach to the assumptions that underlie the language of collaboration and the implications for practice in healthcare.
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Affiliation(s)
- Robyn A Penny
- Child and Youth Community Health Service, Queensland Health, Brisbane, Australia
| | - Carol Windsor
- School of Nursing, Queensland University of Technology, Brisbane, Australia
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Minaker LM, Olstad DL, MacKenzie G, Nguyen N, Azagba S, Cook BE, Mah CL. An evaluation of the impact of a restrictive retail food environment intervention in a rural community pharmacy setting. BMC Public Health 2016; 16:586. [PMID: 27423902 PMCID: PMC4947263 DOI: 10.1186/s12889-016-3281-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 07/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sugar-sweetened beverage consumption is associated with morbidity and mortality. The retail food environment influences food and beverage purchasing and consumption. This study assesses the impact of a community pharmacy's removal of sweet beverages on overall community sales of carbonated soft drinks (CSD) in a rural setting. We also examined whether the pharmacy intervention affected CSD sales in the town's other food stores. METHODS Weekly CSD sales data were acquired from the three food retailers in the town of Baddeck, Nova Scotia (January 1, 2013 to May 8, 2015, n = 123 weeks). Autoregressive integrated moving average (ARIMA) analysis was used to analyse the interrupted time series data and estimate the impact of the pharmacy intervention (September 11, 2014) on overall CSD sales at the community level. Data were analysed in 2015. RESULTS Before the intervention, the pharmacy accounted for approximately 6 % of CSD sales in the community. After the intervention, declines in total weekly average community CSD sales were not statistically significantly. CSD sales at the other food stores did not increase after the pharmacy intervention. CONCLUSIONS This study was among the first to examine the impact of a restrictive retail food environment intervention, and found a non-significant decline in CSD sales at the community level. It is the first study to examine a retail food environment intervention in a community pharmacy. Pharmacies may have an important role to play in creating healthy retail food environments.
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Affiliation(s)
- Leia M Minaker
- Propel Centre for Population Health Impact, Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Dana Lee Olstad
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Melbourne, Australia
| | - Graham MacKenzie
- Atlantic Pharmasave, 491 Chebucto St, Baddeck, NS, B0E 1B0, Canada
| | - Nghia Nguyen
- Propel Centre for Population Health Impact, Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Sunday Azagba
- Propel Centre for Population Health Impact, Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Brian E Cook
- Toronto Public Health, 277 Victoria Street, 5th Floor, Toronto, ON, M5B 1W2, Canada
| | - Catherine L Mah
- Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, 230 Elizabeth Ave, St. John's, NL, A1B 3X9, Canada
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Fakih S, Marriott JL, Hussainy SY. Employing the nominal group technique to explore the views of pharmacists, pharmacy assistants and women on community pharmacy weight management services and educational resources†. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2015; 24:86-96. [DOI: 10.1111/ijpp.12218] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 08/06/2015] [Indexed: 11/30/2022]
Abstract
Abstract
Objectives
The objectives of this study were to investigate how pharmacists, pharmacy assistants and women feel about community pharmacy involvement in weight management, and to identify what pharmacists, pharmacy assistants and women want in weight management educational resources.
Methods
Three homogenous and one heterogeneous nominal group (NG) sessions of up to 120-min duration were conducted with nine women, ten pharmacists and eight pharmacy assistants. The NG technique was used to conduct each session to determine the most important issues that should be considered surrounding community pharmacy weight management services and development of any educational resources. The heterogeneous NG session was used to finalise what women, pharmacists and pharmacy assistants want in educational resources.
Key findings
Overall, pharmacists, pharmacy assistants and women believe that pharmacy staff have an important role in the management of overweight and obesity because of their accessibility, trust and the availability of products in pharmacy. Regarding the most suitable healthcare professional(s) to treat overweight and obesity, the majority of participants believed that no one member of the healthcare team was most suitable and that overweight and obesity needs to be treated by a multidisciplinary team. The importance of having weight management educational resources for pharmacy staff and women that come from trustworthy resources without financial gain or commercialisation was also emphasised.
Conclusion
Pharmacists, pharmacy assistants and women feel that community pharmacies have a definite role to play in weight management. Pharmacy-specific weight management educational resources that are readily available to pharmacy staff and women are highly desirable.
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Affiliation(s)
- Souhiela Fakih
- Centre for Medicine Use and Safety, Monash University, Melbourne, Vic, Australia
| | - Jennifer L Marriott
- Centre for Medicine Use and Safety, Monash University, Melbourne, Vic, Australia
| | - Safeera Y Hussainy
- Centre for Medicine Use and Safety, Monash University, Melbourne, Vic, Australia
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Community pharmacy as a setting for public health nutrition action: Australian nutritionists' perspectives. Public Health Nutr 2014; 18:1864-72. [PMID: 25295409 DOI: 10.1017/s1368980014002201] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To explore public health nutritionists' perceptions of nutrition and its place in community pharmacy (CP) presently and into the future; and to explore perceived opportunities, feasibility and scope of public health nutrition (PHN) interventions in CP, with a focus on maternal and infant nutrition. DESIGN Qualitative data were gathered through semi-structured interviews and drew on hermeneutics as the theoretical framework for analysis and interpretation. SETTING Queensland, Australia. SUBJECTS Public health nutritionists, identified through purposive, criterion sampling, were chosen due to (i) their role as potential stakeholders, (ii) their knowledge and emphasis on nutrition and (iii) their practice experience. RESULTS Opportunities for PHN action focused primarily on actions relating to early nutrient supplementation in pregnancy and breast-feeding protection and promotion. Opportunities in CP were constrained by practitioners' perception of (i) conflict between health care and commercial interests in CP, (ii) problematic practices in CP and (iii) values and motivations of practitioners and other stakeholders in the CP sector. Strategies were suggested to improve practices and enhance the setting from a PHN perspective. Participants suggested both collaborative and regulatory approaches to achieve settings-based changes, identifying the need for these to coexist for effective outcomes. CONCLUSIONS Public health nutritionists suggest that opportunities for PHN action are constrained by perceived conflicted interests and that consumers need to be adequately protected from the influence of commercial interests. PHN action in this setting needs adequate reflection on evidence as well as ethics ensuring that practices are 'for the good' of mothers and infants.
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Comparing women pharmacy consumers' experiences with weight loss treatment in Victoria and Nottingham: a cross-sectional study. BMC Public Health 2014; 14:662. [PMID: 24972611 PMCID: PMC4094681 DOI: 10.1186/1471-2458-14-662] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 06/24/2014] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There has been a recent increase in weight management services available in pharmacies across Australia and England. The aim of this study was to determine the following between women in Victoria and Nottingham: similarities and differences of what weight management options are preferred by women pharmacy consumers; how they feel about pharmacists providing advice in this area; and what they desire in a weight management program. METHOD Women pharmacy consumers were randomly approached by a researcher in community pharmacies in Victoria and Nottingham and asked to complete a questionnaire regarding their own weight management experiences. The questionnaire was self-completed or researcher-administered and was comprised of four main sections that focused on the participant's general health, previous weight loss experiences, their ideal weight management program and their demographics. Data was entered in SPSS 19 and logistic regression was used to identify any differences in weight loss experiences between women. RESULTS The participant rates were high: 86% (n = 395/460) in Victoria and 98% in Nottingham (n = 215/220). Overall, women in Victoria and Nottingham were similar with comparable demographics. Approximately 50% (250/507) of women were in the overweight or obese body mass index category, with over 70% (n = 436/610) of women having attempted to lose weight in the past. The majority of women (n = 334/436) felt comfortable receiving advice from pharmacists. In the logistic regression analysis women in Nottingham were found to be significantly less likely to have utilised a pharmacy weight management program in the last five years (OR: 0.23 CI: 0.08, 0.63) and were significantly less likely to want an ideal weight management program located in a pharmacy (OR: 0.49 CI: 0.30, 0.82) compared to women in Victoria. No significant associations between location and feeling comfortable with a pharmacist advising on weight loss or wanting a pharmacist in an ideal weight management program were seen. CONCLUSION Results from this study have provided information on possible ideal pharmacy weight management programs in both Victoria and Nottingham. Although differences were seen between the two populations, similarities between ideal weight management programs and comfort level with pharmacist interaction were noted.
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