A qualitative exploration of opinions on the community pharmacists' role amongst the general public in Scotland

Impact of Promotional Videos on Public Perception of Pharmacy Services

Background: Promotional videos are an effective means of marketing products or services in this era of social media. However, little is known if such videos can be a useful tool to promote pharmacy services. Objective: To assess the impact of promotional videos on public awareness of the health services provided by New Zealand pharmacists. Methods: This experimental study used an online questionnaire and promotional videos developed by the Pharmaceutical Society of New Zealand as an intervention to assess the public's perspectives about pharmacy services before and after the intervention. The survey was sent out to 1 127 randomly selected members of the public aged 18 and above from all over New Zealand. Data were analysed using descriptive statistics and thematic analysis. Results: A total of 313 participants completed the survey. The majority (95.8%) had not heard of the promotional videos before. However, 84.3% found the videos informative and nearly three-quarters (74.1%) reported a change in their perception of pharmacy services after watching the video. Similarly, 63.2% reported that they or a family member would be more likely to visit a pharmacy in the future after watching the promotional video. Less than half (40%) of the participants reported that the videos were too long and only 11.5% found them boring. Conclusion: The PSNZ videos were found to be an effective tool for educating New Zealanders on different pharmacy services and the pharmacy profession, however, there is a need to choose the advertising platform carefully so as to enhance the coverage.

Development of a Questionnaire to Measure Public Perceptions of the Role of Community Pharmacy in Public Health (PubPharmQ)

BACKGROUND

Community pharmacies are well placed to provide public-health interventions within primary care settings. This study aimed to establish the general public's perceptions of community pharmacy-based public-health services in the UK by designing a structured questionnaire to assess the barriers and facilitators to optimizing this role.

METHODS

A standardized questionnaire was developed informed by the literature, additional semi-structured interviews, and synthesis of key findings with the authors' previous research based on data generated from eight focus groups. The original 42-item questionnaire was distributed online from May to June 2021 via social media platforms to capture the views of non-regular pharmacy users. Following exploratory factor analysis, and Cronbach's alpha analysis, total Likert scale response scores were calculated.

RESULTS

Of the 306 responders, 76.8% were female with a mean age of 34.5 years (SD = 15.09). The most prevalent pharmacy use reported was 1-2 times a year (28.1%). Exploratory factor analysis revealed four scales: Expertise, Role in Public Health, Privacy, and Relationship (18 items) with acceptable internal consistency and good face and content validity. Awareness of well-established pharmacy services was high; however, responders demonstrated poor awareness of public-health-related services and low recognition of pharmacy expertise for this role. A lack of an established relationship with community pharmacies and privacy concerns were also perceived barriers.

CONCLUSIONS

Based on these findings, considerable effort is needed to increase public awareness and address these concerns if strategic plans to utilize community pharmacy in the delivery of public-health policy are to be successful. The PubPharmQ provides a novel, structured questionnaire to measure the public's perceptions of community pharmacy's role in public health.

Community pharmacy role in children's health in England: Experiences and opinions of parents and young people

Little is known about the reason behind the underutilisation of community pharmacy (CP) for children. This study explored the experiences, barriers and recommendations of parents/carers and young people regarding their use of CP services for children. Two-stage facilitated, structured, audio-recorded interviews were conducted at each of four CPs in London, England, between May and November 2019 [1 month in each CP]. Parents/carers or young persons (aged 16-18 years) who visited CP for a child-related matter were invited to participate. Interviews were transcribed verbatim. Data were analysed both quantitatively and qualitatively, using thematic analysis to identify themes. In total, 249 (58.2% of 428 eligible) customers agreed to participate and completed the two interviews. Out of these, 82.3% (205/249) reported positive experiences with the CP. The general practitioner (GP) was the preferred healthcare provider for minor ailments (44.6%,111/249), while 35.7% (89/249) would choose CP. Eighty-two participants (33%) visited an Emergency Department in the last 12 months, with 13.4% (11/82) of them visited for cold and cough reasons. Where a child was present with parents/carer (128/249), there was a low level of interaction between children and pharmacists (13.3%, 17/128). Lack of awareness about the CP services provided for children and privacy were among the barriers identified by participants. Advertising of CP services and creating a child-friendly environment were recommendations suggested by participants. The findings of this paper show that CP remains an underutilised health service for children by parents/carers and young persons. More work is needed to increase public awareness of the roles of CP in children's health and well-being.

Pharmacy practice and clinical pharmacy research in the Middle East: a scoping review of studies from Bahrain, Iraq, Jordan, Kuwait, Lebanon, Oman, Palestine, Qatar, Saudi Arabia, Syria, United Arab Emirates, and Yemen

Background

Pharmacy practice research publications has increased significantly in the last decade. This is also true for Middle Eastern countries.

Aims

The aim of this study was to document and review pharmacy practice literature in the Middle Eastern Arab countries.

Materials and methods

A scoping review was conducted using PRISMA-ScR guidelines. Medline/PubMed and Scopus were used to screen the articles. All published original research articles concerning any facet of pharmacy practice in 12 Arabic Middle Eastern countries during 2009–2019 were included. A thematic analysis was performed to classify the articles.

Results

Nine hundred and eighty-one articles were included in this study. Eight themes emerged from the selected articles. Medication use was the predominant theme 30.78% (302), followed by pharmacy practice and pharmacist services 22.94% (225), and then pharmacy education and professional development 16.31% (160). The KSA, Jordan, Qatar, and the UAE were the leading countries to publish pharmacy practice research.

Conclusions

Pharmacy practice research is growing and significantly adding to enhance pharmaceutical health services in the Middle East Region. There is a need to develop a research agenda. This will help in enriching the practice, as well as to avoid repetitive ideas.

Publics’ Perceptions of Community Pharmacists and Satisfaction with Pharmacy Services in Al-Madinah City, Saudi Arabia: A Cross Sectional Study

Background and Objectives: Pharmacists play a major role in serving patients and delivering pharmaceutical services to the community. It is unclear whether the public fully appreciates what pharmacists can do as key health care providers. This study aims to examine public perceptions of community pharmacists and levels of satisfaction with pharmacy services. Materials and Methods: A cross-sectional study was conducted on a randomly selected sample population (n = 1000) in Saudi Arabia over a period of six months from January through June 2019. A 40-item, structured, self-administered questionnaire was used, comprised of questions on the demographics characteristics of the respondents and their satisfaction with pharmacy services. Descriptive statistics were used to analyze the data. Results: The response rate of the survey was 76.92%. Public opinions were influenced by pharmacists’ availability and knowledge, service promptness, and counseling services. Overall, 80.5% of respondents agreed that community pharmacists treat them with respect. Doctors were identified as the preferred source of drug therapy consultation by 58.7% and pharmacists by 41.29%. About 72.8% of respondents agreed that pharmacists provided them with clear instructions about medication use, and 70.2% trusted pharmacists’ opinions about medications. About 62.5% of respondents expressed satisfaction with pharmacists, and 64.8% with pharmacy services. Conclusions: Customers’ opinions were influenced by pharmacists’ availability and knowledge, pharmacy service promptness, pharmacy location, waiting area, medication knowledge, and counseling. However, the public was greatly satisfied with community pharmacists’ professionalism and pharmaceutical services. This positive perception provides an opportunity for pharmacists to extend their roles as healthcare professionals.

Determinants of community pharmacy utilisation among the adult population in Malaysia: findings from the National Health and Morbidity Survey 2019

BACKGROUND

Community pharmacies provide alternatives for medication procurement and other basic and minor health-related services in addition to mainstream hospitals and primary healthcare services. This study aimed to determine the characteristics of community pharmacy users and associated factors for community pharmacy utilisation in Malaysia.

METHODS

Secondary data analysis was performed using data from the National Health and Morbidity Survey 2019, a nationwide cross-sectional household survey that used a two-stage stratified random sampling design. Adults aged 18 years and over were included in the analysis. Respondents who reported visiting the community pharmacy for health purposes two weeks prior to the study were considered as users. Complex sample descriptive statistics were used to describe the respondents' characteristics. Logistic regression analyses were employed to determine factors associated with community pharmacy utilisation.

RESULTS

Of the 11,155 respondents interviewed, 10.3 % reported community pharmacy utilisation for health purposes. Females (OR = 1.41, 95 % CI = 1.14, 1.73), those with tertiary education (OR = 2.03, 95 % CI = 1.26, 3.29), urban dwellers (OR = 1.42, 95 % CI = 1.13, 1.79), and those with self-reported health problems (OR = 7.62, 95 % CI = 6.05, 9.59) were more likely to utilise the community pharmacy.

CONCLUSIONS

Demographic and socioeconomic factors were important determinants of community pharmacy utilisation in Malaysia with sex, age, education level, locality, and self-reported health problems as the associated factors. These findings serve as evidence for policy interventions, crucial for improvements in accessibility to healthcare services.

A participatory research approach in community pharmacy research: The case for video-reflexive ethnography

Video-reflexive ethnography (VRE) is a qualitative methodology that explores the complex nature of healthcare 'as it really is'. Its collaborative and reflexive process invites stakeholders (e.g. pharmacists and pharmacy support staff) to participate in analysing their everyday work practices as captured on video footage. Through close collaboration with practitioners and attention to their work contexts, VRE may be a useful methodology to engage a time-poor pharmacy workforce in research about themselves, encouraging more practitioner involvement in practice-based research. Aside from research, VRE has also been used effectively as an intervention to facilitate learning and change in healthcare settings, and could be effective in provoking change in otherwise resistant pharmacy environments. Much like traditional ethnographic approaches, VRE researchers have relied on being present 'in the field' to observe, record and make sense of practices with participants. The COVID-19 pandemic however, has introduced restrictions around travel and physical distancing, which has required researchers to contemplate the conduct of VRE 'at a distance', and to imagine new ways in which the methodological 'closeness' to stakeholders and their workplace contexts can be maintained when researchers cannot be on site. In this commentary, we outline the rationale for participatory methods, in the form of VRE, in pharmacy research. We describe the underlying principles of this innovative methodology, and offer examples of how VRE can be used in pharmacy research. Finally, we offer a reflexive account of how we have adapted the method for use in community pharmacy research, to adapt to physical distancing, without sacrificing its methodological principles. This paper offers not only a new methodology to examine the complexity of pharmacy work, but demonstrates also the responsiveness of VRE itself to complexity, and the potential breadth of future research applications in pharmacy both during and beyond the current pandemic.

Pharmacist non-medical prescribing in primary care. A systematic review of views, opinions, and attitudes

BACKGROUND

Uptake of non-medical prescribing by pharmacists working in primary care has been slow. This is despite benefits such as quicker and more efficient access to medicines for patients, a reduction in doctor workload, and enhanced professional satisfaction. This systematic review explores the views, opinions, and attitudes of pharmacists and graduates towards non-medical prescribing.

METHODS

Medline, ScienceDirect, Embase, and the University of Reading Summon Service were searched to identify qualitative and mixed methods papers that examined the views, opinions, and attitudes of pharmacists and graduates towards non-medical prescribing. Papers published between January 2003 and September 2017 were included. Studies were quality assessed using the CASP checklist and then analysed using thematic synthesis.

RESULTS

After 85 full-text articles were assessed, a final 14 studies were eligible for inclusion. The included studies assessed pharmacists who currently prescribe, and other pharmacists and graduates with familiarity of non-medical prescribing. Thematic synthesis identified two themes: (1) practice environment, and (2) pharmacist's role. Non-medical prescribing was considered a natural extension to the role of a pharmacist despite difficulties in completing the required training. The ability to then prescribe was dependent on funding and access to medical records, time, and support staff. Pharmacists experienced professional rivalry with both support and resistance from members of the primary care team. The provision of training was frequently referred to as unsatisfactory. Pharmacists were motivated to prescribe, deriving increased job satisfaction and a sense of professionalism; however, they often felt underprepared for the reality of unsupervised practice. Furthermore, pharmacists reported a cautious approach with a fear of making errors frequently discussed.

CONCLUSIONS

This review has identified themes and subsequent barriers and facilitators to non-medical prescribing. Many of the barriers are more perceived than real and are diminishing. Consideration of these will assist and advance pharmacist prescribing in primary care, leading to positive outcomes for both patient care and the pharmacy profession.

How does the general public balance convenience and cognitive pharmaceutical services in community pharmacy practice

BACKGROUND

Community pharmacy is shifting its focus from traditional, product-focused roles to the provision of cognitive pharmaceutical services (CPS). Previous research has indicated that community pharmacists predominantly want to devote their capacity to CPS. Ideally, services provided also address users' needs. The general public's preferences regarding the services provided by community pharmacists are currently less understood.

AIM

This study investigates the general public's preferences and perceived importance of CPS versus convenience in community pharmacy practice.

METHOD

An online survey of 1.500 members of the Dutch Health Care Consumer Panel containing questions regarding preferences for CPS and convenience was distributed. Descriptive statistics and linear regression analysis were performed to investigate the relationship between preferences and participant characteristics.

RESULTS

516 panel members completed all questions regarding preferences and importance of the availability of services. The majority preferred convenience (68.2%) and a smaller proportion preferred CPS (27.7%). However, participants considered it important from a societal viewpoint that CPS is provided (45.0%). Participants who preferred CPS over convenience were generally older (p < 0.001) and used more medicines (p < 0.001).

CONCLUSION

Convenience of community pharmacy services is most preferred by the general public. However, CPS is perceived as important, especially for elderly who use more medicines. Elderly patients who use more medicines more often rate CPS as more important than convenience. These findings suggest that community pharmacists should ensure that pharmacy logistics are organized efficiently before focusing on the provision of CPS.

Applying a whole systems lens to the general practice crisis: cross-sectional survey looking at usage of community pharmacy services in England by patients with long-term respiratory conditions

OBJECTIVE

UK policy initiatives aiming to extend community pharmacy services to moderate patient demands and to reduce general practitioners' (GPs) workload have had limited success. This study used marketing theory to identify factors that could influence patients to make better use of community pharmacies within the primary care pathway.

DESIGN

Cross-sectional postal survey design applying the '7Ps marketing mix' ('product', 'price', 'place', 'promotion', 'people', 'process' and 'physical evidence').

SETTING

Greater Manchester, England.

PARTICIPANTS

Patients with asthma or chronic obstructive pulmonary disease registered at two GP practices.

PRIMARY OUTCOME

Patient preference for community pharmacy services.

RESULTS

The response rate was 29% (289/1003). Most respondents preferred to use GP practices for invasive/diagnostic services (product) while preferring using community pharmacy for medicines supply and minor ailments (place). Stronger preference for using GP practices over community pharmacy was significantly associated with gender (male>female), age group (≥65 years) and healthcare services previously accessed at the pharmacy. Respondents perceived they would be more likely to use community pharmacy services if pharmacists offered them enough time to discuss any concerns (73.3%) (price), if community pharmacies had private/clean consultation rooms (70%-73%) (physical evidence) and if pharmacy staff had strong interpersonal skills (68%-70%) (people). Respondents were divided on likelihood of using community pharmacy services if pharmacists could access their whole medical record but wanted pharmacists to add information about their visit (59.6%) (process). Respondents would be encouraged to use community pharmacy for healthcare services if they were offered services by pharmacy staff or recommended/referred to services by their GP (44%) (promotion).

CONCLUSIONS

Using the 7Ps marketing mix highlighted that community pharmacies having staff with strong interpersonal skills, good quality consultation rooms and integrated information systems could positively influence patients to use community pharmacies for management of long-term conditions. There are opportunities for community pharmacies to alleviate GP workload, but a whole system approach will be necessary.

The community pharmacy setting for diabetes prevention: A mixed methods study in people with 'pre-diabetes'

BACKGROUND

Diabetes Prevention Programs (DPPs) comprising intensive lifestyle interventions may delay or even prevent the onset of type 2 diabetes in people with pre-diabetes. However, engagement with DPPs is variable with session times and transportation being reported amongst barriers; this may be addressed by community pharmacy (CP) involvement given its recognition for accessibility.

OBJECTIVES

To explore factors influencing engagement with the National Health Service (NHS) DPP and the role of CP in diabetes prevention.

METHODS

Nine hundred and sixty-two questionnaires were posted to people with pre-diabetes identified from five general practices in Norfolk, England between November 2017 and May 2018. Follow-up semi-structured interviews (n = 10) and a focus group (n = 6) were conducted with a sample of questionnaire respondents. Questionnaire data were analysed quantitatively using SPSS and qualitative data analysed inductively using thematic analysis. Themes relating to engagement and the role of CP in pre-diabetes were further analysed using the COM-B model of behaviour change.

RESULTS

A total of 181 (18.8%) questionnaire responses were received, a quarter of whom reported to have either dropped out or declined attending the national DPP. DPP engagers were more likely to report the program location and session times as convenient. Community pharmacy was perceived as an acceptable setting for delivering diabetes prevention services (DPS) and a preferable alternative for regular pharmacy users and people with work and social commitments. Participants felt that opportunity to engage with CP DPS is enhanced by its accessibility and flexibility in making appointments. Knowledge about the DPS provided in CP and previous experience with CP services were central influences of capability and motivation to engage respectively.

CONCLUSIONS

This research outlines factors that could influence engagement with community pharmacy-based DPS and provides evidence to inform intervention development. Further research would be required to determine the feasibility and cost-effectiveness of such interventions.

The Role of Pharmacists in Cardiovascular Disease Prevention: Qualitative Studies from the United Kingdom and Greece

Objective:

In the United Kingdom (UK), cardiovascular disease (CVD) is the second main cause of death (27.4%) and the leading cause of death in Greece, accounting for 48% incidences. Pharmacists, the most accessible health-care professionals, can have a key role in all stages of CVD prevention. This study aimed to explore the current and future role of pharmacists in CVD prevention, focusing on two European countries, the United Kingdom and Greece.

Methods:

Semi-structured interviews were conducted with 40 community pharmacists; 20 in the UK and 20 in Greece. All interviews were audio-recorded, transcribed, and analyzed thematically.

Findings:

Five main themes were identified: current pharmacists' role, future pharmacists' role, communication, resources and tools, and knowledge. Whereas pharmacists in the UK use a patient-centered approach, Greek pharmacists use a paternalistic approach. Nevertheless, the majority found it difficult to initiate a consultation. Both the UK and Greek pharmacists primarily focus on secondary CVD prevention, while dispensing prescribed medications, which is their main current role. Greek pharmacists recognized a potential role in primary prevention and early screening of CVD through the initiation of CVD prevention services with a weight management program being proposed. Barriers identified for a role in CVD prevention included: high workload in Greece and reimbursement issues and interprofessional relations in the UK.

Conclusion:

Pharmacists in both countries perceive having a potential role in CVD prevention based on their accessibility and customer relations. The challenges include a closer working relationship with other clinicians, communication/consultation skills training, and developing a sustainable funding model for the service.

Experiences of the Pharmacy-Led Weight Management Service: Views of Service Providers in England

Obesity constitutes one of the main modifiable risks of developing cardiovascular disease. In the UK, in 2016, 30% of the adult population were obese (30% of females and 29% of males). Community pharmacies are ideally situated to offer weight management (WM) services, enabling individuals to control and lose their excess weight. This study aimed at exploring the views of the pharmacy-led WM service providers in England. Semi-structured interviews were conducted with 15 trained community pharmacists and pharmacy staff-11 (73.3%) from Kent, three (20%) from Kingston and Richmond and one (6.7%) from Hackney and City-offering the WM service, either owning or working in independent pharmacies or for pharmacy chains. All interviews were audio-recorded, transcribed and anonymised. The analysis was conducted using thematic analysis. Three themes emerged: training and support, barriers and approach. Interestingly, service providers (SP) stated that obesity is a tough topic to talk about: they found it difficult to start a conversation about it, even if they had received training to facilitate this role. Additionally, several barriers for running such a service were identified, such as lack of time, too much work pressure and too little advertising, which could potentially lead to poor sustainability of the service. SPs can effectively intervene in an individual's weight through the WM service that they offer. It is clear that further training should be provided in order for SPs to feel more comfortable in approaching and communicating with people and to increase the public's awareness of the pharmacy-led WM service, so as to ensure the service's sustainability.

Supporting respiratory patients in primary care: a qualitative insight from independent community pharmacists in London

Background

Community pharmacists’ (CPs’) interventions have a positive impact on managing respiratory patients. However, methods used by CPs to assess patients’ inhaler technique and adherence are subjective. New technologies to objectively assess inhaler technique and adherence were introduced to address such a gap. This study aimed to explore CPs’ perceptions towards the management of respiratory patients regarding inhaler technique and adherence. In addition, it explored the views of CPs and their need of technologies to objectively assess inhaler technique and adherence. CPs were probed with a new technology called Inhaler Compliance Assessment (INCA) device, designed to objectively monitor both inhaler technique and adherence of patients using a dry powder inhaler, as an example.

Methods

A qualitative study employing semi-structured interviews was conducted. A convenience and snowballing sampling strategy was employed to recruit CPs working in independent community pharmacies within West and South London. Twenty-three pharmacists were interviewed between August and November 2015. Data was analysed thematically using the framework methodology and coded using NVivo10 software.

Results

Analysis revealed five main themes: services and limitations of patient support, the need and acceptability of new technologies to support respiratory patients, fragmented primary care, the need to promote the clinical role of CPs, and professional identity. Patient support was patchy and affected by several barriers related to pharmacists and patients. In addition, lack of communications with different healthcare professionals in primary care and inaccessibility to clinical records were identified as problematic issues. Some CPs perceived their clinical role to be lacking within the patient care pathway. Interestingly, CPs showed positive a attitude towards the use of technologies, such as the INCA technology to support patients and were willing to provide new services. However, remuneration appeared to be a major driver for willingness to offer new services or promote existing services.

Conclusion

The current study highlighted some measures that can augment CPs’ clinical practice while managing patients, such as having accessibility to patients’ medical records and the use of technologies such as the INCA technology to promote objective counselling of patients.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3814-2) contains supplementary material, which is available to authorized users.

Australian Community Pharmacists' Experience of Implementing a Chronic Kidney Disease Risk Assessment Service

Introduction

Community pharmacists are well positioned to deliver chronic kidney disease (CKD) screening services. However, little is known about the challenges faced by pharmacists during service implementation. This study aimed to explore community pharmacists’ experiences and perceived barriers of implementing a CKD risk assessment service.

Methods

Data collection was performed by using semistructured, open-ended interview questions. Pharmacists who had implemented a CKD screening service in Tasmania, Australia, were eligible to participate. A purposeful sampling strategy was used to select pharmacists, with variation in demographics and pharmacy location. A conventional content analysis approach was used to conduct the qualitative study. Transcripts were thematically analyzed by using the NVivo 11 software program. Initially, a list of free nodes was generated and data were coded exhaustively into relevant nodes. These nodes were then regrouped to form highly conceptualized themes.

Results

Five broad themes emerged from the analysis: contextual fit within community pharmacy; perceived scope of pharmacy practice; customer perception toward disease prevention; CKD – an underestimated disease; and remuneration for a beneficial service. Pharmacists found the CKD service efficient, user-friendly, and of substantial benefit to their customers. However, several pharmacists observed that their customers lacked interest in disease prevention, and had limited understanding of CKD. More importantly, pharmacists perceived the scope of pharmacy practice to depend substantially on interprofessional collaboration between pharmacists and general practitioners, and customer acknowledgment of pharmacists’ role in disease prevention.

Conclusion

Community pharmacists perceived the CKD service to be worth incorporating into pharmacy practice. To increase uptake, future CKD services should aim to improve customer awareness about CKD before providing risk assessment. Further research investigating strategies to enhance general practitioner involvement in pharmacist-initiated disease prevention services is also needed.

The future of pharmacy practice research - Perspectives of academics and practitioners from Australia, NZ, United Kingdom, Canada and USA

BACKGROUND

Healthcare is under significant pressure with the explosion of long term conditions, shift in worldwide demographics and is evolving through advances in technology. Aligned with this is the changing role of pharmacy from the traditional dispenser of medicines to having (in addition) a more advanced clinical role. This study aimed to understand what the pharmacy practice research agenda might look like from the viewpoint of pharmacy academics and practitioners across five high-income countries.

METHOD

Qualitative methods were used, and thirty one-hour interviews were undertaken with practitioners and academics from five economically advanced countries. These nations have comparable socio-economic status but differing health systems and include; Australia, Canada, New Zealand, United Kingdom and United States of America. Six key informants were chosen from each country, three academics and three community pharmacists. A general inductive analysis was undertaken to analyse the most common and recurring themes.

RESULTS

These themes of research were based around current community pharmacy practice issues and the enablers to changing the profession. Specific areas pharmacy practice could be more involved with included long term health conditions. Some community pharmacists also believed that research into the impact of professional standards and policy change would be beneficial. The findings of this research suggest that current pharmacy practice research methods are sufficient, but need to be used more effectively.

CONCLUSION

Participants identified a wide range of issues within community pharmacy practice. Academics largely focused on how research can be utilised in the community and how to implement findings to ensure sustainability of pharmacy practice research. Issues that community pharmacists would like to research are related to the current practice model, such as allocating time to provide patient-focused services in addition to managing a business.

Patient and public perspectives of community pharmacies in the United Kingdom: A systematic review

Background

The United Kingdom has been at the forefront of enhancing pharmacist roles and community pharmacy services, particularly over the past decade. However, patient and public awareness of community pharmacy services has been limited.

Objective

To identify and synthesize the research literature pertaining to patient and public perspectives on: existing community pharmacy services, extended pharmacist roles and strategies to raise awareness of community pharmacy services.

Search strategy

Systematic search of 8 electronic databases; hand searching of relevant journals, reference lists and conference proceedings.

Inclusion criteria

UK studies investigating patient or public views on community pharmacy services or pharmacist roles from 2005 to 2016.

Data extraction and synthesis

Data were extracted into a grid and subjected to narrative synthesis following thematic analysis.

Main results

From the 3260 unique papers identified, 30 studies were included. Manual searching identified 4 additional studies. Designs using questionnaires (n = 14, 41%), semi‐structured interviews (n = 8, 24%) and focus groups (n = 6, 18%) made up the greatest proportion of studies. Most of the studies (n = 28, 82%) were published from 2010 onwards and covered perceptions of specific community pharmacy services (n = 31). Using a critical appraisal checklist, the overall quality of studies was deemed acceptable. Findings were grouped into 2 main themes “public cognizance” and “attitudes towards services” each with 4 subthemes.

Discussion and conclusions

Patients and the public appeared to view services as beneficial. Successful integration of extended pharmacy services requires pharmacists’ clinical skills to be recognized by patients and physicians. Future research should explore different approaches to increase awareness.

Customers' perceptions of and satisfaction with medicine retail outlet services in Addis Ababa, Ethiopia: a cross-sectional study

OBJECTIVES

The aim of this study was to assess customers' perceptions of and satisfaction with MRO services in Addis Ababa and to explore factors associated with their satisfaction and reasons for visits.

METHODS

A cross-sectional survey was conducted among customers selected from 28 MROs in Addis Ababa, using multi-stage sampling techniques. Simple descriptive statistics and multivariable logistic regression at 95% confidence interval were used for the analysis.

KEY FINDINGS

Of 396 respondents, 324 (81.8%) visited MROs to purchase prescription medicines. A majority (338/396; 85.4%) of them perceived that pharmacists and druggists (pharmacy professionals) play a major role in healthcare delivery. A third (140/396; 35.4%) of the respondents agreed with the statement that pharmacy professionals are more concerned about patient care than about their business. Regarding reasons for visiting, being married was positively associated with buying over-the-counter, higher educational status was linked with more satisfaction. Overall, 56.8% (225/396) of the respondents reported that they were satisfied with the service provided by MROs.

CONCLUSION

Customers of MROs had mixed perceptions of and satisfaction with the current service. Marital status and age were associated with the reason for visiting, while the educational level was associated with the level of satisfaction. The overall positive perceptions and satisfaction about MROs should be taken as an opportunity to promote and improve pharmaceutical services rendered in MROs, to ensure that the public is receiving maximum benefit.

Development and utilization of the Medicines Use Review patient satisfaction questionnaire

The Medicines Use Review is a community pharmacy service funded in the United Kingdom to improve patients' adherence to medication and reduce medicines waste. The objective was to develop, pilot, and utilize a new Medicines Use Review patient satisfaction questionnaire. A questionnaire for patient self-completion was developed using a published framework of patient satisfaction with the Medicines Use Review service. The questions were validated using the content validity index and the questionnaire piloted through three pharmacies (February-April 2016). The revised questionnaire contained 12 questions with responses on a 5-point Likert scale, and a comments box. The questionnaire was distributed to patients following a Medicines Use Review consultation via community pharmacies (June-October 2016). Exploratory factor analysis and Cronbach's α were performed to investigate the relationships between the items and to examine structural validity. The survey results were examined for patients' reported satisfaction with Medicines Use Reviews, while the handwritten comments were thematically analyzed and mapped against the questionnaire items. An estimated 2,151 questionnaires were handed out, and a total of 505 responses were received indicating a 24% response rate. Exploratory factor analysis revealed two factors with a cumulative variance of 68.8%, and Cronbach's α showed high internal consistency for each factor (α=0.90 and α=0.89, respectively). The survey results demonstrated that patients could show a high degree of overall satisfaction with the service, even if initially reluctant to take part in a Medicines Use Review. The results support the Medicines Use Review patient satisfaction questionnaire as a suitable tool for measuring patient satisfaction with the Medicines Use Review service. A wider study is needed to confirm the findings about this community pharmacy-based adherence service.

Community pharmacists require additional support to develop capacity in delivering alcohol-related health information to older adults

OBJECTIVES

This qualitative study explored the barriers and enablers influencing Western Australian (WA) community pharmacists' knowledge, confidence, willingness and practice in engaging older clients (>60 years) in alcohol-related health discussions.

METHODS

Two focus groups were conducted with a total of 14 community pharmacists who had previously completed a formative quantitative survey (n = 63), and indicated willingness to participate in a follow-up focus group. Focus group questions, informed by the survey results, explored participants' perceptions about barriers and enablers to delivering health information and advice about alcohol to older clients (60+ years). Shaw and colleagues' theoretical framework was used to understand barriers and enablers in relation to role legitimacy, role adequacy and role support.

KEY FINDINGS

Participants acknowledged that providing health information about alcohol to older clients is a legitimate part of a community pharmacist's role, and most were confident performing this role in situations perceived as core to their professional practice, such as while dispensing medicines. However, many participants identified limited knowledge, skills and confidence in assisting older clients who may have alcohol issues, beyond advising them on medication and alcohol use. Structural barriers such as time and financial barriers were also identified.

CONCLUSION

Routine professional practice including dispensing medicine and home medicine reviews may provide valuable opportunities to engage older clients in alcohol-related discussions. However, limited knowledge concerning appropriate strategies to assist older clients reduce their alcohol consumption, coupled with limited skills and confidence among community pharmacists in raising sensitive alcohol-related issues with clients, suggest the need for specific alcohol-related training and support.

Is there potential for the future provision of triage services in community pharmacy?

Background

Worldwide the demands on emergency and primary health care services are increasing. General practitioners and accident and emergency departments are often used unnecessarily for the treatment of minor ailments. Community pharmacy is often the first port of call for patients in the provision of advice on minor ailments, advising the patient on treatment or referring the patient to an appropriate health professional when necessary. The potential for community pharmacists to act as providers of triage services has started to be recognised, and community pharmacy triage services (CPTS) are emerging in a number of countries. This review aimed to explore whether key components of triage services can be identified in the literature surrounding community pharmacy, to explore the evidence for the feasibility of implementing CPTS and to evaluate the evidence for the appropriateness of such services.

Methods

Systematic searches were conducted in MEDLINE, EMBASE and International Pharmaceutical Abstracts (IPA) databases from 1980 to March 2016.

Results

Key elements of community pharmacy triage were identified in 37 studies, which were included in the review. When a guideline or protocol was used, accuracy in identifying the presenting condition was high, with concordance rates ranging from 70 % to 97.6 % between the pharmacist and a medical expert. However, when guidelines and protocols were not used, often questioning was deemed insufficient. Where other health professionals had reviewed decisions made by pharmacists and their staff, e.g. around advice and referral, the decisions were considered to be appropriate in the majority of cases. Authors of the included studies provided recommendations for improving these services, including use of guidelines/protocols, education and staff training, documentation, improving communication between health professional groups and consideration of privacy and confidentiality.

Conclusion

Whilst few studies had specifically trialled triage services, results from this review indicate that a CPTS is feasible and appropriate, and has the potential to reduce the burden on other healthcare services. Questions still remain on issues such as ensuring the consistency of the service, whether all pharmacies could provide this service and who will fund the service.

Role of community pharmacists in the use of antipsychotics for behavioural and psychological symptoms of dementia (BPSD): a qualitative study

OBJECTIVE

This study aimed to use qualitative methodology to understand the current role of community pharmacists in limiting the use of antipsychotics prescribed inappropriately for behavioural and psychological symptoms of dementia.

DESIGN

A qualitative study employing focus groups was conducted. Data were analysed using thematic analysis.

SETTING

3 different geographical locations in the England.

PARTICIPANTS

Community pharmacists (n=22).

RESULTS

The focus groups identified an array of factors and constraints, which affect the ability of community pharmacists to contribute to initiatives to limit the use of antipsychotics. 3 key themes were revealed: (1) politics and the medical hierarchy, which created communication barriers; (2) how resources and remit impact the effectiveness of community pharmacy; and (3) understanding the nature of the treatment of dementia.

CONCLUSIONS

Our findings suggest that an improvement in communication between community pharmacists and healthcare professionals, especially general practitioners (GPs) must occur in order for community pharmacists to assist in limiting the use of antipsychotics in people with dementia. Additionally, extra training in working with people with dementia is required. Thus, an intervention which involves appropriately trained pharmacists working in collaboration with GPs and other caregivers is required. Overall, within the current environment, community pharmacists question the extent to which they can contribute in helping to reduce the prescription of antipsychotics.

An evaluation of community pharmacy-based services for type 2 diabetes in an Indonesian setting: patient survey

Background. Diabetes is an emerging chronic disease in developing countries. Its management in developing countries is mainly hospital/clinic based. The increasing diabetes burden in developing countries provides opportunities for community pharmacists to deliver a range of services. Since the management of diabetes requires the patient’s own involvement, it is important to gain their views in order to develop pharmacy-based diabetes services. Studies on diabetes patients’ views have been limited to developed countries.

Objectives. To investigate, within a developing country setting (Indonesia), current use of pharmacy services by type 2 diabetes patients, and to evaluate their views regarding community pharmacists’ roles, and the characteristics that influence their views.

Methods. A questionnaire survey was conducted within 10 purposefully selected community pharmacies in Surabaya, Indonesia. Each pharmacy recruited approximately 20 patients seeking antidiabetic medications. Usage of pharmacy services was identified using binary responses (‘yes’/‘no’) and views on pharmacists’ roles were rated using Likert scales; an open-ended question was used to identify patient perceived priority roles. Logistic regression models were used to determine characteristics associated with patients’ views.

Results. A total of 196 pharmacy patients with type 2 diabetes responded (58.3% response rate). Most patients used community pharmacies for dispensing (100%) and education on how to use medications (79.6%). There were mixed views towards pharmacists providing services beyond dispensing. The highest priorities identified were from the ‘patient education’ domain: education on medications (i.e., directions for use (64.5%), storage (26.6%), common/important adverse effects (25.5%)); and the ‘monitoring’ domain: monitoring medication compliance (37.3%). Patients with higher incomes or who were working were less supportive of these expanded services, whereas patients who previously used a service, those with risk factors for complications or having poor/unknown glycaemic control were more supportive.

Conclusions. Community pharmacies in Surabaya, Indonesia in this study were mainly utilised for dispensing. However, many type 2 diabetes patients using these pharmacies report limited monitoring of blood glucose levels and poor glycaemic control, which indicates an opportunity for greater pharmacist involvement. Yet for this to occur, patients’ limited expectations of pharmacists roles will need to be broadened. Characteristics influencing these views should inform the development of pharmacy-based diabetes services in the environment of the burgeoning burden of diabetes.

Support for community pharmacy-based alcohol interventions: a Scottish general public survey

BACKGROUND

Community pharmacy teams are recognised by health agencies as vital to increasing capacity in the provision of public health services. Public awareness and support of these services in general, and relating to safe alcohol consumption in particular, have yet to be established. This study aimed to determine the Scottish general public's views regarding the role and involvement of community pharmacists in reducing alcohol consumption amongst customers and alcohol-related harm.

METHODS

A cross-sectional survey of 6000 adults in Scotland randomly sampled from the electoral register. The piloted questionnaire contained items on: those health professions which could potentially advise on safer alcohol consumption; areas of safer alcohol consumption on which pharmacists could advise; attitudes towards pharmacist involvement; and demographics.

RESULTS

Of the 1573 respondents (a 26.6% response rate), more than half (56.4%, 888) agreed that pharmacists could advise on safer alcohol consumption. Those agreeing expressed high levels of support (≥70% agreement) for all activities, particularly referring people to other individuals or organisations, discussing recommended alcohol consumption limits and how consumption may affect health. There was a high level of agreement of trust that pharmacists would discuss issues confidentially (68.7%, 1080), with a similar proportion (64.3%, 1011) agreeing that they would be concerned over privacy in a community pharmacy.

CONCLUSION

Public support exists for pharmacist involvement in reducing alcohol consumption amongst customers and alcohol-related harm, with some concern over privacy. These findings warrant consideration as models of practice are developed and evaluated. Given the widespread availability of pharmacies and the ease of access to professional advice, there is potential for pharmacists to impact safer alcohol consumption although the efficacy of alcohol brief interventions remains to be demonstrated.

Development of a medication monitoring attitude measure using a mixed methods item development process

Objectives

Medication monitoring is important for safe and effective medication use; however, no attitudinal measure exists for a health care provider's medication monitoring attitude. The objectives of this study were to (1) create a measure of a community pharmacist medication monitoring attitude; (2) test concurrent validity using a validated measure of medication monitoring behaviours; and (3) report community pharmacist attitudes towards medication monitoring.

Methods

A mixed methods item development process was employed to generate Likert-type items from qualitative interviews. Following item review and piloting, a four-contact survey, including 20 6-point Likert-type items and the four-item Behavioral Pharmaceutical Care Scale monitoring domain, was mailed to 599 randomly sampled US community pharmacists from the state of Iowa. Exploratory factor analysis, Pearson's correlation and descriptive statistics were used to address study objectives.

Key findings

There were 254 (42.4%) returned and usable surveys. Factor analysis yielded two domains, a seven-item, positively worded internal (α = 0.819) and an eight-item, negatively worded external domain (α = 0.811). Both domains were positively correlated with the monitoring domain of the Behavioral Pharmaceutical Care Scale supporting convergent validity. Overall, respondents had a positive internal monitoring attitude with a mean of 4.62 (0.68), although many practiced in an environment less conducive to monitoring, as evident by a mean of 3.13 (0.88). Pharmacists were more oriented towards medication side effect and effectiveness monitoring than nonadherence monitoring.

Conclusions

The mixed methods item development process created a reliable and valid measure of a pharmacist's medication monitoring attitude. While pharmacists had an overall positive medication monitoring attitude, improvements are needed to bolster adherence monitoring and make pharmacy environments more conducive to monitoring.

An exploratory study of the views of community pharmacy staff on the management of patients with undiagnosed skin problems

Objective

The aim of this study was to explore pharmacist and medicine counter assistant (MCA) perceptions of community pharmacy management of patients presenting with symptomatic skin problems.

Methods

The study involved semi-structured telephone interviews with 10 pharmacists and 15 MCAs from seven pharmacies. Interviews focused on perceptions of their role in managing symptomatic skin problems and views on why people sought pharmacy advice and any barriers to management. Advice from the local ethics committee was that approval was not required for the study. We analysed the interviews using the framework approach.

Key finding

Pharmacists identified two key themes that defined their role; triage and reassurance. In contrast, MCAs defined their role as information gatherers and independent advisors. Themes identified by both pharmacists and MCAs relating to the use of pharmacy as a source of advice were convenience, the perceived non-serious nature of conditions and inaccessibility of the GP. Additionally, MCAs believed familiarity with the pharmacist was important. Both pharmacists and MCAs identified their lack of dermatological knowledge as a barrier with pharmacists reporting insufficient time to deal effectively with patients. MCAs identified the potential for misdiagnosis by pharmacists as another potential barrier.

Conclusion

Our findings suggest that the role of pharmacists and MCAs is complementary; MCAs screen and provide the necessary information to pharmacists who then decide upon an appropriate course of action for the patient. Nevertheless, a major barrier to pharmacy-supported self-care of symptomatic skin problems is a perceived lack of knowledge and training in dermatology.

A review of countries' pharmacist-patient communication legal requirements on prescription medications and alignment with practice: Comparison of Nordic countries

BACKGROUND

Pharmacist-patient communication around prescription medications can optimize treatment outcomes. Society's expectations of pharmacist-patient communication around medications can be expressed in legislation, economic incentives, and authority control. In this study, the Nordic countries of Denmark, Finland, Iceland, Norway and Sweden provide the legislative examples and can be used as a platform to discuss how society's expectations, professional visions, and practice are aligning.

OBJECTIVE

The overall aim of this study was to describe society's expectations of pharmacist-patient communication around medications as expressed by the state in Nordic legislation, economic incentives and authority control. Additionally, this study describes how the states govern Nordic pharmacists in different pharmacy systems.

METHOD

A legal review was performed using online legislative databases. Regulating authorities were contacted to gather supplementary information. Thereafter, a qualitative document analysis was conducted.

RESULTS

The Nordic countries regulate staff-patient communication by using broad laws. The legislation's main focus during dispensing is information on the use of medications, but also generic substitution and pricing. Pharmacies should have internal routines for this in place. Pharmacists' obligation to keep a journal on advice given during dispensing is ambiguously regulated. The economic incentives for communication on prescription medication during dispensing are included in the general pharmacy mark-up. Today's authority control focuses on the pharmacy management and appears to primarily evaluate structure indicators of communication, for example, if there is a routine method of counseling available.

CONCLUSION

Various countries throughout the world differ in their requirements for pharmacy staff to communicate on the use of medicines during dispensing. The Nordic countries all require such communication, which aligns with professional visions. Regardless of the pharmacy system, the states let the employer and pharmacy professions carry out it in practice with apparently little state involvement, thus showing trust in the profession and employers. However, since Nordic communication studies show deviation from the legislation, there are reasons to reevaluate and discuss the legislation, the economic incentives and the control system.