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

OBJECTIVES

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

KEY FINDINGS

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

SUMMARY

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

Patients' knowledge about pharmacists, technicians, and physicians

PURPOSE

Including pharmacists within care teams can lead to positive health benefits, yet pharmacists remain underused. Misperceptions about pharmacists' duties and expertise compared to physicians' may contribute. This study sought to determine how well patients know the differences between pharmacists, technicians, and physicians regarding their duties and levels of education about medications. It also investigated how patients' perceptions affect their likelihood to initiate interactions with pharmacists, as well as reasons why they choose not to speak with pharmacists.

METHODS

An online survey of 477 U.S. adults was administered via Amazon's Mechanical Turk. Participants' knowledge of pharmacists', pharmacy technicians', and medical doctors' education and expertise were measured. Logistic regression determined whether patients' attitudes toward pharmacists predicted patient-pharmacist interactions. Participants' reasons for choosing to not talk to pharmacists about their medications were assessed via an open-ended response.

RESULTS

Patients generally know the duties pharmacists can perform compared to duties of technicians, but they incorrectly believe that physicians have more years of drug education than do pharmacists. Patients who have more positive attitudes toward pharmacists versus doctors are more likely to initiate interactions with pharmacists. Not seeing a need to interact, believing their doctors told them everything, or their ability to find information elsewhere (e.g., the Internet) were the 3 most cited reasons for not interacting with a pharmacist.

CONCLUSION

Reaching across disciplinary lines to colleagues in health communication may assist the pharmacy profession in finding ways to increase patients' knowledge and perceptions about the important role pharmacists can play, thereby increasing the likelihood of patients wanting to interact with pharmacists.

An exploratory investigation amongst Australian mothers regarding pharmacies and opportunities for nutrition promotion

The early years life-stage (1 year either side of childbirth) is an important period for preventive action focusing on optimizing nutritional health for mothers and babies. Community pharmacy is a much utilized, easily accessed setting for health promotion and exposure to the primary health care system. The literature suggests that there has been limited exploration of pharmacy utilization by mothers, particularly in the context of nutrition focused health promotion. This study aimed to explore mothers' expectations and experiences of pharmacy based health care and to explore mothers' attitudes and opinions regarding opportunities and scope for nutrition-related health promotion in pharmacy. Qualitative semi-structured telephone interviews were conducted amongst a purposive sample of 28 mothers from across Queensland, Australia. Interviews were transcribed and analysed thematically using an iterative approach. Participants as relatively frequent users of pharmacy services accessed pharmacy for medicines or product related concerns but expected information and health advice to be available. Opportunities for nutrition promotion in pharmacy, identified by participants, related primarily to addressing their personal needs for information, advice and support during this life-stage. Improving and reorienting pharmacy staff practices may contribute to more supportive guidance being provided to mothers in this setting.