Jugglers and tightrope walkers: The challenge of delivering quality community pharmacy services

Developing a quality framework for community pharmacy: a systematic review of international literature

OBJECTIVE

To identify the defining features of the quality of community pharmacy (CP) services and synthesise these into an evidence-based quality framework.

DESIGN

Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

DATA SOURCES

International research evidence (2005 onwards) identified from six electronic databases (Embase, PubMed, Scopus, CINAHL, Web of Science and PsycINFO) was reviewed systematically from October 2022 to January 2023. Search terms related to 'community pharmacy' and 'quality'.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Titles and abstracts were screened against inclusion or exclusion criteria, followed by full-text screening by at least two authors. Qualitative, quantitative and mixed-method studies relevant to quality in CP were included.

DATA EXTRACTION AND SYNTHESIS

A narrative synthesis was undertaken. Following narrative synthesis, a patient and public involvement event was held to further refine the quality framework.

RESULTS

Following the title and abstract screening of 11 493 papers, a total of 81 studies (qualitative and quantitative) were included. Of the 81 included studies, 43 investigated quality dimensions and/or factors influencing CP service quality; 21 studies assessed patient satisfaction with and/or preferences for CP, and 17 studies reported the development and assessment of quality indicators, standards and guidelines for CPs, which can help define quality.The quality framework emerging from the global literature consisted of six dimensions: person-centred care, access, environment, safety, competence and integration within local healthcare systems. Quality was defined as having timely and physical access to personalised care in a suitable environment that is safe and effective, with staff competent in the dispensing process and pharmacy professionals possessing clinical knowledge and diagnostic skills to assess and advise patients relative to pharmacists' increasingly clinical roles.

CONCLUSION

The emerging framework could be used to measure and improve the quality of CP services. Further research and feasibility testing are needed to validate the framework according to the local healthcare context.

Exploring stakeholders' perspectives on the quality of services provided through community pharmacies

INTRODUCTION

It is important to understand the factors impacting the quality of services provided through community pharmacies. Exploring how key stakeholders perceive good quality in these services is a logical first step. This could also inform the development of quality measures, such as quality indicators (QIs).

AIM

To identify key stakeholders' perspectives on the quality of services provided through community pharmacies in Norway, specifically by exploring their experiences and perceptions about what constitutes good service quality.

METHODS

A convenient sampling approach was used to recruit participants for five semi-structured focus groups from Facebook, pharmacy chains, and patient organizations. The interviews with twenty-six participants were conducted via Microsoft Teams. Interviews were transcribed verbatim, and an inductive thematic analysis with a reflexive approach was used.

RESULTS

Four main themes emerged from the analysis; 1) sufficient and substantively suitable information to cover individual needs, 2) communication skills and relationships with the pharmacy professionals, 3) customer satisfaction with knowledgeable employees and conveniently located pharmacies, and 4) factors that affect the pharmacy working environment.

CONCLUSION

This study has identified areas that pharmacy professionals and customers regard as essential to define good quality of community pharmacy services. Effective communication skills, appropriate provision of information, customer satisfaction, and working environment are all essential factors when developing quality metrics for community pharmacies.

Antimicrobial dispensing process in community pharmacies: a scoping review

Background

Antimicrobial resistance remains a major global public health concern, and antimicrobial dispensing in community pharmacies is an important factor in preventing this damage. However, the current literature focuses on the technical and attitudinal aspects related to antimicrobial dispensing, with little emphasis on the interventions provided in this service. Thus, this study aimed to determine the antimicrobial dispensing process in community pharmacies.

Methods

A scoping review was performed in September 2020 using the PubMed, EMBASE, LILACS, Web of Science, and Cochrane databases. The search terms included words related to dispensing, antibacterial agents, and pharmacies in various combinations. Two reviewers screened the titles, abstracts, and full-text articles according to the eligibility criteria, and extracted the data. The findings were presented in a descriptive form.

Results

Of the 7713 studies screened, 35 were included, of which 22 (63%) were published in Asia. Most studies followed a cross-sectional design (n = 27), and the simulated patient was the most often used method to assess the antimicrobial dispensing process (n = 22). Moreover, 31 (89%) studies investigated antimicrobial dispensing without prescription, and only four (11%) studies evaluated antimicrobial dispensing with prescription. In the 35 studies, the most frequently asked questions were about drug allergies (n = 19) and patient symptoms (n = 18), and counseling mainly focused on the side effects (n = 14), precautions (n = 14), how to take the medication (n = 12), and duration of medication use (n = 11). Another common intervention was referral (n = 15). Among clinical cases, counseling on medication use occurred often in cases of urinary tract infection (51%) and otitis media (50%).

Conclusions

Antimicrobial dispensing processes have been primarily investigated in low- and middle-income countries, with a focus on dispensing antimicrobials without prescriptions. During the dispensing process, pharmacists mostly posed minimal questions and counseling, highlighting the deficiencies that persist in this practice. Our results indicate the need for multifaceted strategies, such as implementing educational, regulatory or administrative strategies and changes in cultural background, especially in low- and middle-income countries, that aim to reduce indiscriminate use of antimicrobials. Therefore, qualifying the antimicrobial dispensing process is a fundamental factor for improving the rational use of antimicrobials and reducing microbial resistance.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13756-022-01157-0.

"What counts can't always be measured": a qualitative exploration of general practitioners' conceptualisation of quality for community pharmacy services

BACKGROUND

The expansion of community pharmacy services is one solution to relieve pressure on general practice in the United Kingdom (UK). There is a paucity of research of general practitioners' (GPs') perspectives of quality of care in the community pharmacy sector. The purpose of this study was to explore GPs': Conceptualisation of quality for community pharmacy services, including the management of acute (low acuity) conditions and defining indispensable aspects of the patient experience ('always events') Opinions regarding whether and how to measure quality in the community pharmacy sector METHOD: Semi-structured interviews were conducted with GPs in the UK. GPs were recruited using the snowballing technique and professional networks. Interviews were audio-recorded, transcribed and analysed using an interpretive approach.

RESULTS

Interviews were completed with 20 GPs from Scotland (n = 8) and England (n = 12). Multidimensional and inter-related concepts of quality were identified; most dimensions related to patient benefit, as well as impact on GP workload or other health service provision. Interviewees cautioned that "what counts can't always be measured". GPs' expectations of quality often mirrored those of their own sector, but were ambivalent about the adoption of a quality outcome framework-type approach. Pharmacist involvement was expected to ensure quality in the management of 'acute consultations', however, GPs lacked awareness of community pharmacy personnel type, roles and training. Interviewees' perceptions of quality varied by pharmacy type; independent pharmacies were sometimes associated with higher quality service delivery than larger chain organisations.

CONCLUSIONS

Quality frameworks for community pharmacy services could be partly informed by GP experience and expectations, but need to be contextual to reflect differences between both settings. The importance of person-centred care, consistency and continuity was emphasised together with the need for competent personnel and privacy of interactions.

Quality indicators and community pharmacy services: a scoping review

BACKGROUND

Quality indicators are a commonly used improvement tool in health care. There is growing interest and activity in the use of quality indicators to improve community pharmacy practice.

OBJECTIVES

To conduct a scoping review of the use of quality indicators for community pharmacy practice, including their methods of development and evaluation.

METHODS

Electronic databases (EMBASE and PubMed) were searched to identify papers published between January 2008 and April 2018. No limits were applied for language of publication or country of origin. Studies were included if they reported empirical data regarding the development or evaluation of quality indicators. All study designs were eligible for inclusion. Duplicate independent screening was undertaken of the search results. Data extraction was performed by one reviewer.

RESULTS

Of the 988 records identified from the database search, 15 articles were included. The studies were conducted in 12 countries from six continents. Eleven studies described the development of quality indicators, eight of which included the evaluation of the psychometric properties of the indicators developed. Four studies examined the impact of quality indicators on practice all of which reported improvements in some aspects of quality, mainly with structure indicators rather than those relating to process and outcome.

CONCLUSIONS

Whilst there is a growing emphasis on promoting improvement in community pharmacy services, evidence is lacking of the effect of indicators on improving quality. Measurable process and outcome indicators are needed. The future development of quality indicators would also benefit from a multi-stakeholder approach.

How does the public conceptualise the quality of care and its measurement in community pharmacies in the UK: a qualitative interview study

OBJECTIVES

This study explored citizens' perspectives about the quality of community pharmacy services in the UK and whether and how the quality of community pharmacy services should be measured.

DESIGN

Semistructured interviews and focus groups were conducted and were audio recorded, transcribed and analysed systematically using an interpretive approach.

PARTICIPANTS

Members of the public were approached via networks, such as Health and Social Care Alliance Scotland, as well as community groups and personal networks.

SETTING

Scotland, England and Wales.

RESULTS

Data were collected from 20 participants: 11 interviews and 2 focus groups (in community settings, with five and four participants). Quality was conceptualised as multidimensional with inter-related overarching themes of person-centredness, professionalism and privacy. The importance of relational aspects with pharmacy personnel was emphasised including the need for a 'friendly' caring service, continuity of care, being known to personnel, including their awareness of individual's health conditions: 'it's quite a personal service I would say…I think it means that they care about your welfare'. Participants discussed the importance of a professional approach to customer interactions including staff behaviour and appearance. Pharmacy design influenced perceptions of privacy, including having sufficient space or a separate consultation room to promote confidential consultations with a pharmacist. Participants suggested that quality assurance is needed to improve quality and to inspire confidence in the public 'it would drive up quality standards overall' but suggested that quality ratings were unlikely to influence their use of specific pharmacies. They emphasised the need for multidimensional quality ratings and for transparency with their derivation.

CONCLUSIONS

The public conceptualises quality of community pharmacy services as multidimensional and value relational aspects of care provided by personnel in this setting. While the development and application of quality indicators may drive improvement, it seems unlikely to influence the public's use of individual pharmacies.