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Almomani HY, Almomani EY, Qablan A, Al-Momany A. Pharmacists' perspectives and perceived barriers to counselling patients with kidney stones. Res Social Adm Pharm 2024; 20:123-133. [PMID: 38462437 DOI: 10.1016/j.sapharm.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/20/2024] [Accepted: 02/25/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND The global increase in kidney stone incidence and its complications emphasise the need for effective management. While pharmacists can play a significant role in counselling and guiding patients, their practices in managing patients with kidney stones remain unclear. OBJECTIVE(S) To explore counselling practices and experiences of pharmacists when dealing with patients with kidney stones and to identify the barriers they face while providing counselling. METHODS A qualitative study was performed using semi-structured phone interviews with pharmacists practising in Jordan. Pharmacists were selected using quota sampling from those who took part in a previous study focused on pharmacists' knowledge of kidney stone aetiology and treatment. The COM-B Model of Behaviour Change was used to develop the interview guide and the analytical framework. Interviews were transcribed verbatim and analysed using a deductive thematic approach based on the pre-specified analytical framework. RESULTS Seven pharmacists (85.7% female; 57.1% working in community pharmacies) were interviewed. Counselling practices of patients with kidney stones were categorised into five themes: (1) Pharmacists' beliefs about patient counselling: perceived importance and desire to improve health through counselling; (2) Most priority patients: Types of patients mostly counselled; (3) Content of kidney stones-specific counselling: patient assessment and recommendations about kidney stones management; (4) Duration of the counselling sessions: time offered and influencing factors; (5) Barriers to patient counselling: patient-related, and pharmacist- and doctor-related challenges. CONCLUSIONS Pharmacists recognise the crucial role of kidney stones counselling but face gaps in their practices, including incomplete dietary education, limited knowledge of medication prescriptions, inconsistent patient-specific approaches, and potential communication challenges. These gaps can be overcome by enhancing training, standardising protocols of kidney stone treatment, promoting interprofessional communication, and improving communication strategies. Future research, including quantitative assessments, is needed to inform strategies that optimise patient counselling practices and facilitate improved outcomes.
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Affiliation(s)
- Huda Y Almomani
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan.
| | - Ensaf Y Almomani
- Department of Basic Medical Sciences, Faculty of Medicine, Al-Balqa Applied University, Al-Salt, Jordan
| | - Ahmad Qablan
- Department of Curriculum and Methods of Instruction, United Arab Emirates University, Al Ain, United Arab Emirates; Faculty of Educational Sciences, Hashemite University, Zarqa, Jordan
| | - Abass Al-Momany
- Department of Clinical Laboratory Sciences, University of Jordan, Amman, Jordan
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Chong JBK, Yap CYH, Tan SLL, Thong XR, Fang Y, Smith HE. General practitioners' perceptions of the roles of community pharmacists and their willingness to collaborate with pharmacists in primary care. J Pharm Policy Pract 2023; 16:114. [PMID: 37789392 PMCID: PMC10546622 DOI: 10.1186/s40545-023-00613-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 09/16/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Community pharmacists (CPs) have the capacity to contribute to patient care given their expertise in medication and accessibility to residents in the community. However, multidisciplinary patient care programmes where CPs collaborate with general practitioners (GPs) in patient care is rare in Singapore despite increasing healthcare demand. OBJECTIVES This study explores GPs' perceptions of CPs' current roles and GPs' ideas for and attitudes towards interprofessional collaboration. METHODS Semi-structured qualitative interviews were conducted with 20 private GPs from August to December 2020 via an online video-chat platform. GPs were recruited from the Primacy Care Research Network (pcRn), primary care networks, and using snowballing strategies. All interviews were recorded, transcribed and coded thematically. RESULTS Current working relationships between GPs and CPs appeared amicable but limited. GPs appreciate the existing roles of CPs: dispensing drugs not stocked in their practices and clarifying prescription details. Still, GPs appeared to rarely consider collaborative working. GPs acknowledged that CPs could enhance patient care with initiatives including medication reconciliation and advising on using medical devices. It was suggested that CPs could coordinate the purchase of drugs for primary care networks to improve GPs' inventory management, but less enthusiasm was expressed for clinical collaborations with CPs. Major concerns about GP-CP clinical collaborations included direct competition with GPs' own business interests, perceived low acceptability of pharmacy-led services by patients (citing extra time and cost), threat to continuity of care and the absence of a shared patient electronic health record system. Current funding mechanisms do not enable reimbursement of clinical services provided by CPs. Adoption of telemedicine technologies and governmental financial support were identified as possible enablers of GP-CP collaboration. CONCLUSIONS GPs saw potential in CPs' increased involvement in patient care, but perceived multiple barriers. Strategies focusing on overcoming these barriers could enable GP-CP collaboration to enhance patient care.
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Affiliation(s)
- Joy Boon Ka Chong
- Watson's Personal Care Stores Pte Ltd, 300 Beach Road, The Concourse, #39-01/04, Singapore, 199555, Singapore.
| | - Clivia Yao Hua Yap
- Watson's Personal Care Stores Pte Ltd, 300 Beach Road, The Concourse, #39-01/04, Singapore, 199555, Singapore.
| | - Shawn Lien Ler Tan
- Ministry of Health Holdings Pte Ltd, 1 Maritime Square, #11-25, Singapore, 099253, Singapore
| | - Xuan Rong Thong
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore, 308232, Singapore
| | - Yang Fang
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore, 308232, Singapore
| | - Helen E Smith
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore, 308232, Singapore
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Davies N, Kolodin V, Woodward A, Bhanu C, Jani Y, Manthorpe J, Orlu M, Samsi K, Burnand A, Vickerstaff V, West E, Wilcock J, Rait G. Models of care and the role of clinical pharmacists in UK primary care for older adults: A scoping review protocol. PLoS One 2023; 18:e0276471. [PMID: 37498969 PMCID: PMC10374084 DOI: 10.1371/journal.pone.0276471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 06/06/2023] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION There has been global investment of new ways of working to support workforce pressures, including investment in clinical pharmacists working in primary care by the NHS in the England. Clinical pharmacists are well suited to support older adults who have multiple long-term conditions and are on multiple medications. It is important to establish an evidence base for the role of clinical pharmacists in supporting older adults in primary care, to inform strategic and research priorities. The aim of this scoping review is to identify, map and describe existing research and policy/guidance on the role of clinical pharmacists in primary care supporting older adults, and the models of care they provide. METHODS AND ANALYSIS A scoping review guided by the Joanne Briggs Institute methodology for scoping reviews, using a three-step strategy. We will search Medline, CINAHL, Scopus, EMBASE, Web of Science, PSYCHInfo, and Cochrane for English language articles, from 2015 -present day. Grey literature will be searched using Grey Matters guidelines, the Index of Grey Literature and Alternative Sources and Resources, and Google keyword searching. References of all included sources will be hand searched to identify further resources. Using the Population, Concept and Context framework for inclusion and exclusion criteria, articles will be independently screened by two reviewers. The inclusion and exclusion criteria will be refined after we become familiar with the search results, following the iterative nature of a scoping review. Data will be extracted using a data extraction tool using Microsoft Excel and presented using a narrative synthesis approach. ETHICS AND DISSEMINATION Ethical approval is not required for this review. Review findings will be disseminated in academic conferences and used to inform subsequent qualitative research. Findings will be published and shared with relevant local and national organisations.
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Affiliation(s)
- Nathan Davies
- Research Department of Primary Care and Population Health, Centre for Ageing Population Studies, University College London, London, United Kingdom
| | - Vladimir Kolodin
- Research Department of Primary Care and Population Health, Centre for Ageing Population Studies, University College London, London, United Kingdom
| | - Abi Woodward
- Research Department of Primary Care and Population Health, Centre for Ageing Population Studies, University College London, London, United Kingdom
| | - Cini Bhanu
- Research Department of Primary Care and Population Health, Centre for Ageing Population Studies, University College London, London, United Kingdom
| | - Yogini Jani
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Jill Manthorpe
- NIHR Applied Research Collaborative (ARC) South London, King's College London, London, United Kingdom
- NIHR Policy Research Unit in Health & Social Care Workforce, King's College London, London, United Kingdom
| | - Mine Orlu
- Research Department of Pharmaceutics, UCL School of Pharmacy, University College London, London, United Kingdom
| | - Kritika Samsi
- NIHR Applied Research Collaborative (ARC) South London, King's College London, London, United Kingdom
- NIHR Policy Research Unit in Health & Social Care Workforce, King's College London, London, United Kingdom
| | - Alice Burnand
- Research Department of Primary Care and Population Health, Centre for Ageing Population Studies, University College London, London, United Kingdom
- Department of Clinical and Movement Neurosciences, University College London, London, United Kingdom
| | - Victoria Vickerstaff
- Research Department of Primary Care and Population Health, PRIMENT Clinical Trials Unit, University College London, London, United Kingdom
| | - Emily West
- Research Department of Primary Care and Population Health, Centre for Ageing Population Studies, University College London, London, United Kingdom
| | - Jane Wilcock
- Research Department of Primary Care and Population Health, Centre for Ageing Population Studies, University College London, London, United Kingdom
| | - Greta Rait
- Research Department of Primary Care and Population Health, Centre for Ageing Population Studies, University College London, London, United Kingdom
- Research Department of Primary Care and Population Health, PRIMENT Clinical Trials Unit, University College London, London, United Kingdom
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Blebil AQ, Saw PS, Dujaili JA, Bhuvan KC, Mohammed AH, Ahmed A, Houssenaly FZ, Hassan BAR, Kaur A, Roien R. Using COM-B model in identifying facilitators, barriers and needs of community pharmacists in implementing weight management services in Malaysia: a qualitative study. BMC Health Serv Res 2022; 22:929. [PMID: 35854383 PMCID: PMC9297607 DOI: 10.1186/s12913-022-08297-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 06/28/2022] [Indexed: 01/04/2023] Open
Abstract
Background Previous qualitative studies exploring the experiences of community pharmacists (CP) in implementing weight management services (WMS) often lack a theoretical underpinning. This study applied the capability, opportunity, motivation, behaviour (COM-B) model to factors associated with WMS implementation among CPs to develop and recommend better intervention strategies. Methods A qualitative study design was used by conducting in-depth, semi-structured interviews with CPs. All the interviews were audio-recorded and duly transcribed. The thematic analysis approach was used to analyse the data, and the themes generated were mapped onto COM-B model components. Results The themes that emerged were (1) motivation of pharmacists and (2) knowledge and skills, which were identified as both barriers and facilitators, and (3) the barriers to implementation in aspects of social norms and resources. Factors were subsequently categorised into the subcomponents of the model: physical capability (e.g., training), psychological capability (e.g., lack of knowledge), physical opportunity (e.g., product range), social opportunity (e.g., stigma), automatic motivation (e.g., remuneration) and reflective motivation (e.g., CPs extended roles). Conclusions In conclusion, programs or training For Cps should develop their psychological capability to change their behaviour by being more proactive in promoting and providing weight management services, with a vital educational component. This behavioural change will improve the promotion of this service and will help many customers who were unaware of this service. Learning opportunities will leave CPs to feel more empowered and overcome barriers to implementing and maintaining WMS in primary care. The study findings provided essential insights into the factors that affect this provided service in Malaysia. The results will help to encourage the embedding of nutrition counselling in academic curricula.
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Affiliation(s)
- Ali Qais Blebil
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia.,Department of Pharmacy, Al-Rafidain University College, Baghdad, 10001, Iraq
| | - Pui San Saw
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Juman Abdulelah Dujaili
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia.,Department of Pharmacy, Al-Rafidain University College, Baghdad, 10001, Iraq
| | - K C Bhuvan
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Ali Haider Mohammed
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia.,Department of Pharmacy, Al-Rafidain University College, Baghdad, 10001, Iraq
| | - Ali Ahmed
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
| | | | | | - Anisha Kaur
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Rohullah Roien
- Medical Research Centre, Kateb University, Kabul, 1004, Afghanistan.
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A qualitative exploration of the healthcare challenges and pharmaceutical care needs of people with Parkinson's and their caregivers. Int J Clin Pharm 2021; 44:53-63. [PMID: 34318400 PMCID: PMC8866252 DOI: 10.1007/s11096-021-01312-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/23/2021] [Indexed: 11/06/2022]
Abstract
Background People with Parkinson’s are at higher risk of healthcare and pharmaceutical care issues. Objective To determine the healthcare challenges, pharmaceutical care needs, and perceived need of a pharmacist-run clinic by people with Parkinson’s and their caregivers. Setting Malaysian Parkinson’s Disease Association. Method A focus group discussion adopting a descriptive qualitative approach was conducted involving people with Parkinson’s and their caregivers. A semi-structured interview guide was used to determine the challenges they faced with their medications and healthcare system, their pharmaceutical care needs, and their views on a pharmacist-run clinic. Data was thematically analysed. Main outcome measure: Healthcare challenges faced by people with Parkinson’s and caregivers along with their pharmaceutical care needs and perceived need of a pharmacist-run clinic. Results Nine people with Parkinson’s and four caregivers participated. Six themes were developed: (1) “It’s very personalised”: the need for self-experimentation, (2) “Managing it is quite difficult”: challenges with medication, (3) “The doctor has no time for you”: challenges with healthcare providers, (4) “Nobody can do it except me”: challenges faced by caregivers, (5) “It becomes a burden”: impact on quality of life, and (6) “Lack of consistency could be counterproductive”: views on pharmacist-run clinic. Conclusion The provision of pharmaceutical care services by pharmacists could help overcome issues people with Parkinson’s face, however there is a need for them to first see pharmacists in their expanded roles and change their limited perception of pharmacists. This can be achieved through integration of pharmacists within multidisciplinary teams in specialist clinics which they frequent.
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Hamidi N, Tan YR, Jawahir S, Tan EH. Determinants of community pharmacy utilisation among the adult population in Malaysia: findings from the National Health and Morbidity Survey 2019. BMC Health Serv Res 2021; 21:649. [PMID: 34217293 PMCID: PMC8254968 DOI: 10.1186/s12913-021-06656-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/17/2021] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- Normaizira Hamidi
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Block B2, NIH Complex, No. 1, Jalan Setia Murni U13/52, Section U13 Setia Alam, 40170, Shah Alam, Selangor, Malaysia.
| | - Yeung R'ong Tan
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Block B2, NIH Complex, No. 1, Jalan Setia Murni U13/52, Section U13 Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Suhana Jawahir
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Block B2, NIH Complex, No. 1, Jalan Setia Murni U13/52, Section U13 Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Ee Hong Tan
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Block B2, NIH Complex, No. 1, Jalan Setia Murni U13/52, Section U13 Setia Alam, 40170, Shah Alam, Selangor, Malaysia
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Sim YC, Mohd-Rosli IS, Lau BT, Ng SY. Patient satisfaction with medication therapy adherence clinic services in a district hospital: a cross-sectional study. Pharm Pract (Granada) 2021; 19:2353. [PMID: 34221203 PMCID: PMC8221750 DOI: 10.18549/pharmpract.2021.2.2353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/30/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Patient satisfaction is one of the essential indicators for assessing the
quality of healthcare services being delivered, including pharmacy
ambulatory care service, as it determines the practicability and
sustainability of the service provided. As such, pharmaceutical care
services provided during medication therapy adherence clinic (MTAC) sessions
need to be assessed to maximise its effectiveness and benefits to the
patients. Objective: This study aimed to assess the association between patient satisfaction and
socio-demographic characteristics, as well as the predictors for patient
satisfaction. Methods: This was a cross-sectional study conducted at the medical outpatient
department in Hospital Port Dickson from January until October 2019.
Convenience sampling method was used to recruit potential study
participants. Patient satisfaction was measured using Validated Patient
Satisfaction with Pharmacist Services Questionnaire (PSPSQ2.0), consisted of
quality of care and interpersonal relationship between pharmacist and
patient domains. Descriptive data were presented as mean and standard
deviation or numbers and percentages, while Independent Sample t-test, ANOVA
and post-hoc analysis, and multiple linear regression were used for
inferential data analysis. Results: There were 37 (25%) diabetes MTAC, 36 (24.3%) respiratory MTAC,
and 75 (50.7%) warfarin MTAC patients recruited. On average, the mean
overall satisfaction score was 3.30(SD=0.43). The mean satisfaction score in
the interpersonal relationship domain [3.35(SD=0.44)] was higher than the
quality of care domain [3.26(SD=0.45)]. There was a significant association
between gender, education level, and patient satisfaction towards
pharmaceutical care service (p<0.05). Gender and education level
statistically predicted respondents’ satisfaction with MTAC services
(p<0.001). Conclusions: The overall patient satisfaction towards MTAC services in this setting was
high. Gender and education level were significant predictors for patient
satisfaction. These findings could potentially contribute to the planning of
MTAC services in the future.
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Affiliation(s)
- Yi C Sim
- BPharm (Hons). Pharmacist. Department of Pharmacy, Hospital Port Dickson, Ministry of Health Malaysia. Negeri Sembilan (Malaysia).
| | - Intan S Mohd-Rosli
- BPharm. Pharmacist. Department of Pharmacy, Hospital Port Dickson, Ministry of Health Malaysia. Negeri Sembilan (Malaysia).
| | - Boon T Lau
- MSc (Clin Pharm). Pharmacist. Department of Pharmacy, Hospital Port Dickson, Ministry of Health Malaysia. Negeri Sembilan (Malaysia).
| | - Siew Y Ng
- MSc Comm Health Sci. Pharmacist. Department of Pharmacy, Hospital Tuanku Ja'afar Seremban, Ministry of Health Malaysia. Negeri Sembilan (Malaysia).
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The Evolving Role and Impact of Integrating Pharmacists into Primary Care Teams: Experience from Ontario, Canada. PHARMACY 2020; 8:pharmacy8040234. [PMID: 33297509 PMCID: PMC7768418 DOI: 10.3390/pharmacy8040234] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/04/2020] [Accepted: 12/05/2020] [Indexed: 02/07/2023] Open
Abstract
The movement to integrate pharmacists into primary care team-based settings is growing in countries such as Canada, the United States, the United Kingdom, and Australia. In the province of Ontario in Canada, almost 200 pharmacists have positions within interdisciplinary primary care team settings, including Family Health Teams and Community Health Centers. This article provides a narrative review of the evolving roles of pharmacists working in primary care teams, with a focus on evidence from Ontario, as well as drawing from other jurisdictions around the world. Pharmacists within primary care teams are uniquely positioned to facilitate the expansion of the pharmacist’s scope of practice, through a collaborative care model that leverages, integrates, and transforms the medication expertise of pharmacists into a reliable asset and resource for physicians, as well as improves the health outcomes for patients and optimizes healthcare utilization.
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Mohiuddin AK. The Excellence of Pharmacy Practice. Innov Pharm 2020; 11. [PMID: 34017646 PMCID: PMC8132542 DOI: 10.24926/iip.v11i1.1662] [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] [Indexed: 12/05/2022] Open
Abstract
Over the past 50 years, the role of pharmacists has evolved along with the health care needs of our population. In addition to dispensing medications and ensuring patient safety, today’s pharmacists are taking a larger role as medical counselors, educators and advocates. They are integral part of the health care team, and are among the most trusted and accessible health care professionals. This accessibility allows them to perform more patient care activities, including counseling, medication management, and preventive care screenings. Beyond the care provided to individual patients, pharmacists have expanded their reach to influence the public health of communities. A pharmacist is uniquely positioned to provide disease state management through appropriate medication therapy management that has been demonstrated to improve patient outcomes and decrease overall health care costs. This role is more important than ever as the environment is demanding new practice and payment models that are required to further optimize care and outcomes while addressing the unsustainable increases in health care costs.
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Affiliation(s)
- A K Mohiuddin
- Department of Pharmacy, World University of Bangladesh, Bangladesh
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10
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Consensus among healthcare stakeholders on a collaborative medication therapy management model for chronic diseases in Malaysia; A Delphi study. PLoS One 2019; 14:e0216563. [PMID: 31075110 PMCID: PMC6510413 DOI: 10.1371/journal.pone.0216563] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/23/2019] [Indexed: 11/22/2022] Open
Abstract
Background The general problem is lack of inter-professional collaboration and the way private primary care responds to manage chronic diseases in Malaysia. Absence of prescription review, inadequate patient education, the highest percentage of prescribing errors and half of the chronic disease patients are nonadherent. Medicines are the most common and life long used interventions in chronic diseases. Hence, the need to manage medicine in chronic diseases becomes obligatory. As both general practitioner and community pharmacist can dispense medications, this has resulted in a business rivalry. There is a need to build consensus among various healthcare stakeholders for a collaborative medication therapy management model (CMTM) where community pharmacist has an active role in chronic care. Method This study utilized modified e-Delphi method to build consensus. A validated e-Delphi survey was administered to a purposive sample of 29 experts. Consensus was pre-defined to be the point where >85% of the experts fall in either agree or strongly agree category for each statement. The inter-expert agreement was computed in both rounds using Intra-class correlation coefficient and Kendall's W. Delphi operates in an iterative fashion till there comes stability in responses. At the end of each round, experts were provided aggregate response, their own response and choice to change their response in the light of aggregate response. Results Response rate was 70.73% and 100% in 1st and 2nd round, respectively. Consensus was achieved on 119/132 statements which mainly referred to the need, structural and regulatory aspects of CMTM model in Malaysia. However, there were some flashpoints on dispensing separation and means to finance this model. Stability in response of experts was achieved after 2nd round; hence, no next round was executed. Conclusion Overall, the study findings witnessed the expert panel’s support for the CMTM model. Study helped to sketch CMTM model and facilitated development of some recommendations to the authorities which may help to formulate a policy to bring CPs under a working relationship with GPs. Hence, this study should be taken as a call for redefining of the roles of CPs and GPs in Malaysia.
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11
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Karampatakis GD, Ryan K, Patel N, Lau WM, Stretch G. How do pharmacists in English general practices identify their impact? An exploratory qualitative study of measurement problems. BMC Health Serv Res 2019; 19:34. [PMID: 30642315 PMCID: PMC6332895 DOI: 10.1186/s12913-018-3842-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 12/19/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND In England, there is an ongoing national pilot to expand pharmacists' presence in general practice. Evaluation of the pilot includes numerical and survey-based Key Performance Indicators (KPIs) and requires pharmacists to electronically record their activities, possibly by using activity codes. At the time of the study (2016), no national evaluation of pharmacists' impact in this environment had been formally announced. The aim of this qualitative study was to identify problems that English pharmacists face when measuring and recording their impact in general practice. METHODS All pharmacists, general practitioners (GPs) and practice managers working across two West London pilot sites were invited, via e-mail, to participate in a focus group study. Appropriately trained facilitators conducted two audio-recorded, semi-structured focus groups, each lasting approximately 1 h, to explore experiences and perceptions associated with the KPIs. Audio-recordings were transcribed verbatim and the data analysed thematically. RESULTS In total, 13 pharmacists, one GP and one practice manager took part in the study. Four major themes were discerned: inappropriateness of the numerical national KPIs ("whether or not we actually have positive impact on KPIs is beyond our control"); depth and breadth of pharmacists' activity ("we see a huge plethora of different patients and go through this holistic approach - everything is looked at"); awareness of practice-based pharmacists' roles ("I think the really important [thing] is that everyone knows what pharmacists in general practice are doing"); and central evaluation versus local initiatives ("the KPIs will be measured by National Health Service England regardless of what we think" versus "what I think is more pertinent, are there some local things we're going to measure?"). CONCLUSIONS Measures that will effectively capture pharmacists' impact in general practice should be developed, along with a set of codes reflecting the whole spectrum of pharmacists' activities. Our study also points out the significance of a transparent, robust national evaluation, including exploring the needs/expectations of practice staff and patients regarding pharmacists' presence in general practice.
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Affiliation(s)
| | - Kath Ryan
- School of Pharmacy, University of Reading, Whiteknights Campus, PO Box 226, Reading, RG6 6AP UK
| | - Nilesh Patel
- School of Pharmacy, University of Reading, Whiteknights Campus, PO Box 226, Reading, RG6 6AP UK
| | - Wing Man Lau
- School of Pharmacy, University of Reading, Whiteknights Campus, PO Box 226, Reading, RG6 6AP UK
- School of Pharmacy, The Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE1 7RU UK
| | - Graham Stretch
- Ealing GP Federation, 179C Bilton Road, Perivale, Greenford, Middlesex, UB6 7HQ UK
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Ryan K, Patel N, Lau WM, Abu-Elmagd H, Stretch G, Pinney H. Pharmacists in general practice: a qualitative interview case study of stakeholders' experiences in a West London GP federation. BMC Health Serv Res 2018; 18:234. [PMID: 29609603 PMCID: PMC5879559 DOI: 10.1186/s12913-018-3056-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/22/2018] [Indexed: 11/10/2022] Open
Abstract
Background Increased patient demand for healthcare services coupled with a shortage of general practitioners necessitates changes in professional roles and service delivery. In 2016, NHS England began a 3-year- pilot study of pharmacists in general practice, however, this is not an entirely new initiative. There is limited, current, evidence-based, UK research to inform the pilot so studies of pre-existing services must suffice until findings from a formal national evaluation are available. Methods The aim of this exploratory, descriptive interview study was to explore the experiences of stakeholders in eight general practices in the Ealing GP Federation, West London, where pharmacy services have been provided for several years. Forty-seven participants, including pharmacy team members (pre-registration and clinical pharmacists, independent prescribers and pharmacy technicians), general practitioners, patients, practice managers, practice nurses and receptionists took part in semi-structured, audio-recorded qualitative interviews which were transcribed verbatim, coded and analysed thematically to extract the issues raised by participants and the practicalities of providing pharmacy services in general practice. Results Findings are reported under the themes of Complementarity (incorporating roles, skills, education and workloads); Integration (incorporating relationships, trust and communication) and Practicalities (incorporating location and space, access, and costs). Participants reported the need for time to develop and understand the various roles, develop communication processes and build inter-professional trust. Once these were established, however, experiences were positive and included decreased workloads, increased patient safety, improved job satisfaction, improved patient relationships, and enhanced cost savings. Areas for improvement included patients’ awareness of services; pharmacists’ training; and regular, onsite access for practice staff to the pharmacy team. Conclusions Recommendations are made for the development of clear role definitions, identification of training needs, dedication of time for team building, production of educational materials for practice staff members and patients, and provision of on-site, full-time pharmacy services. Future work should focus on evaluation of various models of employing pharmacy teams in general practice; integration of pharmacists and pharmacy technicians into multidisciplinary general practice teams; relationships between local community pharmacy and general practice personnel; and patients’ service and information needs. A formal national evaluation of the pilot scheme is overdue. Electronic supplementary material The online version of this article (10.1186/s12913-018-3056-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kath Ryan
- School of Pharmacy, University of Reading, Whiteknights Campus, PO Box 226, Reading, RG6 6AP, UK.
| | - Nilesh Patel
- School of Pharmacy, University of Reading, Whiteknights Campus, PO Box 226, Reading, RG6 6AP, UK
| | - Wing Man Lau
- School of Pharmacy, University of Reading, Whiteknights Campus, PO Box 226, Reading, RG6 6AP, UK.,School of Pharmacy, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - Hamza Abu-Elmagd
- School of Pharmacy, University of Reading, Whiteknights Campus, PO Box 226, Reading, RG6 6AP, UK
| | - Graham Stretch
- Ealing GP Federation, 179C Bilton Road, Perivale, Greenford, Middlesex, UB6 7HQ, UK
| | - Helen Pinney
- Ealing GP Federation, 179C Bilton Road, Perivale, Greenford, Middlesex, UB6 7HQ, UK
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Kho BP, Hassali MA, Lim CJ, Saleem F. Exploring strategies to overcome extra-organisational challenges faced by community pharmacies in Sarawak, Malaysia. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2018. [PMID: 29542834 DOI: 10.1111/ijpp.12438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aims of this research were to determine extra-organisational challenges (e.g. market competition, governing policies) faced by community pharmacies in Sarawak, the coping strategies employed to deal with these challenges and explore potential legislative changes that can attenuate the intensity of these challenges. METHODS Survey questionnaires (n = 184) were posted to all eligible community pharmacies in Sarawak, Malaysia. The questionnaire included sections on participants' demographic data, extra-organisational challenges faced, coping strategies employed and proposals to improve community pharmacy legislations. Items were constructed based on the findings of a prior qualitative research supplemented with relevant literature about these issues. KEY FINDINGS High levels of homogeneity in responses were recorded on various extra-organisational challenges faced, particularly those economy-oriented. Strategic changes to counter these challenges were focused on pricing and product stocked, rather than services provision. Highly rated strategies included increasing discounts for customers (n = 54; 68%) and finding cheaper suppliers (n = 70; 88%). Legislative changes proposed that might increase their share of the pharmaceutical market were strongly supported by respondents, particularly about making it compulsory for general practitioners to provide patients the option to have their medicines dispensed in community pharmacies (n = 72; 90%). CONCLUSIONS Current legislative conditions and Malaysian consumer mindset may have constrained the strategic choices of community pharmacies to deal with the strong extra-organisational challenges. A long-term multipronged approach to address these issues and increased involvement of community pharmacists themselves in this agenda are required to influence practice change.
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Affiliation(s)
- Boon Phiaw Kho
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Penang, Malaysia
| | - Mohamed Azmi Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Penang, Malaysia
| | - Ching Jou Lim
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Penang, Malaysia
| | - Fahad Saleem
- Faculty of Pharmacy and Health Sciences, University of Baluchistan, Quetta, Pakistan
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Lai YF, Lum AYW, Ho ETL, Lim YW. Patient-provider disconnect: A qualitative exploration of understanding and perceptions to care integration. PLoS One 2017; 12:e0187372. [PMID: 29077758 PMCID: PMC5659677 DOI: 10.1371/journal.pone.0187372] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 10/18/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Integrated care has been well-recognized as a solution to improve quality of care for patients with complex needs. As Singapore increasingly develops and promotes integrated models of care, it is unclear if providers, patients, and caregivers share similar understanding of changes in the healthcare system. OBJECTIVES This study aims at exploring three dimensions of care integration: a) understanding of integration; b) challenges and c) changes perceived as essential among three distinct stakeholder groups: providers, patients and caregivers. METHODS This qualitative study was conducted among 41 care providers (clinicians and administrators) and care consumers (patients and caregivers) in Singapore utilizing 29 semi-structured interviews and 2 focus group discussions. Study participants were selected by purposive, snowball sampling from various clinical settings. Data were transcribed, familiarized, coded and analyzed using a conceptual framework. RESULTS Understanding of care integration was generally lacking among patient and caregivers. Most of them focused on healthcare costs and accessibility of services. Providers characterized care integration in clinical process terms and had a more systems view of the concept. Most participants viewed resource constraints as a key challenge in integrating care. Additionally, providers expressed the need for patients and their families to play a greater role in managing their health. Individuals and the community are key components of an integrated care system in the future. Reliance on the healthcare system alone is not sustainable. CONCLUSIONS Patients, caregivers and providers have varying degrees of understanding towards care integration. The success of engaging stakeholders on the ground to be active participants in the healthcare system integration process requires policymakers and healthcare leaders to increase patient engagement efforts and to better appreciate the challenges faced by the healthcare workers in the rapidly changing national and global healthcare landscape.
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Affiliation(s)
- Yi Feng Lai
- Department of Pharmacy, Sengkang Health, Singapore, Singapore
| | | | - Emily Tse Lin Ho
- Regional Health System, Singapore Health Services, Singapore, Singapore
| | - Yee Wei Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Saw PS, Nissen L, Freeman C, Wong PS, Mak V. A qualitative study on pharmacists' perception on integrating pharmacists into private general practitioner's clinics in Malaysia. Pharm Pract (Granada) 2017; 15:971. [PMID: 28943979 PMCID: PMC5597807 DOI: 10.18549/pharmpract.2017.03.971] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 08/22/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Private general practitioners in Malaysia largely operates as solo practices - prescribing and supplying medications to patients directly from their clinics, thus posing risk of medication-related problems to consumers. A pharmacy practice reform that integrates pharmacists into primary healthcare clinics can be a potential initiative to promote quality use of medication. This model of care is a novel approach in Malaysia and research in the local context is required, especially from the perspectives of pharmacists. OBJECTIVE To explore pharmacists' views in integrating pharmacists into private GP clinics in Malaysia. METHODS A combination of purposive and snowballing sampling was used to recruit community and hospital pharmacists from urban areas in Malaysia to participate either in focus groups or semi-structured interviews. A total of 2 focus groups and 4 semi-structured interviews were conducted. Sessions were audio recorded, transcribed verbatim and thematically analysed using NVivo 10. RESULTS Four major themes were identified: (1) Limited potential to expand pharmacists' roles, (2) Concerns about non-pharmacists dispensing medicines in private GP clinics, (3) Lack of trust from consumers and private GPs, (4) Cost implications. Participants felt that there was a limited role for pharmacists in private GP clinics. This was because the medication supply role is currently undertaken in private GP clinics without the need of pharmacists. The perceived lack of trust from consumers and private GPs towards pharmacists arises from the belief that healthcare is the GPs' responsibility. This suggests that there is a need for increased public and GP awareness towards the capabilities of pharmacists' in medication management. Participants were concerned about an increase in cost to private GP visits if pharmacists were to be integrated. Nevertheless, some participants perceived the integration as a means to reduce medical costs through improved quality use of medicines. CONCLUSION Findings from the study provided a better understanding to help ascertain pharmacists' views on their readiness and acceptance in a potential new model of practice.
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Affiliation(s)
- Pui S Saw
- School of Pharmacy, Monash University Malaysia. Selangor (Malaysia).
| | - Lisa Nissen
- Professor and Head, School of Clinical Sciences, Queensland University of Technology, Brisbane QLD (Australia).
| | - Christopher Freeman
- Clinical Senior Lecturer in QUM, School of Pharmacy, University of Queensland. St Lucia, QLD (Australia).
| | - Pei S Wong
- Senior lecturer, School of Pharmacy, International Medical University. Kuala Lumpur (Malaysia).
| | - Vivienne Mak
- Lecturer, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University. Parkville (Australia).
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Kho BP, Hassali MA, Lim CJ, Saleem F. A qualitative study exploring professional pharmacy services offered by community pharmacies in the state of Sarawak, Malaysia. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2017. [DOI: 10.1111/jphs.12181] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Boon Phiaw Kho
- Discipline of Social and Administrative Pharmacy; School of Pharmaceutical Sciences; Universiti Sains Malaysia; Penang Malaysia
| | - Mohamed Azmi Hassali
- Discipline of Social and Administrative Pharmacy; School of Pharmaceutical Sciences; Universiti Sains Malaysia; Penang Malaysia
| | - Ching Jou Lim
- Discipline of Social and Administrative Pharmacy; School of Pharmaceutical Sciences; Universiti Sains Malaysia; Penang Malaysia
| | - Fahad Saleem
- Faculty of Pharmacy and Health Sciences; University of Baluchistan; Quetta Pakistan
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