Primary care pharmacists: provision of clinical-decision services in healthcare

The Potential Role of the Pharmacist in Supporting Patients with Depression - A Literature-Based Point of View

OBJECTIVE

The current article is aimed at identifying the best practice for counseling around depression in community and outpatient pharmacies, resulting in a draft guideline, proposing key steps and an algorithm for integration of community pharmacists into care for patients with depression.

METHODS

A literature review was performed followed by a detailed analysis, for the purpose of creation a short draft document used as a basis for creation of a guideline for pharmaceutical care for patients with depression. The technological scheme PRISMA flow diagram was applied. The paper is based on current knowledge, taking into consideration already published articles, guidelines, and recommendations about pharmaceutical care for patients with depression, giving a basis for further studies.

RESULTS

This paper includes two main sections: 1) depression - a short description of the main symptoms, risk factors and pharmacotherapy guidelines available in Bulgaria important for the purposes of ensuring qualitative community-based pharmaceutical care; and 2) the pharmacists' role in providing high-quality care - the main aspects of pharmaceutical care for patients with depression with specific examples.

CONCLUSION

The involvement of pharmacists in supporting depressive patients is crucial taking into account the specific characteristics of the pharmacological treatment: delayed onset of clinical results, risks in case of sudden pharmacotherapy abruption without physician consultation, multiple adverse drug reactions and drug-drug, drug-food and drug-alcohol interactions, etc. The current article could also be used as an initial document for creating a methodological guideline for providing pharmaceutical care services for patients with depression.

"It Made a Difference to Me": A Comparative Case Study of Community Pharmacists' Care Planning Services in Primary Health Care

In some jurisdictions, governments and the public look to community pharmacies to provide expanded primary health care services, including care plans with follow-up. Care planning services, covered by the Compensation Plan in Alberta, Canada, require pharmacists to assess an eligible patient's health history, medication history, and drug-related problems to establish goals of treatment, interventions, and monitoring plan. Follow-up assessments are also covered by the Compensation Plan. A comparative case study method facilitated an in-depth investigation of care planning services provided by four community pharmacy sites. Data from 77 interviews, 61 site-specific documents, and 94 h of observation collected over 20 months were analyzed using an iterative constant comparative approach. Using a sociomaterial theoretical framework, the perceived value of care planning services was examined through an investigation of the relationships and interactions between people and information. Patients perceived the value of care planning as related to waiting time to access care and co-creating individualized plans. Physicians and other health care professionals valued collaboration, information sharing, and different perspectives on patient care. Pharmacists valued collaboration with patients and other health care professionals, which renewed their sense of responsibility, increased satisfaction, and gave meaning to their role.

Pharmacist's Demand for Optimal Primary Care Service Delivery in a Community Pharmacy: The OPTiPharm Study

BACKGROUND

The US population continues to expand providing the need for primary health care services. Community pharmacies integrated with medicine may provide greater access while providing high quality care.

OBJECTIVE

To gauge pharmacists' demand for primary health care services delivered through community pharmacies.

METHODS

An online survey was administered to determine community pharmacists' preferences for varying primary care services that could be offered in the community pharmacy setting. A Discrete Choice Experiment was employed to show pharmacists competing scenarios with varied primary care service offerings in the community pharmacy setting. Attributes evaluated were operation hours, service provider, medical records, service logistics, physical examinations, point-of-care diagnostic testing, preventative care, and drug prescribing. Respondents chose the scenario most likely to induce switching employment from base pharmacy to one providing advanced services.

RESULTS

The optimal service delivery model from 291 community pharmacists comprised: inclusion of patient prescriptions and health information into the patient's medical record; provision of point of care testing and vital sign, including blood pressure, heart rate and breathing rate, and blood sugar and cholesterol measurement; and pharmacists prescribing (under physician oversight). Pharmacists were 4 times more likely to switch employment from their current pharmacy to their choice for advanced pharmacy services. Pharmacist demand was highest among those with a PharmD, less experience, working >40 hours per week, and in rural areas.

CONCLUSIONS

This study provides empirical support for the model of pharmacists playing a greater role in the provision of primary care health services through community pharmacy settings.