Comparison between European Medicines Agency and US Food and Drug Administration in Granting Accelerated Marketing Authorizations for Covid-19 Medicines and their Utilized Regulations

BACKGROUND

Prompted by the Covid-19 pandemic and the need to ensure timely and safe access to medicines during a pandemic, the aim of this study was to compare and contrast the EU and US regulations, processes, and outcomes pertaining to the granting of accelerated Marketing Authorizations (MAs) for COVID-19 vaccines and treatments with a view to determining how effective these regulations were in delivering safe medicines in a timely manner.

METHODS

MAs for medicines approved for Covid-related indications in the first two pandemic years (March 2020-February 2022) were identified using the European Medicines Agency (EMA) and US Food and Drug Administration (FDA) websites. Authorization reports and utilized regulations were reviewed to determine and compare approval timelines, facilitated pathways, accepted clinical evidence, and effectiveness of the regulations by assessing them against time and safety standards.

RESULTS

By the end of February 2022, the EMA and FDA had granted 12 and 14 MAs, respectively. Two EU and two US approvals were issued in relation to new indications for already-approved treatments; the remaining ones were first-time approvals of novel vaccines and treatments. The median time to approval was 24 days for the EMA's conditional MAs and 36 days for the USFDA's Emergency Use Authorizations (EUA) for all Covid-19 medicines. This is compared with 23 and 28 days, respectively, specifically for first-time novel vaccines and treatments authorized by both USFDA and EMA. The USFDA and EMA differed markedly in terms of the time taken to approve new indications of already-approved treatment; the USFDA took 65 days for such approval, compared with 133 days for the EMA. Where MAs were issued by both authorities, USFDA approvals were issued before EMA approvals; applications for approval were submitted to the FDA before submission to the EMA. Three EU and two US MAs were based on data from two or more phase 3 clinical trials; the remaining ones were based on single trial data. Only six EU and four US trials had been completed by the time of authorization. This was in line with regulations. While the applicable regulations shared many similarities, there were marked differences. For instance, the EU's conditional MA regulation pertains only to first approvals of new treatments. It does not cover new indications of already-approved treatments. This contrasts with the US, where the EUA regulation applies to both types of applications, something that may have impacted approval timelines. Overall, both EU and US utilized regulations were considered to be effective. For most cases, utilizing such regulations for Covid-19 MAs resulted in faster approval timelines compared to standard MAs. They were flexible enough to manage the process of granting emergency approvals while maintaining strict requirements and allowing comprehensive reviews of the supporting evidence.

CONCLUSION

US and EU regulations were effective in ensuring timely accelerated market access to Covid-19 medicines during the pandemic without compromising the approval standards related to safety or efficacy. The population in both regions will receive comparable access to medicines during a pandemic if sponsors submit their applications to both authorities in parallel.

Pharmacy professionals' perceptions of educational supervision in primary care through the lens of Proctor's model

BACKGROUND

Educational supervision plays a vital role in postgraduate medical education and more recently in pharmacy and advanced clinical practitioner training in England. Proctor's three-function model of clinical supervision (consisting of formative, restorative, and normative functions) is assumed to apply to educational supervision, but this has not been tested empirically. The aim of this study was to establish perceptions of the purpose of educational supervision from the perspective of primary care pharmacy professionals enrolled on a national training pathway in England.

METHODS

Using a mixed methods design, data were collected using a validated 25-item online survey and respondents were invited to add comments explaining their responses. The survey was sent to all 902 learners enrolled on a postgraduate training pathway for pharmacy professionals working in primary care. Principal components analysis (PCA) was used to interpret patterns in the survey data, and framework analysis of qualitative free text comments was used to identify themes and aid interpretation of quantitative findings.

RESULTS

One hundred eighty-seven pharmacy professionals responded (response rate 20.7%). PCA extracted three factors explaining 71.5% of the total variance. Factor 1 corresponded with survey items linked to the formative function of Proctor's model, while factor 2 corresponded with survey items linked to the restorative function. No items corresponded with the normative function. Framework analysis of qualitative free-text comments identified two themes: learning support, which corresponded with factor 1; and personal support, which corresponded with factor 2.

CONCLUSIONS

This study identified that pharmacy professionals perceived educational supervision to perform two functions, formative (educational) and restorative (pastoral), but did not perceive it to perform a normative (surveillance) function. Educational supervision has the potential to support allied health professionals advancing their roles and we suggest the need for more research to develop models of effective educational supervision which can inform practice.

To be or not to be: The identity work of pharmacists as clinicians

This study explores how pharmacists legitimise the expansion of their clinical work and considers its impact on pharmacists' professional identity work. In the context of pharmacy in the English NHS, there has been an ongoing policy shift towards pharmacists moving away from 'medicines supply' to patient-facing, clinical work since the 1950s. Pharmacists are continuously engaging in 'identity work' and 'boundary work' to reflect the expansion of their work, which has led to the argument that pharmacists lack a clear professional identity. Drawing insights from linguistics and specifically Van Leeuwen's 'grammar of legitimation', this study explains how the Pharmacy Integration Fund, a nationally funded learning programme, provides the discursive strategies for pharmacists to legitimise their identity work as clinicians.

Community pharmacist consultation service: survey insights into impact of learning on practice, and barriers and enablers to service implementation

Introduction

Some patients attend NHS services with ‘clinically divertible’ urgent low acuity conditions. The NHS Community Pharmacist Consultation Service (CPCS) enables the referral of such patients and subsequent consultation with a community pharmacist. The Centre for Pharmacy Postgraduate Education (CPPE) offered a learning programme to prepare pharmacists for a more clinical and person-centred approach when delivering the CPCS.

Aim

To investigate the impact of the CPPE CPCS learning programme on learnt skills and their application in practice, and barriers and enablers to CPCS delivery.

Methods

A survey was designed to explored participants’ knowledge, confidence and application of taught skills/tools, including clinical history-taking, clinical assessment, record-keeping, Calgary-Cambridge, L(ICE)F (lifestyle, ideas, concerns, expectations, feelings) and SBARD (situation, background, assessment, recommendation, decision) communication tools. Statements on barriers and enablers to CPCS delivery were included. In November/December 2021, CPPE emailed an online survey (one reminder) to CPCS learners who had agreed to be contacted (n=2836). The University of Manchester’s Research Ethics Committee decision tool confirmed that ethics committee approval was not required for this study.

Results

One-hundred and fifty-nine pharmacists responded (5.6%). Sixty percent were female, all ages were represented, the most populous groups being 55-64 (33.3%) and 45-54 years (27.7%). Ethnicity was broadly representative of community pharmacists: 49.0% white, 38.9% Asian, 8.2% black, and 1.9% Arab. Sixty-eight (43%) of respondents were working in a large multiple community pharmacy, 33.3% (n=53) in an independent pharmacy, and 17.0% (n=27) in a small to medium pharmacy multiple. Knowledge of, and confidence in, taught skills were high and respondents reported applying skills in CPCS consultations and wider practice. There was strong positive correlation between the perceived levels of competence and confidence when delivering CPCS (r=0.966, p=<0.001). The level of competence (r=0.259, p=0.003) and confidence increased (r=0.264, p=0.002) with an increasing number of NHS111 referrals. With regards to specific skills learnt, the highest levels of knowledge were recorded for ‘taking a clinical history’ (86% agreement), ‘clinically assessing a patient’ (84%), ‘using L(ICE)F’ (84%), and ‘completing an accurate and concise clinical record’ (81%). Seventy-three percent of respondents agreed they knew how to use the Calgary Cambridge, whilst only 49% knew how to use SBARD. Barriers to CPCS included lack of GP referrals, staffing levels, workload, and GP attitudes. Enablers included a clear understanding of what was expected, minimal concerns over indemnity cover and privacy, and positive patient attitudes towards pharmacy. Those working in independent pharmacies were more likely than those in multiple pharmacies to report that they were receiving GP referrals (68.5% vs. 49.0%, X2=5.249, p=0.022), that they had enough staff to provide the CPCS (45.3% vs. 26.3%, X2=5.526, p=0.019), and that the local GP considers community pharmacy to be an integral part of the primary healthcare team (54.7% vs. 37.2%, X2=4.214, p=0.040). Employed pharmacists were more likely than locums to report that they had a good relationship with their local general practice (57.5% vs. 37.5%, X2=5.436, p=0.020).

Discussion/Conclusion

This study demonstrates that CPPE learning contributed to community pharmacists’ extended knowledge and skills in CPCS delivery, which contributes to enhanced provision of urgent care in England. This study identified barriers, both interpersonal and infrastructural, that may hinder service implementation.

Educational supervision to support pharmacy professionals’ learning and practice of advanced roles

Pharmacy professionals are increasingly moving into advanced roles, including in primary care. In England, the publicly funded Pharmacy Integration Fund (PhIF) enabled employment and training of pharmacy professionals in new patient-facing roles, including general practice and care homes. In recognition of the need for support and supervision during work-based learning and building on established support structures in medicine and nursing, one of the providers of PhIF funded learning developed a supervision structure which mirrors arrangements for postgraduate medical specialty training. This paper describes what informed this supervision model, with a particular focus on educational supervision, its delivery, and the training which was developed to support supervisors. This supervision enabled pharmacy professionals moving into primary care to practise safely, manage workplace challenges, extend their roles and make progress with their education. This model illustrates the benefits of supervision in supporting post-registration learning to facilitate the development of advanced patient-facing clinical roles.

Factors affecting sense of belonging and academic achievement in MPharm students

Introduction

Academic achievement in higher education has been linked to academic ability and a student’s experiences at university. Factors affecting the student experience include demographics (age, gender, ethnicity), and contextual factors (living arrangements, sense of belonging (SOB)).1 Whether SOB is relevant to understanding pharmacy students’ academic achievement has not been investigated.

Aim

This study aims to investigate SOB in students on one MPharm programme and its associations with demographic / contextual factors and academic achievement.

Method

A questionnaire was distributed to all MPharm students at one university (n=601). It included a SOB instrument2 measuring five domains (perceived peer support, faculty support, classroom comfort, isolation, empathetic faculty understanding), demographic and contextual factors, and consent to link responses to end of year marks. Mean marks, % rank, one-way ANOVA with Tukey HST post hoc tests, independent samples t-tests and Pearson’s correlation co-efficient were calculated in SPSS v25 to investigate associations between SOB and demographic / contextual factors and academic achievement. Results: Four-hundred-and-forty-seven students responded (74.4%), of whom 80.1% consented to data linkage with assessment marks. Of the respondents, 317 (71.9%) were female, 408 (91.9%) were younger than 21 when commencing their MPharm, and 275 (61.5%) lived with other students. Respondents’ ethnicity was: 128 (32.8%) white, 158 (40.5%) asian, 53 (13.6%) black, 51 (13.1%) chinese. Analysis suggests SOB domains varied significantly in relation to demographic and contextual factors, with perceived peer support and perceived isolation in particular associated with multiple factors investigated (see Table 1).

Analysis of mean % rank (f=8.601, p=0.001) revealed that white students achieved significantly higher (64.6) than asian (51.5, p= 0.002), black (50.4, p=0.006), and chinese (41.9, p=0.014) students. Students who lived with other students achieved a significantly higher mean % rank (58.3), than those who did not (48.3, t=3.251, p=0.001). A positive correlation was identified between perceived peer support (r=0.211, p=0.001) and % rank. Perceived isolation was negatively correlated to % rank (r= -0.192, p=0.001).

Conclusion

Although limited to one UK school of pharmacy, yet with a good mix of student ethnicity, findings suggest important differences in the student experience, and that for some subgroups this may be associated with their academic achievement. This study offers valuable understanding of factors potentially impacting academic achievement, and provides insights to inform targeted interventions aimed at improving the student experience with a view to addressing SOB and achievement gaps. Further research is required to quantify the effect of the factors and their interdependence.

References

1. Mountford-Zimdars A, Sabri D, Moore J, Sanders J, Jones S, & Higham L. (2015). Causes of differences in student outcomes. Report for HEFCE by Kings College London, ARC Network and the University of Manchester. Available at: https://dera.ioe.ac.uk/23653/1/HEFCE2015_diffout.pdf accessed October 2020.

2. Hoffman M, Richmond J, Morrow J, & Salomone K. (2002). Investigating “Sense of Belonging” in First-Year College Students. Journal of College Student Retention: Research, Theory & Practice, 4(3), pp. 227–256.

Cross-sector pre-registration pharmacist placements in general practice in England: lessons from a national evaluation

Introduction

In 2019/2020, the Pharmacy Integration Fund commissioned delivery of cross-sector pre-registration pharmacist training incorporating 3–6 month placements in general practice (GP). GP placements were managed by Health Education England (HEE) and organised as one (or more) blocks, or as spilt weeks/days across base sector (hospital/community) and GP. Trainees had a pharmacist tutor at base and in GP.

Aim

to evaluate the implementation of cross-sector pre-registration pharmacy placements in GP in England, and to identify barriers and enablers of a successful placement.

Methods

A qualitative approach was taken, with case study sites purposively sampled for maximum variation: pharmacy base (hospital/community), number of pre-registration pharmacist trainees in base doing GP placement, length of GP placement, organisation of GP placement and geographical location. With consent, trainees and tutors identified as meeting sampling criteria were emailed invitation letters and participant information sheets. Where the trainee and their tutor(s) agreed to participate, semi-structured telephone interviews were conducted January - July 2020. Questions developed from literature(1, 2) and the HEE handbook were tailored to understanding trainees’ and tutors’ views on the implementation of pre-registration pharmacist placements in GP, including benefits, unintended consequences and impacts. Thematic analysis across sites was undertaken with a focus on exploring inter and intra group themes.

Results

Thirty-four interviews were completed in 11 study sites (5 GP/hospital; 6 GP/community pharmacy). Trainees and tutors considered GP placements had been successful. Contributing factors were: placement planning (induction, contingency arrangements for cover should GP tutor be unavailable); tutors working together (good communication and collaboration); GP tutor support (regular contact, reflection; identifying learning needs; opportunities for learning); integration of GP placements within training year (specific learning/training activities at base during GP placement); and GP tutors having backing of their organisation to supervise effectively. A lack of these impacted negatively. Trainees completed a wide spectrum of activities and gradually moved from administrative to clinical tasks. They built up confidence to undertake patient-facing activities, with more direct supervision at the beginning moving to indirect supervision using debriefing. Thirteen weeks in GP was considered an appropriate minimum duration by all trainees and tutors; those based in community felt that 26 weeks in GP provided more opportunities for clinical and consultation skills learning. Cross-sector experience facilitated a better understanding of patient pathways and the importance of holistic patient care. All trainees considered working in GP in future but highlighted the lack of a cross-sector GP foundation programme. Base tutors felt the time commitment was comparable to single sector placements. Base and GP tutors felt that a clear set of competencies for GP placements and a broader governance framework would ensure standards and consistency.

Conclusion

This is the first national evaluation of cross-sector pre-registration pharmacists in general practice placements in England. Sampling as case studies enabled data triangulation and generated a multi-faceted understanding on factors impacting GP placements. A key limitation was the volunteer bias associated with recruitment. Key attributes of a successful pre-registration cross-sector training experience are highlighted and can inform policy reforms including change from pre-registration to foundation year training.

References

1. Gray N. Review of Experience of Pre-registration Pharmacist Placements in the General Practice Setting – Final Report. 2019.

2. Jee SD, Schafheutle EI, Noyce PR. Is pharmacist pre-registration training equitable and robust? Higher Education, Skills and Work-Based Learning. 2019;9(3):347–58.

Implementing, embedding and sustaining simulation-based education: What helps, what hinders

OBJECTIVES

Although there is much evidence to support the use of simulation-based education (SBE) in undergraduate education of health care professionals, less attention has been paid to how SBE, viewed as a complex intervention, is implemented and becomes embedded and sustained. This paper aims to explore factors that inhibited or promoted SBE becoming normal practice in undergraduate health care professional programmes.

METHODS

Participants involved in the organisation, design and delivery of SBE in the north of England were recruited purposefully from higher education institutions (HEI) and National Health Service (NHS) Trusts through local networks for qualitative telephone interviews. Transcripts were analysed inductively using a hybrid approach involving simultaneous inductive open coding and deductive coding using normalisation process theory (NPT) as a theoretical lens.

FINDINGS

A total of 12 NHS staff from 11 trusts and seven individuals from four HEIs were interviewed. There was considerable variation in the approach taken to implementation across organisations, which resulted in varying degrees of embeddedness. Implementation was challenged or enabled by organisational leadership, professional buy-in and the development and maturity of the strategic approach. Variation in understanding of the scope and pedagogical aims of SBE led to inequity between professions and organisations in investment and participation, as well as design and delivery of SBE.

CONCLUSIONS

Given the complexity of SBE, best practice in implementation should be considered fundamental to the successful delivery of SBE. The findings provide an explanation of how contextual factors can support or hinder implementation to maximise potential benefits and learning outcomes; this understanding can be used to better inform development of SBE strategies and highlight potential factors needed to navigate contextual barriers so that learning outcomes can be maximised.

High-fidelity simulation-based education in pre-registration healthcare programmes: a systematic review of reviews to inform collaborative and interprofessional best practice

Simulation-based education (SBE) is recognized as an effective interprofessional teaching and learning method. Whilst there is a large volume of research evidence concerning elements of SBE there is a lack of clarity concerning foundational principles of best practice. This is important for educators wishing to utilize high-quality SBE to deliver interprofessional education. The aim of this review is to synthesize review evidence of SBE best practice in a broad range of pre-registration healthcare programs and contextualize findings in light of relevant educational theory. A systematic search of PubMed, Scopus, Medline/Ovid, British Nursing Index, and the Cochrane Library databases was undertaken in February 2020. Data extraction and quality evaluation were undertaken by two authors. Fifteen reviews were included. In addition to identifying barriers and enablers to implementation, three interdependent themes regarding SBE best practice were found: curriculum level integration and planning (curriculum level integration, the opportunity for deliberate repeated practice, distribution, and sequencing); simulation design and delivery (clearly defined learning outcomes and benchmarks, pre-brief, multiple learning strategies, interactivity and individualized learning, feedback, and debrief); and resources (facilitator competency, controlled environments). These themes broadly align with the social constructivist theory of experiential learning whereby structured opportunities to learn via concrete experience, reflective observation, abstract conceptualization, and active experimentation are provided through effective planning, design, and delivery of SBE. Interdependencies suggest that integration of SBE at curriculum-level enables planning and implementation of best practice principles which are associated with effective learning, which also inform and facilitate the availability of adequate simulation resources.

Does curriculum reform influence perceived preparedness for practice of graduates? A comparison of two cohorts

OBJECTIVES

Using performance standards (PS) set by the General Pharmaceutical Council (GPhC), this study compared the views of two consecutive cohorts of MPharm graduates from one pharmacy school, pre- and postcurriculum reform on preparedness for practice (PFP).

METHODS

Preparedness was investigated using the GPhC's 76 PS, grouped into three domains of practice: professional activity, interpersonal skills and ability to provide an effective pharmaceutical service. Respondents were asked to (dis)agree with how they perceived the MPharm had sufficiently prepared them to meet each of the 76 PS. Differences in mean score between the two cohorts were analysed via the independent-samples t-test. Regression analysis was used to determine whether the year of graduation was a predictor of PFP once other variables were controlled for.

KEY FINDINGS

A response rate of 30.1 and 42.4% was achieved for the 2014 and 2015 cohort, respectively. Significantly more respondents of the 2015 cohort (postcurricular reform) felt prepared for practice than respondents of the 2014 cohort (precurricular reform), for all domains of preregistration performance standards. Multiple regression analysis demonstrated that year of graduation was the independent variable that made the strongest unique contribution to explaining PFP (β = 0.527, P ≤ 0.005).

CONCLUSIONS

Overall findings of this study suggest that increasing adoption of undergraduate active learning opportunities and integrating learning of core subjects may enhance the overall feeling of preparedness for practice.

Investigating the organisational factors associated with variation in clinical productivity in community pharmacies: a mixed-methods study

Background

Community pharmacies play a key role in health-care systems, dispensing prescriptions and providing medicine-related services. Service provision varies across community pharmacy organisations and may depend on organisational characteristics, such as ownership, staffing and skill mix.

Objectives

To inform the commissioning of community pharmacy services by (1) exploring variation in clinical productivity (levels of service delivery and service quality) in pharmacies, (2) identifying the organisational factors associated with this variation and (3) developing a toolkit for commissioners.

Design

Mixed-methods study: community pharmacy survey, administrative data analysis, patient survey, stakeholder interviews and toolkit development.

Setting

Nine socioeconomically diverse geographical areas of England.

Participants

Stage 1: community pharmacies in nine study areas. Stage 2: in 39 pharmacies, two consecutive samples of approximately 30 patients each following receipt of (1) dispensing and (2) medicines use review (MUR) services. Pharmacy and commissioning representatives from across all types of pharmacy and study sites.

Main outcome measures

Stage 1: dispensing, MUR, new medicines service volume and safety climate. Stage 2: patient satisfaction, Satisfaction with Information about Medicines Scale (SIMS) and Medication Adherence Report Scale (MARS).

Data sources

Stage 1: (i) community pharmacy activity data; (ii) socioeconomic and health needs data; and (iii) community pharmacy questionnaire (ownership type, organisational culture, staffing and skill mix, working patterns, management structure, safety climate, pharmacy–general practice integration), all linked by pharmacy postcode and organisational ‘F’ code. Stage 2: (i) patient questionnaire (background, patient satisfaction, SIMS, MARS); (ii) semistructured stakeholder interviews (variation in quantity and quality of service provision, opportunities and barriers to clinical productivity, mechanisms by which different organisational characteristics may help or hinder clinical productivity). Quantitative data were analysed by fitting a series of fixed-effects linear, logistic and multilevel logistic regression models in Stata® (version 13; StataCorp LP, College Station, TX, USA). Qualitative data were analysed thematically using a framework approach in NVivo10 (QSR International, Warrington, UK).

Results

In stage 1, 285 out of 817 pharmacy questionnaires were returned [valid response rate 34.6% (277/800)]. In stage 2, 1008 out of 2124 patient questionnaires were returned [valid response rate 46.5% (971/2087)]. Thirty pharmacy and 10 commissioning representatives were interviewed face to face or by telephone. Following integration of stage 1 and 2 findings, clinical productivity was associated with pharmacy ownership type, organisational culture, staffing and skill mix, and pharmacy–general practice relationships. Extra-organisational associations included local area deprivation, age profile and health needs, pharmacy location, public perceptions and expectations, supply chain problems, commissioning structures/processes, levels of remuneration and legal/regulatory constraints. Existing arrangements for monitoring clinical productivity focused primarily on quantity.

Limitations

Non-random selection of study sites and non-participation by four major pharmacy chains limited generalisability. Investigation of the full scope of pharmacy service provision was prevented by a lack of available activity data for locally commissioned services. Quantitative exploration of service quality was limited by available validated measures.

Conclusions

These findings have important implications for community pharmacies and service commissioners, highlighting the importance of ownership type, organisational culture, staffing and skill mix for maximising the delivery of high-quality pharmacy services and informing the development of a commissioners’ toolkit.

Future work

Future studies should (1) develop tools to measure community pharmacy service quality; (2) describe and evaluate different models of skill mix; and (3) explore how services are commissioned locally from community pharmacies and the extent to which local needs are met.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

Patient-centred professionalism in pharmacy: values and behaviours

PURPOSE

Research on patient-centred professionalism in pharmacy is scarce compared with other health professions and in particular with pharmacists early in their careers. The purpose of this paper is to explore patient-centred professionalism in early career pharmacists and to describe reported behaviours. DESIGN/METHODOLOGY/APPROACH - This study explored patient-centred professional values and reported behaviours, taking a qualitative approach. In all, 53 early-career pharmacists, pharmacy tutors and pharmacy support staff, practising in community and hospital pharmacy in England took part; the concept of patient-centred professionalism was explored through focus group interviews and the critical incident technique was used to elicit real-life examples of professionalism in practice.

FINDINGS

Triangulation of the data revealed three constructs of pharmacy patient-centred professionalism: being professionally competent, having ethical values and being a good communicator.

RESEARCH LIMITATIONS/IMPLICATIONS

It is not known whether our participants' perspectives reflect those of all pharmacists in the early stages of their careers. The data provide meaning for the concept of patient-centred professionalism. The work could be extended by developing a framework for wider application. Patient-centred professionalism in pharmacy needs further investigation from the patient perspective.

PRACTICAL IMPLICATIONS

The findings have implications for pharmacy practice and education, particularly around increased interaction with patients.

SOCIAL IMPLICATIONS

The data contribute to a topic of importance to patients and in relation to UK health policy, which allocates more directly clinical roles to pharmacists, which go beyond the dispensing and supply of medicines.

ORIGINALITY/VALUE

The methods included a novel application of the critical incident technique, which generated empirical evidence on a previously under-researched topic.

Identifying and managing performance concerns in community pharmacists in the UK

OBJECTIVES

To explore current arrangements for identifying and managing performance concerns in community pharmacists in the UK.

METHODS

Semi-structured qualitative telephone interviews were conducted with 20 senior managers from community pharmacies and locum agencies.

RESULTS

A strong emphasis was placed on business performance alongside other aspects of professional performance in the identification of performance concerns in pharmacists. The majority of concerns were identified reactively, through customer complaints, peer- or self-referral, or following a dispensing error. Community pharmacies sought to manage performance concerns internally where possible, but only the larger organizations had the infrastructure to provide their own training or other remedial support. Several challenges to identifying and managing performance concerns were identified. There were few mechanisms for identifying and supporting locum pharmacists with performance issues.

CONCLUSIONS

Being 'for-profit' organizations, community pharmacies may prioritize business performance over ensuring the professional performance of pharmacists, the responsibility for which would be left to the individual pharmacist. This may be detrimental to the quality of care provided. With the growth of independent sector providers more widely, these findings may have implications for the regulation of other health care professionals' performance.

Affordability of medicines and patients' cost-reducing behaviour: empirical evidence based on SUR estimates from Italy and the UK

INTRODUCTION

Studies have demonstrated that co-payments on medication reduce the consumption of both non-essential and essential drugs, and that the latter can lead to worse health outcomes. Far less is known about how patients cope with the cost of medication, particularly if affordability is an issue, and how this compares across two countries with different prescription charge policies. Therefore, the aim of this article is to explore empirically how, and to what extent, costs incurred by patients influence their decision-making behaviour in accessing medicines.

METHODS

Based on the findings from focus groups, a questionnaire was designed that addressed medication cost issues relevant to patients in both the UK and Italy. Using an econometric model, several hypotheses are tested regarding patients' decision-making behaviour and how it is influenced by health status, sociodemographic characteristics and the novel concept of a self-rated affordability measure.

RESULTS

Quite a large percentage of patients (70.3% in the UK and 66.5% in Italy) stated they have to think about the cost of medicines at least sometimes. Respondents adopted numerous cost-reducing strategies, subdivided into (i) those initiated by patients and (ii) those involving self-medication. Their use was strongly influenced by income and drug affordability problems, but the self-rated affordability measure was a stronger predictor. Commonly used strategies were not to get prescribed drugs dispensed at all, prioritizing by not getting all prescribed items dispensed or delaying until the respondent got paid. Furthermore, respondents with affordability issues were also cost-conscious when self-medicating with over-the-counter (OTC) products for minor conditions such as dyspepsia. Despite patients in both countries using cost-reducing strategies, their use was more pronounced in the UK, where the prescription charge was significantly higher than in Italy.

DISCUSSION/CONCLUSION

The results from this study provide detail on the kinds of strategies patients use to reduce the cost burden of prescription charges, and support previous research showing they may be foregoing essential medication. Because the same questionnaire was applied in two European countries, where the national health systems aim to provide healthcare services that are accessible to all citizens in need, it offers interesting insights for policy makers in other countries, where patients may have to pay a larger share of their drugs out-of-pocket, such as the US.