Abstract
BackgroundAs primary healthcare professionals, community pharmacists have both opportunity and potential to contribute to the prevention and progression of chronic diseases. Using cardiovascular disease (CVD) as a case study, we explored factors that influence community pharmacists’ everyday practice in this area. We also propose a model to best illustrate relationships between influencing factors and the scope of community pharmacy practice in the care of clients with established CVD.MethodsIn-depth, semi-structured interviews were conducted with 21 community pharmacists in New South Wales, Australia. All interviews were audio-recorded, transcribed ad verbatim, and analysed using a “grounded-theory” approach.ResultsOur model shows that community pharmacists work within a complex system and their practice is influenced by interactions between three main domains: the “people” factors, including their own attitudes and beliefs as well as those of clients and doctors; the “environment” within and beyond the control of community pharmacy; and outcomes of their professional care. Despite the complexity of factors and interactions, our findings shed some light on the interrelationships between these various influences. The overarching obstacle to maximizing the community pharmacists’ contribution is the lack of integration within health systems. However, achieving better integration of community pharmacists in primary care is a challenge since the systems of remuneration for healthcare professional services do not currently support this integration.ConclusionTackling chronic diseases such as CVD requires mobilization of all sources of support in the community through innovative policies which facilitate inter-professional collaboration and team care to achieve the best possible healthcare outcomes for society.
Highlights
Cardiovascular disease (CVD) is the leading cause of death in high- and middle-income countries, and ranks among the top five causes in low-income countries [1]
This paper focuses on an in-depth exploration of factors influencing community pharmacists in their everyday practice in the secondary prevention of cardiovascular disease (CVD)
Sampling and recruitment The study was conducted in New South Wales (NSW), a state where the highest proportion (30%) of all employed pharmacists in Australia was located [10]
Summary
Cardiovascular disease (CVD) is the leading cause of death in high- and middle-income countries, and ranks among the top five causes in low-income countries [1]. The use of secondary prevention medicines for CVD in high-, middle-, and low-income countries has been found to be suboptimal [4], while the provision of continuing support regarding lifestyle modifications to patients with established CVD after discharge following hospitalization has been found to be lacking [5]. To strengthen the prevention of chronic diseases such as CVD, the mobilization of financial, human and technical resources through a cooperative and inclusive approach has been proposed [6]. This represents a momentum to enhance roles of untapped healthcare resources, including pharmacists [7].
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