Community Pharmacists In England Research Articles

Integration and differentiation: A conceptual model of general practitioner and community pharmacist collaboration

Background The drive for integrative systems and collaboration across organizations and professions involved in the provision of health and social care has led to the development of a number of scales and models that conceptualize collaborative behavior. Few models have captured the dynamics of the collaboration between community pharmacy and general medicine, 2 professional groups that are increasingly being encouraged to adopt more collaborative practices to improve patient care. Objectives This article presents a new model of collaboration derived from interviews with general practitioners (GPs) and community pharmacists in England involved in service provision that required some form of collaboration. Methods Qualitative interviews were conducted with purposive samples of 13 GPs and 18 community pharmacists involved in the provision of local pharmaceutical services pilots and 14 GPs and 13 community pharmacists involved in the provision of repeat dispensing. Results The model highlights key components of collaboration, including the importance of trust, communication, professional respect, and “knowing” each other. It is argued here that previous models fail to recognize the asymmetry and differentiation between GPs and community pharmacists, including differences in perception toward and importance assigned to trust and communication. GPs were found to adopt demarcation strategies toward community pharmacies and pharmacists, with independent pharmacies being favored over multiple chains and regular pharmacists favored over locum/sessional pharmacists. This differentiation was repeatedly highlighted by GPs and found to affect their ability or willingness to collaborate. Conclusion The model provides a foundation for the future development of strategy and research focused on the improvement or study of collaborative relationships between community pharmacy and general practice.

Evaluation of the impact of recent changes in postgraduate continuing education for community pharmacists in England

Abstract Postgraduate continuing education for community pharmacists in England has undergone a radical change since the establishment of the Centre for Pharmacy Postgraduate Education (CPPE) in 1992. The present study was undertaken to assess the impact of the introduction of the CPPE on levels of participation and attitudes towards continuing education. Comparisons are drawn with an analysis made in 1991. Results showed that 76.8 per cent of respondents had participated in CPPE-based continuing education, as either workshops or distance learning. This level of participation is far higher than that previously recorded. Those pharmacists who attended the workshops also tended to request distance learning packages, while a significant proportion of users of distance learning declined to attend workshops. Owners of community pharmacies were significantly more likely than managers to use computer assisted learning material. Attitudes concerning restraints against participation in continuing education focused on the value pharmacists place on their spare time and the absence of a postgraduate education allowance for community pharmacists.

The clinical autonomy of community pharmacists in England. 2. Key findings

Abstract Objective To investigate the perceived autonomy of community pharmacists in clinical settings and any differences between subgroups of pharmacists. Method A specially designed instrument, a central feature of which was 12 scenarios, was distributed by post to a systematic random sample of 2000 community pharmacists in England selected from the Royal Pharmaceutical Society of Great Britain database. Data were analysed using techniques including contingency tables, main effects binary logistic modelling and Cronbach's alpha scores. Key findings The response rate was 31% (626 community pharmacists). Comparison with a regional survey confirmed that the respondents were representative of the community pharmacy workforce. ‘Reality checks’ indicated that, notwithstanding variations, the scenarios were perceived as being within the experience of many respondents and of importance for clinical autonomy. Community pharmacists' perceptions of their autonomy were mainly affected by occupational status and work pattern. Contractor pharmacists were much more likely to opt for high autonomy responses than employees and locums. Similarly pharmacists who worked full-time were more likely to opt for these responses than those working part-time. Little association was found between high autonomy and gender, size of employing organisation and length of time qualified. Conclusions Differences in perceived autonomy may be due, in part, to the extent to which organisational and managerial constraints operate. With the moves towards an enhanced role for community pharmacists in a primary care-led NHS, these differences should be taken into account in safeguarding pharmacists' professional standing, policy making and managing service delivery.

Professional practices and experiences with complementary medicines: a cross-sectional study involving community pharmacists in England

Abstract Objective As retailers of complementary medicines (CMs), pharmacists are well placed to advise consumers on the safe and effective use of these products; where CMs are available in pharmacies, pharmacists should be well informed about such products. This study explored the extent to which CMs are available in community pharmacies in England, and examined pharmacists' experiences, professional practices and training with regard to these products. Method A cross-sectional study was conducted, involving a structured questionnaire posted to community pharmacists. Coded follow-up mailings were sent to non-responders after 2 and 4 months, and a reminder telephone call made after 3 months. Setting All community pharmacists in six areas (Devon, Cornwall, Bradford, Leeds, Manchester, Stockport) of England (total n = 1337). Key findings The response rate was 66.5%. Overall, 92% of respondents reported that CMs (excluding vitamins/minerals) are sold in the pharmacy in which they practise, 81% had received requests from patients/consumers for specific CMs in the previous year, and 58% had recommended CMs. Around 70% of respondents rarely/never asks about CMs use when counter-prescribing conventional medicines or when receiving reports of suspected adverse drug reactions (ADRs) associated with conventional medicines. In total, 40% of respondents had undertaken training in complementary/alternative medicine (CAM). Pharmacists who had undertaken training were more likely to ask patients/consumers specifically about use of CMs when counter-prescribing conventional over-the-counter (OTC) medicines (37.0% versus 23.4%, respectively; χ2 = 17.4; P = 0.0003) and when receiving reports from patients/customers of suspected ADRs associated with conventional (prescribed or OTC) medicines (35.6% versus 23.8%, respectively; χ2 = 13.0; P = 0.0003). Conclusion CMs are widely available in pharmacies in England, and pharmacists interact with users of these products. An opportunity exists for pharmacists to embrace a professional role as expert advisors on CMs. However, pharmacists' training, professional practices and competence with respect to CMs first need to improve.

The clinical autonomy of community pharmacists in England. 1. Designing and testing a survey instrument

Abstract Objective To design and test an instrument for measuring variations in the extent to which community pharmacists perceive they can exercise autonomy in clinical settings. Method To assist with the design of the instrument a focus group comprising practising community pharmacists from a variety of backgrounds was used. The group contributed ideas for 12 scenarios, based on critical incidents in community pharmacy, which comprise the core of the instrument, and a range of responses that reflect varying degrees of autonomy. Testing involved two pilot surveys in different areas of the UK and rigorous appraisal by the research team and focus group. Various refinements were subsequently made including simplification of the scale of responses and the addition of ‘reality checks’. Key findings Data from the two pilots provided evidence of variations in perceived autonomy between contractors, employees and locums. Conclusions The instrument was deemed to meet the criteria of credibility; reliability, in terms of consistency; and criterion and construct validity and therefore was suitable for a full-scale survey which is reported in a second paper.

`Islands' and `doctor's tool': the ethical significance of isolation and subordination in UK community pharmacy

Empirical ethics research is increasingly valued in offering insights into how ethical problems and decision-making occur in healthcare. In this article, the findings of a qualitative study of the ethical problems and decision-making of UK community pharmacists are presented, and it is argued that the identified themes of pharmacists' relative isolation from others and their subordination to doctors are ethically significant. Semi-structured interviews were conducted with 23 community pharmacists in England, UK. Analysis of interviews revealed that isolation involved separation of pharmacists from their peers, other healthcare professionals, patients and customers. Such isolation is argued to be inimical to ethical practice - impeding ethical discourse as understood by Habermas, resulting in a form of anomie that inhibits the transmission of professional values, leading to a lack of proximity between pharmacist and patient or customer that may impede ethical relationships and resulting, psychologically, in less ethical concern for those who are less close. Pharmacists' subordination to doctors not only precipitated some ethical problems but also allowed some pharmacists to shift ethical responsibility to a prescribing doctor, as in the case of emergency hormonal contraception. The emergence of atrocity stories further supports a culture of subordination that may cause ethical problems. The study has implications for community pharmacy practice in terms of supervision issues, developments such as prescribing responsibilities and how ethical values can be taught and communicated. The potential for isolation and subordination in other healthcare professions, and resultant ethical problems, may also need to be addressed and researched.

Effect of national guidelines on prescription of methadone: analysis of NHS prescription data, England 1990-2001

Though there is strong evidence to support the use of methadone maintenance for opiate addiction1 it is often delivered poorly. Evidence based guidelines were developed in 1996 and 1999 (see...