Community Pharmacies Research Articles

Antimicrobial stewardship in sub-Saharan African community pharmacies: a systematic review of community pharmacists’ knowledge, practice and challenges faced

Abstract Introduction The indiscriminate use of antimicrobials contributes significantly to antimicrobial resistance (AMR). The World Health Organization (WHO) recommends antimicrobial stewardship (AMS) as one of the global sustainable development interventions to tackle AMR. Implementation of AMS interventions have been documented to be successful in high-income countries 1, however, there is paucity of data regarding the implementation and effectiveness of AMS in low-income settings including sub-Sahara Africa (SSA). Community pharmacies in the SSA play a critical role in the dispensing of medicines, including antibiotics. Aim To evaluate community pharmacists' knowledge, practice, and challenges faced in relation to AMS in SSA community pharmacies. Methods The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) framework guided the review. We searched six electronic databases (PubMed, Web of Science, ProQuest Central, Google Scholar, African Journal Online and Wiley Online library) from January 2010 to December 2022. Reference lists of included articles were screened for additional studies. Studies published in English that described AMS interventions, antibiotic dispensing practices, community pharmacists’ knowledge and perceptions of AMS/AMR were included. Literature reviews and systematic reviews were excluded. AMS in hospital pharmacy and animal studies were also excluded. Two reviewers independently screened the abstracts and full texts according to pre-defined inclusion criteria. Disagreements were resolved through discussion. The Mixed Methods Appraisal Tool (MMAT) was employed to assess the quality of the included studies2. Data were extracted using a standardised form in Microsoft excel and double checked for accuracy. Data were synthesised using narrative synthesis. The review protocol was registered with PROSPERO (CRD42023381320). The study did not require ethical approval because it did not involve conducting primary or secondary research involving human participants. Results The review identified 1972 articles, of which 23 studies met the inclusion criteria. Studies varied in settings, design, and data collection methods. Two broad categories were identified from the narrative synthesis. (1) Community pharmacists’ knowledge, attitude, perception, and dispensing practices (n=20). Studies reported that community pharmacists displayed an understanding of how antibiotics work. They also acknowledged threats posed by AMR. Some studies reported misconceptions on clear guidelines about the practical implementation of AMS, other studies described good adherence to antibiotic dispensing practices, including taking medication histories, assessing symptoms, advising on completion of antibiotic courses and making referrals. One study described the perception of community pharmacists of AMS as crucial for improving patient care. (2). Determinants of non-prescription antibiotic sales (n=3). The studies explored factors influencing the sale of antibiotics without prescription. Studies identified pharmacy owners’ expectations (profitability) and lack of public awareness regarding the risks of non-prescription antibiotic use as contributing factors. Limited patient access to doctors and low economic status in SSA were also cited as determinants. Conclusions Community pharmacists have knowledge of antibiotics, and they also acknowledged the importance of AMS. There were also positive dispensing practices despite existing challenges regarding implementation of AMS and sales of antibiotics without prescription. Further research should prioritize well-designed studies that evaluate the effectiveness of AMS in this setting and address the challenges identified. Heterogeneity of study methods limits the generalisability of findings.

Student experiences of cultural competence encounters during MPharm placements and foundation year training

Abstract Introduction Cultural competence is the ability of a healthcare professional to work effectively with clients from different backgrounds. With 18.3% of the UK population identifying with non-white1, pharmacists need to be culturally competent as they have a patient-facing role. Having a multicultural society would require culturally competent pharmacists to effectively deliver healthcare services to patients of different cultures. Exploring pharmacy students' experiences of CC encounters during their MPharm placements and foundation year training is crucial as it helps identify the challenges and barriers they may face when providing healthcare to diverse populations. Understanding these experiences can inform the development of effective training programs to enhance cultural competence among future pharmacists and highlight the impact of cultural factors on patient care and outcomes. Ultimately, this exploration contributes to the overall goal of improving healthcare delivery and promoting patient-centred, culturally sensitive pharmacy practice. Aim This study aimed to explore experiences of student regarding cultural competence encounters during placements and training. Methods A qualitative study was conducted between Oct – Dec 2023. All currently enrolled students in Parts 3, 4 and the foundation year were eligible to participate. Convenience sampling was used. Semi-structured interviews were conducted online using a pilot-tested script. Interviews were audio and video recorded and held online through a Microsoft Teams account, where an automatic electronic transcript was generated. Initial codes were generated from each transcript, to create themes and sub-themes. The researcher scrutinised the themes before defining and naming them. Ethical clearance was obtained. Results A total of 15 students (8 males and 7 females) participated in the study. Four participants were from year 3, five were from year 4, and six were from the foundation year. Six participants were from Asian backgrounds, four were Black, and three were White. All students had a placement in hospital, while 14 had a placement in community pharmacy in addition to hospital, and 8 had a placement in a GP surgery in addition to the hospital and community pharmacy. Key themes identified were 1) Impact of culture on patient health including language barriers and ethnic diversity, 2) Influence of personal culture on practice during placements and training such as using patient’s language to communicate, personal cultural awareness, and the influence of religious teachings, 3) Recommendations for improving cultural competence training in MPharm programme such as having more case studies. Conclusion This study provides a unique exploration into the experiences of pharmacy students and shows the importance of immersing in diverse cultural groups during placements and foundation training. There is a need to enhance pharmacy students’ training through curricular reforms that build on theoretical knowledge to instil confidence during placements and training. This approach will equip future pharmacists to navigate complex cultural dynamics, to meet the demands of an inclusive healthcare system. Ultimately this research extends beyond the current reforms to the MPharm curriculum, and advocates for an equitable and inclusive healthcare system to reduce health disparities. The predominance of participants from Asian backgrounds may limit the generalisability of the findings. Reference 1. Office for National Statistics. Measuring equality: A guide for the collection and classification of ethnic group, national identity and religion data in the UK. Office for National Statistics 2021 https://www.ons.gov.uk/methodology/classificationsandstandards/measuringequality/ethnicgroupnationalidentityandreligion. Accessed 20 Dec 2023.

Exploring facilitators and barriers to scope of practice expansion with Pharmacist independent prescribers in North Wales: a qualitative study

Abstract Introduction Independent non-medical prescribing allows qualified nurses, pharmacists and other healthcare professionals to prescribe within their competence, which is initially narrow in scope. Previous research identified that this competence requirement has potential to limit pharmacist independent prescribers’ (PIPs) ability to expand their prescribing scope1. The Royal Pharmaceutical Society has published guidance for PIPs on expanding scope of practice after qualification2. Research asking how, why and what factors affect the process of scope expansion is lacking. Aim To explore the reasons why PIPs may or may not expand their prescribing scope of practice after qualification and what factors may prevent or enable this. Methods A qualitative semi-structured interview study was utilised. Participants were PIPs working within North Wales who self-reported at least 2 years’ experience as a prescriber, prescribing at least monthly and had expanded their scope of practice since qualification. Recruitment was via gatekeepers. The study obtained ethical approval from Cardiff University School of Pharmacy Research Ethics Committee (Reference 2324-03) and was registered with Betsi Cadwaladr University Health Board. Purposive sampling ensured inclusion of pharmacists from multiple pharmacy sectors. Interviews were face-to-face or online and recorded on MSTeams®. Deidentified verbatim transcripts were analysed via inductive thematic analysis. Results Ten participants were interviewed, from a mixture of hospital, primary care, out of hours and community pharmacy sectors. Themes identified included intrinsic factors (experience and attitude) and extrinsic factors (support, service factors, governance and workplace social context). Experience sub-themes included confidence, a holistic approach and awareness of professional boundaries as facilitators for scope expansion. Attitude included being motivated and fulfilment in the role. Support was a key factor including time, funding, mentorship, peer and managerial support – all identified as facilitators and lack of each as a barrier. Other support sub-themes included structured training programmes, such as the All Wales 111 competency framework, easy access to experienced colleagues for advice on cases and space for reflective thinking, either as a team or with a mentor. Governance was identified as both a barrier and facilitator, with some appreciating the structure of local prescribing policies whilst others found it restrictive. Service factors included new roles, an expectation of the role to prescribe for multiple conditions, such as in 111 or the community pharmacy independent prescribing service, changes in team skill mix, service review and patient requests. Workplace social context that facilitated scope expansion included independent prescriber role models, nurturing teams and working within a multidisciplinary team. A lack of multidisciplinary working, such as lone working in community pharmacy, was seen as a barrier. Discussion / Conclusion Themes identified align with previously published literature and models on expertise development in independent prescribing(4), suggesting that expanding scope of prescribing aligns with expert practice development needs. This exploratory study highlights factors that PIPs found both helpful and a hindrance for expanding their prescribing scope of practice, although limited by the small sample size. Further research is needed to corroborate these findings with other professions and in other parts of the UK before incorporating into future guidance.

Patient, financial and environmental impacts of a Medicines Optimisation in Care Homes (MOCH) service on polypharmacy following structured medication reviews

Abstract Introduction An NHS community trust was commissioned in February 2023 to deliver a MOCH service to about 15,000 care home residents across an Integrated Care System (ICS). Pharmacists in the MOCH service undertake Structured Medication Reviews (SMRs) to reduce inappropriate polypharmacy, working closely with care homes, General Practitioners (GPs) and community pharmacies. Pharmacy technicians undertake medication reviews to reduce low clinical value medicines. A patient-centred approach means medicines are stopped or changed following shared-decision making with the resident, carer or family. Aim To find out the impact of the MOCH service on reducing inappropriate polypharmacy, reducing medicines-related harm for residents, and to report financial savings and the environmental impact through reduction of CO2 emissions. Methods This service evaluation was approved by the Trust. No ethics approval was required. Quarterly and 6- monthly data sets covering one week reported by the MOCH service in the financial year 2023/2024 were used. These data sets were extrapolated to a full year. This service reported the number of medicines stopped, started and changed over one week of each quarter for SMRs and, pharmacy technicians reported every six months. Cost savings were calculated using the drug tariff based on continued use of medicines for one year. Pharmacists reported reduction in harm from medicines every six months based on a health interventions risk assessment scoring tool, assessing how many residents had potentially avoided moderate to serious harm following a SMR. The carbon savings were calculated based on financial savings from medicines stopped or changed using the DEFRA SIC 2020 Greenhouse Gases emission factor 0.621(kgCO2e/£) for pharmaceuticals1. Results In the first year the MOCH service completed SMRs for 11,363 residents (75% of care home residents in the ICS). Around 20,000 medicines for residents were stopped (one to two medicines per resident). Pharmacists predicted moderate to high-risk harm from medicines was reduced in approximately 4,200 residents. The cost savings from medicines stopped or changed was approximately £2.8 million, which translated to carbon savings of 1,773,340 kgCO2e, the equivalent of removing 644 cars from the road for one year. Discussion and Conclusion Reducing inappropriate polypharmacy resulted in a reduction of treatment burden, potential harm to residents2 and financial savings. Social impacts include reducing workload for care homes, GPs and community pharmacies, ultimately increasing the capacity of this stretched workforce (less dispensing, reduced risk of error, shorter medicine rounds and more time for residents). The environmental impact goes beyond carbon savings from pharmaceuticals to include reduction in workload, consumables, delivery and cost of waste disposal and prevention of hospital admissions.3 The limitations of this evaluation are that data collected over one week and then extrapolated may not be representative of all the other weeks in terms of cost savings and reduction of harm to residents, however MOCH pharmacists undertake peer reviews of reduction in harms to mitigate this. Costs incurred in making the financial savings were excluded. As the demographic of older people rises in the next 20 years a medication review is increasingly important to residents, the health economy, workforce, and our environment.

Qualitative study exploring perceptions and experiences of Pharmacy technicians’ professional identity in NHS Scotland

Abstract Introduction Pharmacy technicians worldwide share workplace challenges including: job role; scope of practice; level of pharmacist’ supervision; and education1. In the USA, Canada and many European countries, pharmacy technicians require national or state registration2. In the UK, Pharmacy technicians became registered professionals in 2011, as a means of improving patient safety through compliance with General Pharmaceutical Council (GPhC) standards. There are approximately 2,500 pharmacy technicians and 5,500 pharmacists registered with the GPhC in Scotland3. Given the importance of professional identity, and the lack of research exploring pharmacy technicians’ professional affiliation, we explored the perspectives and experiences of pharmacy technicians’ professionalism across Scotland. Aim To explore pharmacy technicians’ perceptions and experiences of their professional status and professional identity. Methods Following West of Scotland Research and Ethics Service Scientific Officer’s approval, Pharmacy technicians from all fourteen Scottish territorial health boards were invited by email using snowball sampling technique to provide a national representation. A draft semi-structured interview was piloted on four pharmacy technicians. Between May and August 2023, 36 pharmacy technicians were recruited: 23 from acute services; mental health (n=1); rehabilitation hospitals (n=1); primary care (n=8); and community pharmacy (n=3). Twenty two participants were interviewed in person and 14 on line. Interviews lasted between 17-91 minutes, were audio recorded, transcribed verbatim and accuracy checked, then analysed thematically using a framework approach and NVivo software. Three researchers analysed data including initial coding, categorisation, and theme generation. Any disagreements were discussed and addressed within the research team. Results Seven themes emerged from the data describing pharmacy technicians: feeling stuck in the shadow of pharmacists; underrepresented in policy and practice; and marginalised, undervalued and underpaid. There was frustration at the lack of awareness of pharmacy technician roles amongst the wider healthcare team. Primary care pharmacy technicians were thought to have more opportunities than secondary care colleagues. There was a pervasive feeling that pharmacy technicians were increasingly squeezed between pharmacists and support workers and a lack of confidence and feeling unsupported in the delivery of clinical roles. Pharmacy technicians acknowledged that they may not have used their initiative to take new opportunities, but did not feel they had sufficient clinical and educational opportunities. Catalysts to professional development were recognised including pharmacy technician led management and leadership, readiness to undertake traditional pharmacist roles and the potential positive impact of strengthened professional identity. Interviewees described the absence of a structured, funded career framework, and lack of post-registration higher-level professional qualification as inhibiting increased responsibility and scope of practice. Discussion/Conclusion Professional registration does not appear to have strengthened pharmacy technicians’ professional identity. There is a pervasive lack of development opportunities impacting negatively on pharmacy technicians and therefore, service delivery across Scotland. A review of defined roles is required. A lack of previous qualitative evaluation limits comparisons with the perceptions and experiences of pharmacy technicians worldwide. Findings offer a starting point to inform practice and policy. Further research could explore pharmacy technicians’ perceptions of the potential impact of the emerging career framework on developing roles and responsibilities. Keywords: Pharmacy technician, Professional identity

Exploring the career aspirations of pre-registration trainee and qualified pharmacy technicians in NHS Birmingham and Solihull using a self-administered questionnaire

Abstract Introduction The NHS Long-Term Workforce Plan (LTWP) recommends expanding the number of pharmacy technicians to support transformation across the pharmacy workforce.1 Birmingham and Solihull Pharmacy Faculty (BSPF) undertook workforce planning, identifying challenges around recruitment and retention. Aim To identify the career aspirations of pre-registration trainee pharmacy technicians (PTPTs) and pharmacy technicians (PTs) to improve recruitment and retention and inform the BSol pharmacy workforce strategy. Method A self-administered online questionnaire (Microsoft Forms) was developed and piloted before emailing to PTPTs and PTs via the BSPF members to all sectors during November to December 2023. Themes included career aspirations (and support required to achieve these), views on career progression and pathways (and skill utilisation), training received, opinions on cross-sector working, retention and concerns post qualification. An excel spreadsheet of downloaded responses were analysed using descriptive statistics. Ethical approval was not required. Results PTPTs: Responses received were 29 (45%) out of 64 ICS PTPTs from all sectors. The majority, 20 (69%) were from secondary care, two (7%) worked cross-sector. Twenty (69%) were women, with seventeen (27%) aged 25 years and above on entering training. Post qualification, 21 (72%) preferred secondary care; role expectations included medication histories, accuracy checking and patient facing work. Post qualification concerns were autonomy, responsibility, utilising skills and changing sector. PTs: Responses received were 62 (13%) out of 477 ICS PTs from all sectors. The majority, 21 (34%) were from secondary care, six (10%) worked cross-sector. Fifty (81%) were women, length of experience varied with 16 (26%) working for 25 years or more. Common themes PTs identified limited career progression (clinical and leadership), feeling undervalued, work-related stress and salary as factors for leaving the profession. PTPTs and PTs identified location, continuity, familiarity, and progression as reasons for retention. Seventeen (27%) PTs said their skills were underutilised, 25 (40%) stated lack of opportunities affected progression. Only 17 (27%) said their organisation had a career pathway. Twenty (69%) PTPTs expected post-qualification training, but 17 (27%) PTs had received no training in the last three years (or gave no reply). Educational, clinical and leadership roles were common career aspirations for both PTPTs and PTs, facilitators being training opportunities, encouragement from seniors, cross-sector experience and creation of career pathways. Nineteen (66%) PTPTs and 46 (74%) PTs desired cross-sector working. All PTPTs were unfamiliar with other pharmacy sectors, 12 (41%) wanted shadowing opportunities. Discussion / Conclusion The study informs the BSol pharmacy workforce strategy to include: cross/multi-sector working, increase novel ‘top-of-license’ roles and develop career pathways for PTs, to support the NHS LTWP. PTPTs results suggest systems should recruit from an audience wider than schools and colleges, to explore this, the BSPF have funded a BSol PT fellowship. The BSPF are providing shadowing opportunities and the promotion of different pharmacy sectors in colleges. This study provides an insight into career aspirations to improve recruitment and retention of BSol pharmacy technicians. Study limitations include; participants are from BSol and/or the Midlands only, self-selected and small numbers (few from community pharmacy), with PTPTs at colleges only, thus results are not generalisable and risk bias. Reference 1. NHS England (2019). The NHS Long Term Plan. Available at: www.longtermplan.nhs.uk/publications/nhs-long-term-plan (accessed 31st May 2024). NHS Improvement (2019).

A scoping review of the integration of non-medical prescribing for acute common clinical conditions by community pharmacists

Abstract Introduction Non-medical prescribing enhances patient care, safety, and medication accessibility, while also maximising expertise1. Some evidence exists for a variety of factors at individual, organisational, regulatory, and policy levels impacting the implementation of PP in community pharmacy2. Common clinical conditions (CCC) can be defined as ‘a broad range of self-limiting conditions that are more complex in their diagnosis and treatment than minor ailments and management that often involves the need for prescription medicines’. Aim To collate and characterise literature on the integration of non-medical prescribing for acute common clinical conditions by community pharmacists. Method This scoping review followed the Arksey and O’Malley framework. The review team comprised a doctoral student (LK), a research fellow (TJ) and a professor of pharmacy (SC), all with experience of review methodology, community pharmacy research and /or practice. Eligibility criteria, search databases and terms were defined. Medline, International Pharmaceutical Abstracts, Cumulative Index to Nursing and Allied Health Literature and Google Scholar were searched for full text, English language, peer reviewed original papers, randomised controlled trials, cross-sectional and cohort studies, papers reporting empirical data from primary research and review articles including systematic reviews /scoping reviews /narrative reviews from January 2006 to October 2023. The (global) focus was on services delivered by pharmacists and pharmacy team members in community pharmacy for the management of CCC, using non-medical prescribing rights. Search terms included “independent prescrib*”, “pharm* independent prescri*”, “pharm* prescrib*”, “non-medical prescri*, “non-medical prescri*”, “pharm* supplementary prescri*” and “collaborative prescrib*”. Following screening and full text review a narrative synthesis approach3 was used to address the aim which involved: preliminary synthesis through data extraction and tabulation of key study characteristics, exploration of relationships and differences across the studies and finally evaluation of the robustness of the synthesis. The Consolidated Framework for Implementation Research provided a theoretical lens to support synthesis, identifying barriers and facilitators for integration. All steps were independently checked by two review team members. Ethics approval was not required because this was a scoping review. Results From a total 1018 records identified, 10 papers remained after removal of duplicates, title /abstract screening and full text review. The majority of studies were from Canada and the aims and linked outcomes of studies focused on pharmacists’ views and experiences, evaluation of safety, effectiveness, and patient satisfaction. A range of CCCs were included with a focus on antibiotic prescribing. A wide range of barriers and facilitators to implementation were identified including “regulatory constraints” and “fiscal challenges” at a macro socio-organisational level and a plethora of dichotomous challenges within organisations including a lack of clarity on the pharmacist’s scope of practice and linked consumer confusion, staffing levels and workload, with specific mention of paperwork and access to patient records. Conclusion The small number of studies included indicates that there is a paucity of research in this area. There is a need for increased efforts to consider this topic further and identify ways to address the challenges for further widespread implementation and uptake of such services.

Patient privacy and the need for private consultation areas in Kuwait’s polyclinic pharmacies

Abstract Introduction In Kuwait, pharmacists provide essential medication counseling and education. However, the open layout of polyclinic pharmacies often compromises patient privacy, deterring individuals from seeking necessary consultations. Objective This study aims to assess how patients perceive the level of privacy in Kuwait’s polyclinic pharmacies and evaluate patients’ need for a private consultation area. Method A cross-sectional study was conducted among patients at polyclinic pharmacies in Kuwait. Convenience sampling was used to select the polyclinics. Patients were approached after collecting their medications and invited to participate in the study. Those who consented completed a questionnaire that included sections on demographics, six items assessing the privacy construct, four items evaluating the need for a consultation area, and an open-ended question for additional comments. Ethical approval was obtained from the Human Ethical Committee, Health Sciences Center, Kuwait University. Results The study included 210 participants, with a majority residing in the Capital Governorate (55.2%), and being female (70%). The median age was 43 years old (IQR=29-55). Over two-thirds of the participants held a university degree (69%). Most participants were collecting medication for themselves (83.8%), and were exempt from fees (84.3%). When measuring patients’ privacy satisfaction, a score was calculated and a scale was divided into good to excellent (24 - 30), fair (18 - 23), and poor (6 -17). In addition, when measuring the need for a private consultation area score, a scale was divided into high need (16-20), fair need (12-15), and no need (4-11). Regarding perceived privacy, only 20% of participants had a good to excellent score, while 41.9% had a fair score and 38.1% had a poor score. When asked about the need for a private consultation room, 63.8% expressed a high need, while 15.2% believed it was unnecessary. Participants who had lower privacy scores reported a higher need for private consultation areas. Discussion The findings provide valuable insights into patient perspectives and highlight the necessity of improving pharmacy practices in Kuwait. Enhancing privacy in pharmacies could significantly improve the public’s perception of pharmacists as essential healthcare providers. However, several limitations should be noted. The sample is not representative of the population, as the proportion of non-Kuwaiti participants is less than the actual population ratio. Consequently, the results cannot be generalized to the entire population. Future studies should aim for a more representative sample and consider a longer data collection period to address these limitations. Conclusion The results of this study reveal that a significant number of patients perceive privacy in Kuwait's polyclinic pharmacies as fair, with many expressing a strong need for private consultation areas. These findings underscore the importance of enhancing privacy measures in these settings1. Implementing private consultation rooms in polyclinic pharmacies could greatly improve patient satisfaction and the overall quality of healthcare services provided by pharmacists. Reference 1. Waheedi S, Marshall V, Alharbia H, Farris KB. Patients’ perceptions of privacy and the need for a private consultation area in community pharmacy. Poster Abstracts. International Journal of Pharmacy Practice. 2016;24:33–60

Creating an inclusive workforce in 2024: Are pharmacy teams across England committed to embedding equality, diversity, and inclusion?

Abstract Introduction The Pharmacy Workforce Race Equality Standard (PWRES) published in 2023 provided evidence of the varied experiences that registered pharmacy professionals in NHS trusts face, particularly in relation to gender and ethnicity.1 Following this, the Inclusive Pharmacy Practice delivery group at NHS England set out to raise awareness of the data and to support regions in developing action plans to drive improvements in equality, diversity and inclusion (EDI) within pharmacy teams. Aim The aim of this study was to identify current initiatives within NHS providers that promote EDI within the pharmacy workforce with a view to enabling the sharing of good practice, and identifying implementation barriers. Methods A questionnaire was created by the Chief Pharmaceutical Officer’s Clinical Fellows and distributed by the 6 regional chief pharmacists within NHS England to their networks. The questionnaire was also promoted in regional pharmacy leadership meetings. Responses were collected between 1st February and 31st May 2024. Data was collected on an Excel spreadsheet. London was excluded from data collection as a similar questionnaire was distributed in 2023. No ethical approval was needed for non-sensitive anonymised data. Results There were 77 responses: 75% (n = 58) from hospital trusts, 13% (n = 10) from integrated care boards and the remaining 9 responses included the Local Pharmaceutical Committee, Hospice and Mental Health Trust. 86% of respondents (n = 66) indicated that their organisation has EDI initiatives in place. These have been summarised into six key themes: 1) EDI network/steering group (n = 44), 2) action plan (n = 14), 3) EDI training/accreditation (n =14), 4) reverse/reciprocal mentoring (n = 11), 5) awareness days (n = 10) and 6) inclusive recruitment practices (n = 10). In contrast, only half of respondents indicated that their team had EDI initiatives. The impact of any initiatives was measured by feedback from staff (e.g. Internal staff survey, NHS staff survey, focus groups, open staff forums) and regular staff demographic data collection. 55% of respondents (n = 36) indicated that recruitment panel members received compulsory EDI training for interviews and 54% of respondents (n = 35) received mandatory recruitment training. Barriers and challenges identified with implementing EDI initiatives included organisational change, workforce capacity, competing priorities and staff apathy. Discussion The survey results highlight a strong commitment to EDI initiatives at an organisational level, with most organisations having established EDI frameworks. However, the lower prevalence of EDI initiatives within individual pharmacy teams suggests a gap in implementation. This discrepancy indicates a need for better dissemination and integration of EDI practices within pharmacy team settings. There is evidence of varied practice in terms of EDI training requirements of interview panellists, and these variations are opportunities where improvements can be made in terms of IPP. The survey was only sent to the managed NHS sector and is not reflective of primary care or community pharmacy. One of the next steps is for regions to use the results of the questionnaire in combination with the PWRES data to develop and implement local action plans to address these issues. Reference 1. NHS England. Pharmacy Workforce Race Equality Standard Report 2023. [Accessed 4th June 2024]. Available from https://www.england.nhs.uk/long-read/pharmacy-workforce-race-equality-standard-report/

Establishing a biologics and biosimilars committee/network: assessing educational requirements of pharmacy and other healthcare professionals

Abstract Introduction Successful professional networking involves shared, mutually beneficial interactions between individuals and/or individuals and groups1. Biologics and biosimilar medicines prescribing is rapidly evolving with an increasing number of clinical indications in healthcare2,3. Despite their importance, the absence of a structured national network dedicated to these complex therapies has left a gap in professional education and resource sharing among pharmacists. Recognising the necessity for a cohesive support system, this work explores the learning and professional needs of pharmacists regarding biologics and biosimilars and the potential development of a national pharmacy network to address these gaps. Aim The survey aimed to explore the educational needs and preference for a network and/or committee for pharmacy and other healthcare professionals focused on biologics and biosimilars medicines. Methods An electronic survey was developed and deployed for pharmacy and other healthcare professionals involved in the management of biologics and biosimilars via email cascade and social media, 12th February - 6th March 2023. The survey explored the preferred structure of the proposed group; formal committee and/or informal network, what the group would deliver, and any educational needs for members. The survey included questions about the respondent’s roles, sectors of work, regions and their clinical area(s). The open text responses were themed. The NHS health Research Authority tool was used to identify this project as service improvement and development, therefore did not require ethical approval. Results The responses received were from 46 pharmacists, 1 pharmacy technician, 15 doctors and nurses and 4 participants whose roles were unknown, working across multiple sectors; hospital, community, industry, and academia with representation from the devolved nations (n=3) and internationally (n=1). Most respondents expressed a need for a dedicated network and committee n=52 (79%), n=10 (15%) formal network, and n=4 (6%) informal committee. Common themes in response to what the group should deliver and educational needs included; harmonisation of approaches to guidelines and policies, pathway design, reduction in unwarranted variation (68%); platform to share new ideas, knowledge and peer advice (44%); strategy and leadership in service delivery and promotion of best practice and cost training, horizon scanning (29%); working collaboratively to produce multi-centre research projects (24%); to create a structured training programme for health care professionals (9%). Discussion/Conclusion The survey results highlight a gap in the current educational and professional support systems for PP’s concerning biologics and biosimilar medicines. The identified learning needs point to a strong demand for a structured network that can provide targeted education, share best practices and facilitate professional networking. The expertise within the group can also create formal eLearning programmes for healthcare professionals. This work serves as a foundational step towards the development this network, highlighting the critical areas of focus and the collective interest of the pharmacy community in bridging these gaps. The network should also facilitate communication and collaboration across different sectors, fostering a more cohesive and informed pharmacy community. Such an innovative network would not only enhance individual competency but also contribute to the overall advancement of pharmaceutical care in this specialised area.

Adherence towards good pharmacy practice of community pharmacists in central Visayas, Philippines

Abstract Introduction Community pharmacists play a pivotal role in bridging gaps in the delivery of health care services and for taking the roles of ensuring the rational use of medicines. With the advent of Good Pharmacy Practice, it is essential that there be an established national framework of quality standards and guidelines; however, there is dearth in the evaluation of GPP implementation in the country. Philippine community pharmacist's practices are expected to exhibit expertise in medications nonetheless, their practices often diverge significantly from these expectations. In this literature study, community pharmacists grapple with consultation roles due to lack of clinical guidelines, training, skills, and patient self-selection behavior. Aim The aim of the study was to assess the adherence towards Good Pharmacy Practice among community pharmacists in Central Visayas, Philippines and proposed a policy brief formulated based on the findings to gain a better understanding of the country's existing approach to community pharmacy practice. Methods The study used a quantitative descriptive cross-sectional research design to scrutinize community pharmacist practices in the Philippines, specifically in FDA-registered independent and chain pharmacies in Bohol, Cebu, Negros Oriental, and Siquijor provinces. Ethics approval was obtained from the Institutional Ethics Review Committee and four experts validated the instrument, resulting in a high and acceptable S-CVI and a reliability index of .893, indicating good reliability. The selection process involved stratified random sampling and a modified closed ended questionnaire from Badro et al. (2020) tallying 321 respondents. Data was recorded as 1 for Yes responses and 0 for No. The GPP adherence levels were categorized as poor adherence for <50% or good adherence for >75%. Results The demographic profile of the respondents indicates that the majority belongs to the Millennial generation aged 27- 45 years old. These respondents are predominantly female community pharmacists, mostly in Cebu. They hold a BS Pharmacy degree, having 3 years to less than 6 years of practice. Their work schedule typically exceeds 40 hours per week, and they operate within independent pharmacy. Findings revealed that the majority of community pharmacists in Central Visayas, Philippines have a poor adherence to the GPP indicators on data management and data recording with 69.8% (224), services and facilities with 94.7% (304), dispensing, preparation, administration and distribution of medicines with 96.2% (309) but good adherence to storage with 75.4% (242). The most significant challenges identified were time restrictions, a lack of understanding, a lack of training and resources. Additionally, time constraints, excessive workload, workforce shortage, lack of support from employers and other colleagues were recognized. But the majority shows compliance to FDA storage regulations and standards as a minimum requirement to continue the establishment and pharmacists operate in the community setting. Therefore, a three-pronged strategy is likely necessary: increasing the number of trained pharmacy staff, engaging in professional development and regulatory advocacy. Conclusion The majority of respondents demonstrated good adherence to storage indicators and poor adherence to data management, services and facilities and dispensing indicators. These findings highlight the need for targeted interventions and tailored strategies to elevate standards.

Characteristics, Perspectives, and Experiences of Cyproheptadine Users at Community Pharmacies in the Context to Prescription Medication Misuse

Some people abuse the antihistamine medication cyproheptadine in an attempt to reach their desired shape, weight, and appearance. This study aims to investigate the characteristics of cyproheptadine misusers as well as their behaviors, perceptions, experiences, and sources of information regarding using this medication. A descriptive cross-sectional study was carried out in Sebha City among customers of community pharmacies. Each customer who has taken cyproheptadine was invited to participate in this research. The data was collected from April 2022 until September 2022. Almost all of the participants (n=99, 96.1%) reported they purchased cyproheptadine from community pharmacies and obtained the drug without a prescription n=79 (76.7%). Over half of the respondents (n=53, 51.5%) use this drug for increasing appetite, compared to (n=25,24.3%) and (n=19, 18.4%) respondents who said they used it to improve their shape and lose weight, respectively. Most participants indicated they were unaware of other uses of a drug (n=72, 69.9%) or its side effects (n=61, 59.2%). Furthermore, twenty participants (19.4%) denied receiving information concerning the precautions and contraindications of using cyproheptadine. The highest rate of source of drug information reported by participants was “friends or family member” (n=34, 33%) followed by pharmacists (n=29, 28.2%). Community pharmacies must employ qualified pharmacists on staff to give customers trustworthy information regarding prescription pharmaceuticals such as cyproheptadine.

Short-term outcome of personalized theory-based pharmaceutical care service on the medication administration problems of family caregivers: a pre-post intervention study.

Family caregivers face many problems during administration of medications. Pharmacists are reliable and accessible healthcare providers in addressing family caregivers' medication related inquiries in primary care. This study aimed to evaluate theshort-term outcome of apersonalized theory-based pharmaceutical care service on the medication administration problems of family caregivers. This pre-post intervention study was carried out among family caregivers at a community pharmacy in Istanbul, Türkiye from May through December 2022. The service was developed by mapping problems using theTheoretical Domains Framework and selecting related behavioural change techniques. The primary outcome was the change in the scores on the Turkish version of the Family Caregiver Medication Administration Hassles Scale (FCMAHS-TR) from baseline to the one-month follow-up assessment. Secondary outcomes were their ability to read health related materials, care burden, and satisfaction. Among family caregivers (n = 100), total score of FCMAHS-TR was significantly reduced after receiving theory based pharmaceutical care service (median [IQR]23.0 [17.0-27.0] vs 17.0 [10.3-20.0]; p < 0.001). The proportion of family caregivers with high ability to read health related materials was significantly increased (34.0% vs 48.0%; p < 0.05) with non-significant change in the proportion of family caregiver with high burden (97.0% vs 94.0%; p > 0.05). Younger family caregivers had significantly higher scores on the Turkish version of Patient-Oriented Pharmacy Services Questionnaire (PSPSQ) 2.0 when compared with the older ones (≥ 65 y) (p < 0.05). Family caregivers' medication administration problems werereduced after receiving thetheory based pharmaceutical care service. Long term impact and national implementation of this service should be assessed in the further studies.

Drug dispensing in public community pharmacies: evidence from the MedMinas project

BackgroundDrug dispensing is a service provided by pharmacists to ensure the supply of medications and other health-related products. However, despite the importance of dispensing services, Public Community Pharmacies (PCP) in Brazil still focus on the control and distribution of medicines and supplies. Thus, this paper aims to evaluate how the pharmacists in charge conduct and the challenges they encounter in dispensing services in PCP.MethodsThis is a mixed methods study, with a representative sample of 26 municipalities (whose populations vary between 37,784 and 409,341 inhabitants) in the state of Minas Gerais, Brazil. Data collection took place between April and October 2019 and included interviews and documentary research. Quantitative data analysis was carried out using descriptive statistics and qualitative data was subjected to thematic content analysis.Results24 dispensing services were analyzed. The PCP had, on average, two active pharmacists and operated full-time (40 h per week). In relation to dispensing services, the most frequently mentioned steps were checking the adequacy of the prescription received, followed by providing counseling to the user about the medicines, mainly regarding administration, storage and disposal. The results highlighted a need for improvements in terms of infrastructure, workforce and the pharmacist’s work process.ConclusionIt is necessary to invest and to design improvement strategies in dispensing services, especially regarding physical infrastructure, human resources and work processes.

Exploring public perception and utilization of medication home delivery services in the United Arab Emirates: a cross-sectional study

IntroductionThe Medication Home Delivery (MHD) service from community pharmacies involves the safe and efficient delivery of pharmaceuticals (prescription and non-prescription medications), and health products directly to the patient’s/consumer’s home. There are several issues encountered by the users of the MHD service that have an impact on their satisfaction with the service. The study aimed to assess the public’s perceptions of the MHD service in the United Arab Emirates (UAE), their willingness to utilize it, and the practical use of the service.MethodA cross-sectional exploratory study was conducted in the UAE using a validated online survey. The inclusion criteria were adults residing in the UAE. Statistical analysis was performed to identify the association between the variables, the service use, and the level of service efficiency.ResultsA total of 556 participants filled out the survey, with 69.4% of them using the service. The majority of participants were females (75.9%) and aged less than 40 years old (71.6%). Three variables showed a statistically significant association with the use of the MHD service (P < 0.05): the participant’s educational level, their medical/health background, and the frequency of visits to community pharmacies. The most common issues raised were receiving the wrong order, delay in delivery, and paying delivery fees. Most participants agreed that the MHD service reduces the risk of exposure during pandemics, serves the elderly, serves disabled people, makes it more comfortable for parents with children at home, and reduces overcrowding in health facilities, as well as the MHD service making pharmacy services more efficient.ConclusionThe study indicated positive perceptions among the public in the UAE towards the MHD service. However, there was a concern that this service may diminish the communication between pharmacists and patients, which potentially minimizes the amount of information received by patients regarding their treatments.

Innovative student project proposals to leverage community pharmacy to address the social determinants of health

Background: The objective of this paper is to describe the development and implementation of a student project to brainstorm strategies to address the social determinants of health (SDOH) through community pharmacy partnerships. Methods: This project reimagined the BUILD Health Challenge for second-year Pharm.D. students in a Community Pharmacy Elective course. Students worked in groups to complete a community needs assessment and then developed a customised proposal for a feasible collaboration addressing at least one upstream social risk factor. Results: A total of ten proposals were developed from 2021 to 2023. Novel collaborative partnerships included a local high school, regional opioid prevention services, rideshare partners, food trucks, and more. The most common social risk factor addressed through this project was transportation (n = 6; 60%). Conclusion: This project was effective at inspiring innovation and entrepreneurial thinking about the social determinants of health as it pertains to community pharmacy.

Assessing the Impact of a Leadership Development Programme for Community Pharmacy Neighbourhood Leads in South East London

Community pharmacists continue to deliver a growing number of services, with an increased need for collaborative work between local teams in community settings. In South East London, the Integrated Care Board and Pharmacy Alliance have invested in the development of community pharmacy neighbourhood leads (CPNLs), who represent community pharmacies in a locality and provided a tailored five-session leadership course that ran between November 2023 and March 2024, covering theory and implementation. This study aimed to evaluate the experiences of the CPNLs and other colleagues who participated in the leadership development programme. Participants were asked to complete an evaluation survey after each session, along with individual interviews taking place with those who volunteered. Ethical approval was received. There was a total of 37 participants at the sessions, and 7 participated in an interview. Overall confidence increased throughout the course, with males statistically more confident than females. Relationships with new stakeholders also increased throughout the course. The proposed actions after each session echoed the topics covered, with planning meetings being prioritised. The interviews highlighted new opportunities identified and being acted on, a greater understanding of the role, and an increase in confidence and key relationships. Barriers in the role included time for meetings. Overall, investment in the CPNL role showed that learning from the programme was applied in practice, with an increase in confidence and understanding of the role and improved local relationships. The findings from this study can be used by others to support community pharmacy transformation and integration.

Assessing Barriers to COVID-19 Diagnostic Testing in Community Pharmacies: Insights from Alabama.

The COVID-19 pandemic stressed the critical role of diagnostic testing in controlling the spread of infectious diseases. Due to their accessibility and presence in underserved areas, community pharmacies have become vital in decentralizing COVID-19 testing. Despite their potential, pharmacies face significant barriers in integrating testing services. This study aimed to assess the provision of COVID-19 diagnostic testing across community pharmacies in Alabama and investigate how various pharmacist and pharmacy characteristics, along with perceived barriers, influence the likelihood of offering COVID-19 testing services. A cross-sectional study was conducted targeting 1,172 community pharmacies in Alabama. Data were collected via a mixed-mode survey from February to April 2023, achieving a response rate of 20.5% (n = 240). The primary measure was the new Pharmacist Perceived COVID-19 Diagnostic Testing Barriers (PDT-B), a nine-item Likert scale. Bivariate and multivariable logistic regression analyses were conducted to identify factors associated with testing provision. Out of 240 pharmacies, 28.3% provided COVID-19 testing. Providers were significantly more likely to be corporately-owned (61.8%, p < 0.001); they also had higher prescription volumes (median 300, p < 0.001) compared to independent pharmacies. Lower perceived barriers in Organizational Logistics significantly increased the likelihood of offering testing (OR = 0.55, p = 0.028). In corporately-owned pharmacies, lower perceived personal exposure risk was a significant factor (OR = 0.65, p = 0.047), whereas independent pharmacies faced challenges related to regulatory compliance (OR = 0.35, p = 0.025). The study highlights distinct barriers faced by corporately-owned and independent pharmacies. Corporately-owned pharmacies benefited from higher operational capacities but faced notable exposure concerns. Independent pharmacies, however, struggled with regulatory compliance, which impacted their testing service provision. Addressing the unique barriers different pharmacy settings face with tailored strategies is crucial for enhancing COVID-19 testing accessibility and strengthening public health efforts and pandemic preparedness.

Disposal of Unused Antibiotics in Community Pharmacies in Saudi Arabia: A Mixed-Methods Study.

Improper disposal of unused antibiotics poses a significant global challenge, drawing attention from various stakeholders. This discharge of antibiotics into the environment can occur through various means such as industrial production, consumption, and excretion by humans and animals, as well as improper disposal of unused or expired antibiotics. The aim of our study is to investigate the availability of proper disposal of antibiotics in community pharmacies and to explore obstacles and opportunities from pharmacist's point of view. This study used a mixed-methods approach that consisted of two study arms: quantitative and qualitative. The quantitative arm used a mystery-shopper method for assessing the disposal of antibiotics in community pharmacies. The qualitative study arm consisted of several in-depth semi-structured focus groups with a sample of pharmacists working in community pharmacies in Riyadh. The mystery shopper arm showed that 85% (n=88) refused to take the return of antibiotics. Interviews with pharmacists have indicated a lack of knowledge on safe disposal methods for antibiotics and medications. Additionally, pharmacists have cited several factors contributed to accumulation of the antibiotics such as nonadherence or policies mandating the sale of whole medication packs instead of the required amounts as a contributing factor to this issue. Furthermore, there is a lack of dedicated facilities for the population to safely dispose of their medications and/antibiotics. By acknowledging the factors contributing to improper disposal practices, recognizing the importance of proper antibiotic disposal, and advocating for multi-faceted initiatives, we can work towards mitigating this critical issue. Through collaborative efforts involving education, policy interventions, and community engagement, we can foster a culture of responsible medication disposal, ultimately safeguarding public health and environmental well-being.

Implementation of an adult life-course vaccine review service, VaxCheck, in community pharmacy: A qualitative analysis

BackgroundCommunity pharmacists are well placed to identify and vaccinate unimmunized or under-immunized individuals who can put themselves and communities at risk of preventable disease. We designed and tested VaxCheck, a novel life-course vaccine review service that can be used to raise awareness and guide personal vaccination action plans, in community pharmacies in Ontario, Canada. ObjectiveTo understand the experiences of community pharmacists and staff directly involved with providing the VaxCheck service as part of initial testing. MethodsSemi-structured interviews were performed with pharmacy staff from nine pharmacies who participated in the study. Interviews were conducted at baseline and following each of three plan-do-study-act quality improvement cycles. Activities undertaken to perform VaxCheck were assessed. An inductive thematic analysis was performed to identify dominant themes and subthemes. Activities and descriptive codes were then correlated to the Consolidated Framework for Implementation Research (CFIR). Results26 interviews were conducted. Pharmacy staff described VaxCheck activities as spanning three stages: (1) Promotion/offering of VaxCheck, (2) Completing the VaxCheck, and (3) Enacting recommendations and follow-up. VaxCheck activities were compatible with workflow related to delivery of other vaccines and medication reviews. Thematic analysis found three considerations guided VaxCheck adoption: (1) Aligning VaxCheck with workflow through flexible integration, (2) Enabling patient-oriented vaccination services, and (3) Contributing to community healthcare provision. Data aligned with all CFIR domains with strengths noted in constructs from the “Innovation characteristics” and “Individuals” domains. Barriers to implementation were identified in “Inner setting”, “Outer setting” and “Process” domains, such as pharmacy workflow capacity, patient knowledge about vaccination, availability of vaccine records, and interactions with other healthcare providers. ConclusionCommunity pharmacists found VaxCheck to be a valuable, accessible service that was well-received by patients and supported adult vaccination reviews and individualized recommendations. VaxCheck was compatible with pharmacy workflow but needed additional resources for sustainability and promotion with stakeholders.