Evolving Health Care System Research Articles

Experiences of Multiple Myeloma Patients With Treatment in the Palestinian Practice: A Multicenter Qualitative Study in a Resource-Limited Healthcare System.

Background Multiple myeloma is a crippling cancer that puts a significant strain on patients and their families alike. The long and exhausting treatment journey with the disease is challenging not only for patients but also for healthcare systems. This exploratory study was conducted to look into these patients' experiences with their treatment and explore their recommendations and views to improve the Palestinian healthcare system, which can be viewed as an evolving healthcare system within a resource-limited and developing country. Methods The consolidated criteria for reporting qualitative research (COREQ) checklist was used for conducting this multicenter exploratory qualitative study. A total number of eight patients with multiple myeloma who received treatment in the Palestinian healthcare system participated in semi-structured in-depth interviews. The semi-structured in-depth interviews followed a set interview schedule. Thematic analysis of the data was done using the qualitative interpretive description approach. Results A total of 5.48 h (329 min) of total interview time was analyzed. Among the patients, 6 (75%) were males, 5 (63.5%) lived in urban areas, 5 (62.5%) reported satisfaction with their household income, 6 (75%) underwent bone marrow transplantation, and all of them (100%) had governmental insurance. The qualitative data that emerged after analysis were classified into three major themes and multiple sub-themes. The three major themes were: (1) treatment side effects, (2) factors affecting treatment experience, and (3) recommendations to improve healthcare service. Conclusion The results of this qualitative study offer insight into how people with multiple myeloma view the healthcare system in Palestine and shed light on the variable and challenging experiences with their treatment, side effects, and communication with healthcare providers within the context of a resource-limited and developing country. Future research should involve hemato-oncology doctors and benefit from their expertise in the field.

Developing paediatric skills and knowledge in pharmacy education: an exploration of a novel work-based learning experience

Abstract Introduction Pharmacy education in the United Kingdom must adapt to produce independent prescribing pharmacists ready to join an evolving healthcare system. Current placement practices exclude approximately 21% of the population due to a lack of specific recommendations surrounding paediatric experience and knowledge within the MPharm programme.[1] In turn, students’ current experiences may be limited by lack of interaction with unique learning outcomes offered by some healthcare settings, such as paediatric hospitals.[2] To promote student exposure in an overlooked speciality, novel approaches to work-based learning can be utilised. Aim This study aimed to explore pharmacy students’ experiences of work-based learning in a paediatric hospital setting. Methods In October 2022, fourth-year MPharm students at one school of pharmacy were invited to undertake work-based learning sessions across one academic year. The sessions aimed to develop students’ paediatric consultations skills and knowledge. Sessions consisted of a briefing, ward activities, scaffolded consultations with children and carers, and debriefs with a clinical supervisor. Debriefs included students reporting clinical information, required action and learning outcomes. All debriefs provided by students were transcribed by a clinical supervisor using a spreadsheet which recorded the date, ward visited, patient details, student handover, follow-up (if required) and learning outcomes. Data was initially cleaned, quality checked, and underwent content analysis to identify patterns and key themes to describe student experiences. Results Seventy-four students took part in sessions and delivered 233 consultations covering the medical history of the patient (76%, n=177), with varied levels of completeness. Students were exposed to acute conditions (41%, n=96) and chronic conditions (33%, n=76), with 13% (n=30) still awaiting diagnosis. Forty-eight percent (n=81) of learning points related to the pathology, diagnosis and symptoms of conditions, 24% (n=41) to medicines, 15% (n=25) to patient care, 11% (n=18) to non-clinical experiences and 2% (n=4) to other outcomes. In addition to carrying out ward activities, students underwent the processing of experiences during post-session debriefs: “It’s uncomfortable seeing a child struggle to breathe” [P131]. The process of active reflection was also evidenced in debriefs: “I felt very anxious, like a tightness in the chest, to hear that a child had a short life expectancy” [P145]; “I realised they had zero cultural competence after seeing a patient from the Middle East with jaundice” [P233]. Conclusion The study demonstrates a proof of concept that students can be exposed to complex care needs and challenging consultations under indirect supervision, demonstrating the paediatric setting to be a suitable work-based learning host. However, findings are limited to a single cohort of students at a single site, meaning transferability may be limited. Future studies could focus on longitudinal educational and emotional outcomes of students by measuring clinical knowledge, competence and confidence. Utilising post-session debriefs with peers and supervisors created a space to share both pharmaceutical and emotional learning points, aiding in managing the cognitive load of students. This experience not only highlights the requirement of paediatric exposure in pharmacy education programmes to aid the students’ future practice, but the importance of supervised reflective activities following work-based learning experiences.

Cultivating leaders for primary health care: A revised approach for transformative development.

Family physicians require leadership skills to strengthen team-based primary care services. Interviews with South African district managers confirmed the need to develop leadership skills in family physicians. The updated national programmatic learning outcomes for South African family physician training were published in 2021. They sparked the need for curriculum renewal at the University of Cape Town's Division of Family Medicine. A review of the leadership and governance module during registrar training showed that the sessions were perceived to be content heavy with insufficient opportunities for reflection. Following a series of stakeholder engagements, the module convenors co-designed a revised module that was blueprinted on the updated learning outcomes. The module incorporates a group coaching style, facilitating learning through reflection on one's experiences. The revised module was implemented in 2022. It aims to provide a transformative learning experience centred on students' perceptions of themselves as leaders, as well as professional identity formation and resilience building. This short report describes preliminary insights from the revised module's developmental phase and forms part of an ongoing iterative evaluation process.Contribution:Family physicians should lead across all their defined roles. Formal and informal learning opportunities are needed to facilitate their growth as leaders and help them to meet the health needs of communities served by an evolving health care system. This short report describes an example of a revised postgraduate module on leadership and governance, which may be of value to clinician educators and academic departments exploring innovative methods for the African region.

How microsimulation translates outcome estimates to patient lifetime event occurrence in the setting of heart valve disease.

Treatment decisions in healthcare often carry lifelong consequences that can be challenging to foresee. As such, tools that visualize and estimate outcome after different lifetime treatment strategies are lacking and urgently needed to support clinical decision-making in the setting of rapidly evolving healthcare systems, with increasingly numerous potential treatments. In this regard, microsimulation models may prove valuable additions to current risk-prediction models. Notable advantages of microsimulation encompass input from multiple data sources, the ability to move beyond time-to-first-event analysis, accounting for multiple types of events, and generating projections of lifelong outcomes. This review aims to clarify the concept of microsimulation, also known as individualized state-transition models, and help clinicians better understand its potential in clinical decision-making. A practical example of a patient with heart valve disease is used to illustrate key components of microsimulation models, such as health states, transition probabilities, input parameters (e.g., evidence-based risks of events), and various aspects of mortality. Finally, this review focuses on future efforts needed in microsimulation to allow for increasing patient-tailoring of the models by extending the general structure with patient-specific prediction models and translating them to meaningful, user-friendly tools that may be used by both clinician and patient to support clinical decision-making.

Matters We Metric Vs. Metrics that Matter.

Geriatric fracture is a pressing global health issue, marked by elevated mortality and morbidity rates and escalating health care costs. The evolving health care system from fee-for-service to quality-based reimbursement has led to externally driven reward and reimbursement systems that may not account for the complexity of caring for older adults with fracture. The aim of this review is to highlight the need for a shift towards meaningful metrics that impact geriatric fracture care and to issue a call to action for all medical societies to advocate for national reimbursement and ranking systems that focus on metrics that truly matter. Traditional metrics, while easier to capture, may not necessarily represent high quality care and may even have unintentional adverse consequences. For example, the focus on reducing length of stay may lead to older patients being discharged too early, without adequately addressing pain, constipation, or delirium. In addition, a focus on mortality may miss the opportunity to deliver compassionate end-of-life care. Existing geriatric fracture care metrics have expanded beyond traditional metrics to include assessment by geriatricians, fracture prevention, and delirium assessments. However, there is a need to further consider and develop patient-focused metrics. The Age-Friendly Health Initiative (4Ms), which includes Mobility, Medication, Mentation, and what Matters is an evidence-based framework for assessing and acting on critical issues in the care of older adults. Additional metrics that should be considered include an assessment of nutrition and secondary fracture prevention. In the realm of geriatric fracture care, the metrics currently employed often revolve around adherence to established guidelines and are heavily influenced by financial considerations. It is crucial to shift the paradigm towards metrics that truly matter for geriatric fracture patients, recognizing the multifaceted nature of their care and the profound impact these fractures have on their lives.

Competency-Based Medical Curriculum: A Resurgent Paradigm for Medical and Dental Graduates

Present society is characterized by its growing complexity, dynamics and knowledge intensity, which requires professionals who are able to face new situations and problems confidently and expertly. Education faces the problem that knowledge acquisition does not necessarily mean the successful application of the same knowledge. In case of academic professionals, they should possess a broad and profound domain-specific knowledge and skills, the capability to acquire knowledge expeditiously and know-how where and when needed. Learning in a professional context has, therefore, become more important and general academic education is becoming more professional oriented. Medical education is changing to meet the demands of ever evolving health care system. One of these changes is the development and implementation of competency-based medical education (CBME). Competency-based learning and training is an approach to teaching and learning more often used in learning concrete skills than abstract learning. It differs from other non-related approaches in that the unit of learning is extremely fine-grained. Rather than a course or a module, every individual skill or learning outcome (known as a competency) is one single unit. Learners work on one competency at a time, which is likely a small component of a larger learning goal. The student is evaluated on the individual competency and can only move on to other competencies after they have mastered the current skill being learned. After that, higher or more complex competencies are learned to a degree of mastery and are isolated from other topics. Another common component of competency-based learning is the ability to skip learning modules entirely if the learner can demonstrate mastery. This can be determined through prior learning assessment or formative testing. This article pertaining to the discipline of medical education gives a broad overview and elaborates on this emerging competency based medical education approach and its related concepts.

Quality Control in Primary Healthcare in Saudi Arabia: A Systematic Review

Introduction: The quality of primary healthcare is crucial for ensuring efficient and effective patient care, particularly in rapidly evolving healthcare systems like that of Saudi Arabia. With ongoing reforms aimed at improving healthcare delivery, there is a pressing need to assess the state of quality control within primary healthcare settings. This systematic review aimed to evaluate the effectiveness of various quality control interventions implemented in primary healthcare centers in Saudi Arabia, focusing on their impact on patient care and system efficiency. Methods: The review strictly included interventional studies and clinical trials published in the last years up to 2022, employing a comprehensive search across multiple databases including PubMed, Scopus, Web of Science, and the Cochrane Library. Inclusion criteria were set to consider only studies that directly addressed quality control measures within primary healthcare settings in Saudi Arabia, with clear intervention and outcome measures. The analysis synthesized data on the types of interventions, sample sizes, and effectiveness, including risk ratios and percentage improvements with their confidence intervals. Results: Seven studies were included, revealing a range of interventions from EHR implementations to provider training programs and patient feedback systems. Key findings include a 55% reduction in medication errors following EHR system implementation, a 35% increase in compliance with national quality standards post-provider training, a 20% increase in patient satisfaction with the introduction of patient feedback systems, and a 30% improvement in patient outcomes from clinical guideline updates for chronic disease management. Conclusions: The review demonstrates that targeted interventions can significantly enhance quality control in primary healthcare settings in Saudi Arabia, with notable improvements in medication accuracy, compliance with quality standards, patient satisfaction, and clinical outcomes. These findings highlight the potential of comprehensive, integrated quality control measures to advance patient care and healthcare system efficiency.

Primary care in the world of integrated care systems: education and training for general practice

Here, we discuss the required education and training for the emergent and evolving roles of GPs and other healthcare professionals within Integrated Care Systems (ICSs). We underscore the importance of collaborative skills for all medical specialties, and the need for interprofessional education and leadership development in undergraduate and postgraduate medical training. We also argue for a paradigm shift in medical education, away from traditional siloed approaches and toward comprehensive training that prepares practitioners to excel in integrated and multidisciplinary healthcare environments, within which expert generalists (GPs) and specialists collaborate in individual patient care and concurrently co-develop innovative system pathways for chronic medical conditions, including complexity and frailty. We highlight the need to align workforce development with evolving healthcare systems and the existing obstacles hindering this alignment.

Emergency department patient navigators successfully connect patients to care within a rapidly evolving healthcare system

In the United States, adherence to follow up medical appointments among patients discharged from the emergency department varies between 26% and 56%, depending on the population. It is well known that patients face significant barriers to care within an increasingly complicated system of care. In an effort to better support patients, in 2020, NewYork-Presbyterian Queens implemented a Patient Navigator Program with 7 bilingual Patient Navigators who were trained to deliver culturally sensitive education and support, and to schedule follow up appointments for patients experiencing barriers to care. Between February 2020 and December 2022, 30,164 patients were supported by the 7 Patient Navigators. Ninety-four percent of patients without a primary care provider had a new provider and appointment upon discharge, and 81% of patients attended the appointment scheduled by the Patient Navigator. This study demonstrates that Patient Navigators can work alongside clinical colleagues, and as members of emergency department health care teams, to support patients to connect to care and to attend follow up appointments. It also highlights that Patient Navigators are uniquely qualified to build trust and to support patients to achieve appropriate, continuous care within a rapidly evolving health care system.

Clients' Perspective towards Family-centered Care Health Services of Family-provider Partnership

Abstract
 Objective: The purpose of this study is to investigate the family-centered care health services of family-provider partnership in Baghdad/ Iraq.
 Methods: A descriptive cross-sectional study is conducted in Baghdad Province. A cluster samples of 440 clients who review family centered care for the purpose of health services. The instruments underlying the study phenomenon deals with client's socio-demographic characteristics and family centered care questionnaire which include (partnership related to decision-making team, supporting the family as the constant in the child’s life, family-to-family and peer support and supporting transition to adulthood). The reliability of the questionnaire was achieved through a pilot study and then presented to experts to prove its credibility. The data were collected by using interview techniques method and analyzed through the application of descriptive and inferential statistical analysis.
 Results: Findings show participants age, the mean age for clients' is 39, the age 20-29 years old were recorded the highest percentage among (n=179; 40.7%), female were predominated among clients who reviews family-centered care (n=281; 63.9%), the illiterate clients were records the highest percentage (n=97; 22%), most of reviews health services in terms of vaccines (n=188; 42.7%). The clients who included in the study sample were expressed a poor level of family-provider partnership. There were significant differences in family-provider partnership health services with regard to clients' education level and types of services were received at p-value <0.05.
 
 Conclusion: Partnerships between family and providers are out of the ordinary. In order for a fast evolving health care system to be effective, family-provider collaboration in care design, delivery, and assessment is essential. To improve care and results, stakeholders are increasingly recognizing the importance of focusing care on the patient and incorporating patient and family viewpoints.
 Recommendations: Family health centers need to be monitored and evaluated periodically with regards to providing health care services according to the standard, which is reflected in gaining the confidence of the individual in the health center. , Further researches need to be conducted in evaluating the quality of health services of family health care centers, based on international standards approved by international health organizations.

Challenges and Opportunities in Academic Physiatry: An Environmental Scan.

Environmental scans determine trends in an organization's or field's internal and external environment. The results can help shape goals, inform strategic decision making, and direct future actions. The Association of Academic Physiatrists convened a strategic planning group in 2020, composed of physiatrists representing a diversity of professional roles, career stages, race and ethnicity, gender, disability status, and geographic areas of practice. This strategic planning group performed an environmental scan to assess the forces, trends, challenges, and opportunities affecting both the Association of Academic Physiatrists and the entire field of academic physiatry (also known as physical medicine and rehabilitation, physical and rehabilitation medicine, and rehabilitation medicine). This article presents aspects of the environmental scan thought to be most pertinent to the field of academic physiatry organized within the following five themes: (1) Macro/Societal Trends, (2) Technological Advancements, (3) Diversity and Global Outreach, (4) Economy, and (5) Education/Learning Environment. The challenges and opportunities presented here can provide a roadmap for the field to thrive within the complex and evolving healthcare systems in the United States and globally.

The status and future of emergency care in the Republic of Kenya.

Kenya is a rapidly developing country with a growing economy and evolving health care system. In the decade since the last publication on the state of emergency care in Kenya, significant developments have occurred in the country's approach to emergency care. Importantly, the country decentralized most health care functions to county governments in 2013. Despite the triple burden of traumatic, communicable, and non-communicable diseases, the structure of the health care system in the Republic of Kenya is evolving to adapt to the important role for the care of emergent medical conditions. This report provides a ten-year interval update on the current state of the development of emergency medical care and training in Kenya, and looks ahead towards areas for growth and development. Of particular focus is the role emergency care plays in Universal Health Coverage, and adapting to challenges from the devolution of health care.

Postgraduate pharmacist development- an evaluation of Jordanian pharmacist experiences to inform and shape an evidence-based professional development policy.

Building capacity for developing skills as leadership, teamwork, and continuous academic support has become essential for fulfilling a successful pharmacy career. This study aims to assess Jordanian pharmacists’ views on professional development, namely: the continuous education infrastructure, strategies and programs for personal development, leadership skills, incentive schemes, drug information resources and digital services. As well as exploring options for better academic support delivered to pharmacists. To capture participant’s views, an online validated and reliable survey was developed. Non-probability sampling design was used. Participants were qualified pharmacists working at Royal Medical Services (RMS) and Community Pharmacists (CP). Comparison and descriptive statistics were used to report the results. A total of 271 pharmacists participated, 144 from RMS (8% more than the needed sample) and 127 CP (7% more than the needed sample). There was a strong desire amongst both RMS and PC groups for continuous educational training particularly in the following areas, first: Advanced counselling and communication skills (means = 8.99±0.145, CI 95% = 3.70–4.28 and 9.37±0.096, CI 95% = 4.18–4.56). Second: Personal development skills (mean = 8.92±0.142, CI 95% = 3.64–4.20 and 9.02±0.145, CI 95% = 3.73–4.30). Third, Pharmaceutical health promotion (mean = 8.05±0.180, CI 95% = 2.70–3.41 and 8.57±0.159, CI 95% = 3.26–3.89). Only 19.4% and 18.1% of the RMS and CPs respectively reported the presence of a written policy for personal development and leadership in their workplace. There were few incentives for pharmacists to participate in research. Few pharmacists used the available drug information and toxicology centers. The professional and continuous personal development of pharmacists support an evolving healthcare system. This study emphasizes the need for a tailored and documented postgraduate educational strategy, personal development, and leadership skills training in Jordan. Implementing a well-defined scheme of incentives should be encouraged to engage pharmacists in continuous professional development programs and pharmaceutical research. Such strategy and training should enhance both professional and personal performance.

Parking Meters to Touch Screens: The Unforeseen Barriers That Expansion of Telemedicine Presents to the Disability Community.

Greater than 25% of annual healthcare expenditures in the United States are associated with the medical needs of people with disabilities. People with disabilities often experience inequalities with access to healthcare services, resulting in increased costs of living with disability. The economic burden of living with a disability results in nearly US $400 billion spent annually from combined public and private payor sources. Historically, disparities in health care are associated with intersections between race, culture, and environmental factors. Minority status also plays a significant role in health outcomes, and studies have highlighted the additional burdens faced at the junction of race and disability status. COVID-19 changed the landscape of healthcare delivery in the United States, resulting in a drastic increase in telehealth utilization. Traditional nonmedical barriers to persons with disability, such as unforeseen parking fees, are documented in the literature. However, conditions surrounding access to the necessary technology required to participate in a telehealth-driven medical landscape are less clear. This article addresses the nonmedical barriers and costs associated with living with a disability and discusses potential solutions in the evolving healthcare system.

Understanding Healthcare Social Enterprises: A New Public Governance Perspective

AbstractIn recent years ‘social enterprises’ have become important partners in the delivery of key public services such as healthcare. However, little is known about how healthcare social enterprises contribute to public service provision in the health sector. We analyzed 172 social enterprises from four continents involved in healthcare to assess the types of interventions, processes, and roles they play responding to rapidly evolving healthcare systems. We found that they are engaged broadly in three dimensions of health service provision: improving access to health services; improving the quality of health services; and building public health capacity. We contribute to social policy theory by enhancing understanding of the micro-level interventions of social enterprises in the healthcare sector and articulating new dimensions of NPG that include co-innovation, co-lobbying, and co-integration in the context of healthcare.

Development of the novice nurse practitioner role transition scale: An exploratory factor analysis.

ABSTRACTBackground:Novice nurse practitioner role transition (NNPRT) can be described as stressful and turbulent, leading to decreased job satisfaction and increased intent to leave. No published instrument exists to measure NNPRT. Thus, researchers, educators, and administrators are limited in their ability to measure the concept and therefore understand the factors that lead to a successful, or unsuccessful, role transition experience. An instrument with evidence of validity and reliability is needed to conduct large-scale and systematic examinations of NNPRT.Purpose:The purpose of this study was to develop and examine the initial factor structure of a novel instrument that measures NNPRT.Methods:Initial item development was guided by concept analysis, literature review, and qualitative data. Face and content validity were established from expert review. Using pilot data from 89 novice nurse practitioners (NPs), an exploratory factor analysis (EFA) was conducted to examine the instrument's internal factor structure.Results:The NNPRT Scale includes 40 items that measure an individual's perception of their role transition experience. The EFA revealed a five-factor structure: organizational alignment, mentorship, sense of purpose, perceived competence and self-confidence, and compensation.Implications for practice:In an evolving health care system, provider well-being is at the center of workforce, educational, and organizational conversations. Understanding how to optimize the workforce and prepare NPs for health care delivery is increasingly important. The NNPRT Scale will allow for large-scale examinations of the factors that influence NP role transition, as well as assess interventions to prepare and support novice NPs' transitions.

Internet of Things as a Logical Way to Tackle the Emerging COVID-19 Virus

The outburst of thenovel coronavirus (COVID-19) that hasledto millionsof deathsglobally appears tobe overwhelming. This virushas become a focus of worldwide consideration. The Internet of Things (IoT) can be well-thought-out as a practical way to forecast, monitor, and avert the emerging COVID-19 virus. Internet of Things represents a connected-network of smart objects, sensors, devices, and people over which information can be acquired and communicated via the cloud for trend and patterns analysis. This technology has gained immense research plethora in health care and industrial applications. The IoT revolution is reforming contemporary healthcare schemes through integrating high-tech, commercial, and societal views. This paper briefly examines the potential of IoT technology as a logical way to tackle COVID-19 by evolving healthcare systems from conventional to more personalized healthcare systems through whichillness can be detected, treated, and supervisedeffortlessly

Sustainability of Biosimilars in Europe: A Delphi Panel Consensus with Systematic Literature Review.

Introduction: Biosimilars have the potential to enhance the sustainability of evolving health care systems. A sustainable biosimilars market requires all stakeholders to balance competition and supply chain security. However, there is significant variation in the policies for pricing, procurement, and use of biosimilars in the European Union. A modified Delphi process was conducted to achieve expert consensus on biosimilar market sustainability in Europe. Methods: The priorities of 11 stakeholders were explored in three stages: a brainstorming stage supported by a systematic literature review (SLR) and key materials identified by the participants; development and review of statements derived during brainstorming; and a facilitated roundtable discussion. Results: Participants argued that a sustainable biosimilar market must deliver tangible and transparent benefits to the health care system, while meeting the needs of all stakeholders. Key drivers of biosimilar market sustainability included: (i) competition is more effective than regulation; (ii) there should be incentives to ensure industry investment in biosimilar development and innovation; (iii) procurement processes must avoid monopolies and minimize market disruption; and (iv) principles for procurement should be defined by all stakeholders. However, findings from the SLR were limited, with significant gaps on the impact of different tender models on supply risks, savings, and sustainability. Conclusions: A sustainable biosimilar market means that all stakeholders benefit from appropriate and reliable access to biological therapies. Failure to care for biosimilar market sustainability may impoverish biosimilar development and offerings, eventually leading to increased cost for health care systems and patients, with fewer resources for innovation.

The future of nursing: leading change, advancing health

The Nursing practice has broader scope as it covers a broad continuum from health promotion, to disease prevention, to coordination of care, to cure and to palliative care when cure isn't possible. However, many members of the profession require more education and preparation to adopt new roles quickly in response to rapidly changing health care settings and an evolving health care system. IOM received these recommendations by acknowledging the unique role that nurses play within the health care system. Because nurses have regular and shut proximity to patients and scientific understanding of care processes across the continuum of care, they have a singular ability to act as partners with other health professionals and to steer within the improvement and redesign of the health care system and its many practice environments, including hospitals, schools, homes, etc.In addition, the IOM recommendations focus on enhancing the facility of nurses at work place and need to help bridging the gap between advancing health, coordinate with available resources and also update her knowledge and skills accordingly. This really expects a greater modification and rebuilding of Nursing curriculum and focus on essential trainings, redesigning of the job responsibilities, define the scope of Nursing Practice, and revise the monetary benefits available for nurses in a challenging world. This will give rise to inception of various new nursing designations, widen the scope of nursing practice by providing ample opportunity for the budding nurses and thereby increasing the employment rate.

Community Pharmacists' Perceptions of Patient Care Services within an Enhanced Service Network.

Background: Pharmacists are positioned as an accessible source of patient care services (PCS). Despite the adversity community pharmacies continue to face, the expanding opportunity of offering PCS continues to be a pathway forward. Objective: To identify community pharmacists’ perceptions to deliver PCS within an enhanced service network. Methods: One-on-one semi-structured phone interviews were conducted as part of a mixed-methods approach. Interview transcripts were analyzed using a consensus codebook to draft thematic findings. Participants were recruited from an electronic survey targeting community pharmacists from the New York chapters of the Community Pharmacy Enhanced Services Network (CPESN). Results: Twelve pharmacists were interviewed with four main themes identified. The majority of study participants were pharmacy owners (92%) devoting an average of 15 h/week to PCS and 8 h/week addressing social barriers. The main themes identified include: (1) perceptions of pharmacy profession, (2) reimbursement models and sustainability of PCS, (3) provision of patient care services, and (4) how PCS address social determinants of health. Conclusions: Offering PCS opportunities for patients is a direction many community pharmacists have embraced and are working to succeed. Ongoing research is needed focusing on community pharmacists’ self-perceptions of the clinical impact and role they hold in an evolving healthcare system.