Professional Pharmacy Services Research Articles

Cost Evaluation of Professional Services in a Rural Community Pharmacy: A Monocentric Exploratory Approach.

The increasing pressure on healthcare systems (HCSs) is a cause for concern worldwide. Rising costs, uncertainty about sustainability, and aging populations are the main issues that make it challenging to allocate scarce resources to the needs of HCSs. Clinical professional pharmacy services (PSs) have been shown to help alleviate system stress and to reach the entire population, although a cost of provision is borne. The objective of this study was to evaluate the provision costs of three PSs, a medicine-dispensing service (MDS), a multicompartmental compliance aid system service (MCAS), and a cognitive impairment screening service (CISS), in a rural community pharmacy. A cost analysis was performed using a time-driven activity-based costing model. The time dedicated to PS provision was appropriately recorded, and the corresponding expenses were extracted from the accounting records. A provision time of 4.80 min and a cost of EUR 2.24 were estimated for the MDS, while 18.33 min and EUR 8.73 were calculated for the MCAS, and 122.20 min and EUR 56.72 were calculated for the CISS. The total provision time represented 85% of the pharmacist's effective working time. Tailored cost analysis is a useful tool for making decisions on the implementation of a PS. Larger studies including a variety of pharmacies and locations are necessary to accurately assess costs and engage in discussions on funding and remuneration.

Breastfeeding friendly pharmacy from pharmacists perspective

<b>Objective:</b> The primary goals of our research were to explore pharmacists’ perception of breastfeeding friendly pharmacy (BFPh) requirements and factors associated with their awareness about these requirements.<br /> <b>Methods:</b> A cross-sectional study design was conducted using a self-administered survey. A convenience sample (n=381) of community pharmacists, was recruited through social media resources. Data were entered and analyzed using SPSS software version 35. The frequency or percentages were used for categorical variables while means and standard deviations were used for continuous variables. Also, linear regression analysis was used to evaluate factors affecting pharmacists’ awareness about BFPh requirements.<br /> <b>Results:</b> The majority of recruited pharmacists were female (n=329, 86.4%), aged between 23 to 30 years of age (78.7%, n=300). The most common steps to describe a pharmacy as a BFPh from the perspective of surveyed pharmacists were training all pharmacy staff to develop the necessary skills (n=239, 62.7%)) followed by informing all pregnant women about the benefits of breastfeeding (n=225, 59.1%)) and having a written policy on feeding infants and young children according to the recommendations of the WHO and in compliance with the international code (n=209, 54.9%)). Furthermore, pharmacists aging 40 years or less showed a significantly higher awareness about BFPh requirements compared to those aging above 40 years (beta=-0.013, p= 0.045). In addition, 37% (n=142) of pharmacists perceived that answering general questions or concerns on general medication intake while breastfeeding babies is their major role in breastfeeding support.<br /> <b>Conclusion:</b> Breastfeeding support is a promising area for promoting professional pharmacy services. Training all pharmacy staff and informing all pregnant about the benefit of breastfeeding are the most common two steps to describe a pharmacy as BFPh. Additionally, the awareness of BFPh requirement was associated with pharmacists age. Future focus should be placed on implementing BFPh project in Jordanian pharmacies, where the steps of this project are modified in line with the capabilities of pharmacies in Jordan within governmental pharmaceutical control.

A Short Review on Hospital Pharmacy

The profession of pharmacy has undergone enormous changes in recent decades. The function of the pharmacy has expanded to include more health services. However, the extent to which this role is fulfilled can vary. This review aims to describe the range and extent of professional pharmacy services offered in hospital pharmacies in different countries and the barriers associated with inadequate or incomplete implementation of these services.

A cross-sectional investigation of the impact of COVID-19 on community pharmacy

BackgroundCOVID-19 caused Australian government and state legislative/regulatory changes which impacted directly on aspects of professional community pharmacy. ObjectivesTo examine the views and experiences of community pharmacists regarding the impact of COVID-19 on professional pharmacy services in Western Australian community pharmacies. MethodsA Qualtrics questionnaire link was emailed to all 668 community pharmacies in Western Australia in March 2021. Data were collected on the impact of COVID-19 on professional pharmacy services (telehealth, digital image prescriptions, continued dispensing and emergency supply, home delivery services, medicine and medical resource substitutions), the pharmacy environment (work hours) and professional pharmacy structure (staffing and any measures implemented). Questions included 5-point Likert responses as well as yes/no or option responses. Descriptive statistics were used to summarise questionnaire responses. Chi Squared analysis was used to investigate differences between metropolitan and rural community pharmacies. ResultsThe response rate was 97/668 (14.5%). Many pharmacies belonged to banner groups (47/95; 40.5%). Use of telehealth was reported (25/96; 26.0%), most commonly for MedsChecks. Many received digital image prescriptions (83/88; 94.3%) and continued dispensing, emergency supply requests, or both (78/84; 92.9%) daily. For home deliveries, most used pharmacy staff (56/78; 71.8%). Shortages were reported for many medicines. Panic buying/stock-piling and the media contributed to increased panic and shortages. Little change occurred in trading hours although many reported increased workloads (67/75; 89.3%). ConclusionsCovid-19 has fast-tracked digitisation in Western Australian community pharmacies. This change is likely similar in other parts of Australia. This was facilitated through the expedition of regulatory changes to enable digital health. Whilst electronic prescribing has progressed, telehealth in pharmacy remained underutilised. The pandemic has contributed to pronounced medicine and medical resources shortages, which increased the workloads and pressure of community pharmacists. Pharmacists were confronted with a lot of legislative change in a short period of time. There is a need for clear and concise communication from all levels of government in future pandemics.

Community pharmacists’ provision of sexual and reproductive health services: A cross-sectional study in Alberta, Canada

BackgroundIn many countries, pharmacists’ scope of practice enables the delivery of professional pharmacy services related to sexual and reproductive health (SRH). Studies exploring practices and perspectives regarding a wide range of SRH professional pharmacy services and the extent to which pharmacists are involved in prescribing or administering injections are limited. ObjectivesThis study aimed to explore SRH professional pharmacy services provided by pharmacists, evaluate pharmacists’ self-reported confidence in providing SRH education and determine preferences for additional training. MethodsA cross-sectional Web-based survey was administered to pharmacists working in community pharmacies in Alberta, Canada. The survey was sent via e-mail and was open for 8 weeks between June and August 2020. Descriptive statistics were used to analyze the data. ResultsMost of the 303 participants were female (66%) and received their first pharmacy degree in Canada (69%). Approximately two-thirds had additional prescribing authorization (APA), and 97% had injections authorization; 90% and 94% of participants reported administering injectable contraceptives and human papillomavirus vaccine, respectively, and more than 95% renewed prescriptions for oral contraceptives. Of the participants with APA, approximately 40% reported providing initial prescribing services for contraceptive products. Overall, participants reported confidence in providing SRH education for most topics. Most selected topics for additional training were related to sexually transmitted and blood-borne infections; sexual health concerns of lesbian, gay, bisexual, transgender, queer or questioning; and abortion medications. ConclusionPharmacists in Alberta reported providing a wide range of SRH services and are interested in expanding their SRH role. These findings highlight opportunities to improve access and reduce inequities in the delivery of SRH services through community pharmacies. However, pharmacists’ training needs should be considered.

The health coaching competency gap - Analysis of pharmacist competency frameworks from Australia, Canada, New Zealand the United Kingdom and the United States of America.

The traditional competency frameworks for coaches, the International Coaching Federation (ICF) and the European Mentoring and Coaching Council (EMCC) disregard the differences in expertise required among the diverse professions that may provide coaching. A recent systematic review has identified competencies specific to health professionals who health coach. There are increasing workload pressures in primary care; pharmacists can potentially shift to the greater provision of health promotion services, such as health coaching. The provision of such services needs to be underpinned by competency frameworks, which support the role of pharmacists as health coaches. This analysis identifies the competency gaps for pharmacists if they are to take on the role of health coaching. The enabling competencies of health coaches were compared to the competency frameworks of pharmacists from Australia (AUS), Canada (CAN), New Zealand (NZ), the United Kingdom (UK) and the United States of America (USA). Correlations between the international pharmacist competency frameworks and the competencies enabling health coaching showed that entry to practice pharmacists from AUS, CAN and NZ all require training enabling the health coaching competency 'demonstrates confidence', whereas competency frameworks for pharmacists from both the UK and the USA included all competencies required to health coach. Although pharmacists from the countries examined had most of the competencies required to health coach, gaps within the international pharmacist competency frameworks were apparent, university curricula addressing these gaps would equip entry to practice pharmacists with the knowledge and understanding to confidently provide emerging professional pharmacy services such as health coaching.

Sexual and reproductive health services provided by community pharmacists: a scoping review

ObjectivesPharmacists are increasingly providing patient-focused services in community pharmacies, including in the area of sexual and reproductive health (SRH). Specific SRH areas have been the focus of research, but a...

Does the national competency standards framework for pharmacists in Australia support the provision of behaviour change interventions?

Australian pharmacists are increasingly moving towards the provision of patient-centred professional pharmacy services for chronic disease management. Some of these services are targeted towards improving patients' health and wellbeing through the facilitation of patient-driven health behaviour change. This paper investigates whether the provision of behaviour change interventions by Australian pharmacists is adequately underpinned by the current competency framework. The foundation and behaviour change competences within each of the domains in the generic health behaviour change competency framework (GHBC-CF), was mapped to the Australian pharmacist competency framework. Although the Australian competency framework underpins most of the foundation and behaviour change competences of the GHB-CF required to undertake low-intensity interventions, for medium to high-intensity interventions four specific task-related competences need to be addressed. These are F12 'Ability to recognise barriers to and facilitators of implementing interventions', BC4 'ability to agree on goals for the intervention', BC5 'capacity to implement behaviour change models in a flexible but coherent manner' and BC6 'capacity to select and skilfully apply most appropriate intervention method'. Additional training is necessary if pharmacists aspire to provide behaviour change interventions for chronic disease management, in particular those that are complex as they involve changes to multiple health behaviours. SO WHAT?: The identification of these gaps is critical and can potentially be addressed in postgraduate training programs and as pharmacy curricula are updated.

Scale development and an educational program to reduce the stigma of schizophrenia among community pharmacists: a randomized controlled trial

BackgroundStigma associated with mental disorders is rooted among many pharmacists, and represents a major barrier to patient support in community-based psychiatry. We developed an assessment scale that is specifically designed to assess the level of stigma that pharmacists may have toward schizophrenia, and then examined the effects of reducing stigma with an educational program that focuses on communication with patients diagnosed with schizophrenia (PDS) using the newly developed Stigma Scale towards Schizophrenia for Community Pharmacists (SSCP).MethodsSSCP was developed by exploratory factor analysis with promax rotation based on responses from 822 randomly selected community pharmacists. Furthermore, a randomized controlled trial was conducted for 115 community pharmacists to clarify the effects of reducing the stigma of schizophrenia using an educational program for them with a focus on communication with PDS. Participants were individually allocated to two groups: educational lecture group (56; only attending a lecture on schizophrenia) or contact-based intervention group (59; communicating with PDS and attending the lecture). The stigma assessment using SSCP was conducted immediately before and after the educational intervention.ResultsA total of 4 factors and 27 items were extracted from the exploratory factor analysis to comprise the SSCP. Cronbach’s α of SSCP, social distance at professional pharmacy service (factor I), attitudes towards PDS (factor II), self-disclosure (factor III), and social distance in personal (factor IV) were 0.89, 0.88, 0.76, 0.62, and 0.62, respectively. Educational program-related changes of the median (interquartile range) total SSCP score from baseline were − 9.0 (− 16.0 – − 5.0) in the contact-based intervention group and − 3.0 (− 7.0–1.0) in the educational lecture group, reflecting a significant reduction of stigma levels in the contact-based intervention group. On examining the SSCP subscales, scores for factor I and factor II significantly improved. The educational program was more effective for pharmacists aged 20–39 years or with negligible experience of communicating with PDS at work and/or in private life.ConclusionsSSCP and the educational program for community pharmacists that focuses on communication with PDS were useful for assessing and reducing, respectively, the stigma attached by these pharmacists to schizophrenia.Trial registrationUMIN Clinical Trials Registry (UMIN000043189, registered on January 30, 2021), Retrospectively registered.

Australian Community Pharmacy Harm-Minimisation Services: Scope for Service Expansion to Improve Healthcare Access.

Community pharmacies are well positioned to participate in harm-minimisation services to reduce harms caused by both licit and illicit substances. Considering developments in pharmacist practices and the introduction of new professional pharmacy services, we identified a need to explore the contemporary role of community pharmacy in harm minimisation. Semi-structured interviews were undertaken to explore the opinions of stakeholders, pharmacy staff, and clients about the role of community pharmacy in harm minimisation, including provision of current services, experiences, and expectations. Participants (n = 28) included 5 stakeholders, 9 consumers, and 14 staff members from seven community pharmacies. Three over-arching themes were identified across the three participants groups: (i) scope and provision, (ii) complexity, and (iii) importance of person-centred advice and support in relation to community pharmacy harm minimisation services. Community pharmacies are valuable healthcare destinations for delivery of harm minimisation services, with scope for service expansion. Further education, support, and remuneration are needed, as well as linkage to other sector providers, in order to ensure that pharmacists and pharmacy staff are well equipped to provide a range of harm minimisation services.

Interest in and use of person-centred pharmacy services - a Swiss study of people with diabetes

BackgroundDiabetes is one of the most important chronic diseases and affects 9% of the world’s population. To support these people in the day-to-day management of their treatments, pharmacies can offer professional pharmacy services. These are defined as one or more actions organized or provided in a pharmacy to optimize the process of care, with the goal of improving health outcomes and the value of healthcare. Such services have to be tailored to the needs and interests of patients. This study aimed to evaluate interest in and use of pharmacy services among people with diabetes in the canton of Vaud, Switzerland.MethodsThis cross-sectional study analysed self-reported data from 790 people with diabetes included in the CoDiab-VD cohort. Questions focused on sociodemographic and economic characteristics, diabetes and its management, and interest in and use of pharmacy services related to (1) medication intake and adherence and (2) diabetes and general health. Descriptive analyses were first conducted. Logistic regression analyses were then performed for pharmacy services that were of interest to ≥50% of respondents.ResultsThe mean age of participants was 66 years, and the sample included more males (59%) than females. The pharmacy services that interested the most respondents were individual interview, pill boxes or weekly pill boxes, treatment plans, checks of all medications, first medical opinions from pharmacists and counselling on devices. Factors significantly associated with interest in pharmacy services were being older, having a lower self-efficacy score, taking more than three medications and having a positive opinion about pharmacists.ConclusionsThis study provides key information on interest in and use of pharmacy services among patients with diabetes in Switzerland; it should help pharmacists individualize their services for patients.

Systematic review of pragmatic randomised control trials assessing the effectiveness of professional pharmacy services in community pharmacies

BackgroundImplementation of Professional Pharmacy Services (PPSs) requires a demonstration of the service’s impact (efficacy) and its effectiveness. Several systematic reviews and randomised controlled trials (RCT) have shown the efficacy of PPSs in patient’s outcomes in community pharmacy. There is, however, a need to determine the level of evidence on the effectiveness of PPSs in daily practice by means of pragmatic trials.To identify and analyse pragmatic RCTs that measure the effectiveness of PPSs in clinical, economic and humanistic outcomes in the community pharmacy setting.MethodsA systematic search was undertaken in MEDLINE, EMBASE, the Cochrane Library and SCIELO. The search was performed on January 31, 2020. Papers were assessed against the following inclusion criteria (1) The intervention could be defined as a PPS; (2) Undertaken in a community pharmacy setting; (3) Was an original paper; (4) Reported quantitative measures of at least one health outcome indicator (ECHO model); (5) The design was considered as a pragmatic RCT, that is, it fulfilled 3 predefined attributes. External validity was analyzed with PRECIS- 2 tool.ResultsThe search strategy retrieved 1,587 papers. A total of 12 pragmatic RCTs assessing 5 different types of PPSs were included. Nine out of the 12 papers showed positive statistically significant differences in one or more of the primary outcomes (clinical, economic or humanistic) that could be associated with the following PPS: Smoking cessation, Dispensing/Adherence service, Independent prescribing and MTM. No paper reported on cost-effectiveness outcomes.ConclusionsThere is limited available evidence on the effectiveness of community-based PPS. Pragmatic RCTs to evaluate clinical, humanistic and economic outcomes of PPS are needed.

The influence of intervention complexity on barriers and facilitators in the implementation of professional pharmacy services - A systematic review.

Community pharmacies increasingly offer professional pharmacy services, whose implementation is often influenced by facilitating or obstructive implementation factors. The occurrence and composition of implementation factors vary among different services with discrete characteristics and complexity of the intervention, making it difficult to foresee potential barriers in implementation. This paper investigates potential associations between intervention complexity and occurring implementation factors. A systematic literature search on the implementation factors and intervention complexity of professional pharmacy services in the community setting was carried out in electronic databases (PubMed, CINAHL, and PsycINFO) throughout December 2018. Implementation factors were extracted from semi-structured interviews, focus groups, and surveys with community pharmacists and categorized using the Consolidated Framework for Implementation Research (CFIR). The complexity of each service was assessed using the following complexity parameters: (I) number of involved healthcare professions, (II) number of service components such as recruiting of patients, screening intervention, and follow-up, (III) frequency of the service, (IV) expenditure of time per patient (encounter), and (V) workflow distortion, i.e. booking appointments for intervention with the patient. Finally, the association between implementation factors and intervention complexity was analyzed by quantifying implementation factors and by relating them to specific intervention characteristics using Fisher's exact test. 15 studies covering a broad spectrum of professional pharmacy services were included. There was a trend that in services with higher complexity more implementation factors occurred (p=0.094). Single key complexity parameters can trigger specific implementation factors. For instance, general practitioner and pharmacy technician involvement were significantly associated with interprofessional communication and leadership engagement, respectively. Key implementation factors and associated complexity parameters seem to be of similar or more importance than the total number of implementation factors with regard to successful implementation. By assessing various complexity parameters of an intervention, potential key barriers could be identified and subsequently addressed prior to implementation.

Are professional pharmacy services being offered for free in pharmacies? A feasibility study exploring the use of a time motion study in New Zealand.

Background:Pharmacists report to be providing patient-focused clinical services for which they receive no remuneration. Limited literature exists about unfunded services leading to difficulties in ascertaining an appropriate study design for such research.Objective:This study aims to assess the appropriateness of a proposed study design before launching a nationwide study to investigate the provision of unfunded patient care services.Methods:A multi-methods approach was utilised consisting of (1) continuous time motion study in community pharmacies (2) semi structured patient interviews (3) patient follow up (4) semi structured interviews with pharmacy owners/managers. All observations of unfunded patient care services were recorded, numerically coded and descriptively analysed. Semi structured interviews were audio recorded and transcribed verbatim. A semantic thematic analysis was carried out. Appropriateness of study design was dictated by the ability to characterise services and obtain patient perceptions.Results:Ten pharmacies took part in the feasibility study, across the city of Dunedin, New Zealand, representing a range of different practice settings and demographics. Ten patients were interviewed and six responded to follow up. Both pharmacy and patient recruitment proved challenging due to concerns around disruption to workflow and patient privacy. A continuous observation time motion study was found to be appropriate as it minimises disruption to workflow with no additional work required from the pharmacy teams.Conclusions:A continuous observation time motion study proved to be an appropriate method to investigate the provision of unfunded services on a national scale. The findings of the study suggest design changes such as length of observation time, increasing patient recruitment and additional patient questions to enhance the nationwide study.

Training in Professional Pharmacy Services through Educational Videos

The authors express thanks to Faculty of Pharmacy, University of Granada, Spain; to the actors and actresses who played the role in each video; and to the professional technicians who produced and edited the videos.

Implementation of Professional Pharmacy Services

Quality of pharma-services is defined by the strategies of the pharmacy practices & the patient outcomes. In order to prevent the disease & provide the drug therapy to patients, the strategies of pharmacy practices should be enhanced accordingly. The main aim of the pharmacists' professionals is to enhance the quality of the health-care services by adopting the favourable practices. The standards of the services mainly depend upon the provision of the service. Hence, the aim of present research is to identify qualified pharma-service by adopting the service delivery model for community pharmacy. Previously, the pharmacy practices and the standards were described in several ways, for example, analysing the quantitative aspects related with the pharmacy practices, depending upon the strategies of pharmacy practices that allows personal or indirect use of their advanced healthcare expertise, for patients or other healthcare professionals, to improve the treatment cycle with a view to enhancing healthcare outcomes and importance of healthcare. The interpretation of qualified pharmaceutical services integrates operational function principles, method metrics and result steps. A basic computational framework is introduced to integrate all community pharmacy programs. The term can assist in multiple ways including awareness of the broad spectrum of facilities offered by pharma-community, & promoting establishment of benchmarks for the development and effective delivery of qualified pharmacy services.

Community pharmacists’ perspectives about the sustainability of professional pharmacy services: A qualitative study

ObjectivePharmacists have been increasing patient-focused care through the implementation and provision of professional services. However, there is a lack of evidence on how to achieve long-term sustainability of the service once it is implemented. A framework identifying the factors affecting the sustainability of professional pharmacy services was developed. The objectives of this study were to explore the experiences of community pharmacists providing professional services to contextualize and assess the applicability in practice of the sustainability framework. MethodsA qualitative study was undertaken across Australia. Community pharmacists were identified using snowball sampling. Data were collected through semistructured interviews. Eighteen interviews were conducted and analyzed using framework methodology in NVivo 12 (QSR International). ResultsA range of major sustainability factors was identified and organized in social, economic, and environmental domains. In the social domain, most of the interviewees stated the importance of motivating staff to increase service promotion and patients’ demand. Most of the participants emphasized that having an adequate number of trained staff is required to enhance and maintain services over time. The perceived reluctance of some patients to spend more time than usual at the community pharmacy was another factor highlighted as affecting service sustainability. In the economic domain, the concern about lack of remuneration for service provision was highlighted by most of the interviewees. Having economic support was seen as essential for achieving sustainable services. In the environmental domain, the necessity of government recognition of the pharmacists’ role and value to the health care system was identified as a new key sustainability driver. ConclusionThe applicability of the framework for the sustainability of professional services was evaluated in practice. The identified factors will guide pharmacists to maintain implemented services and achieve their sustainability. Future research should focus on designing a tool to measure the sustainability of pharmacy services.

Health needs assessment in a regional community pharmacy using the PRECEDE-PROCEED model

Community pharmacies have capacity to provide a variety of professional pharmacy services. However, planning models are underutilised when guiding pharmacists in assessing local health and social needs for providing tailored services to meet community needs and priorities. The objective of this was to utilize the PRECEDE-PROCEED model to perform a health needs assessment to identify health concerns in a regional Australian community for guiding professional pharmacy service development. A health needs assessment using the PRECEDE-PROCEED model was conducted in November 2019 using a convergent mixed-methods design through: (1) convenience sampling of pharmacy customers with a survey, (2) purposive sampling of a sole community pharmacist with a semi-structured interview, and (3) collection of regional health and social data from online databases. The community survey response rate was 44.8%. Of 113 participants, the majority were female (71.7%) and town dwellers (89.4%), representing 6.4% of the town's population. Mental illness was cited by 35.3% of community survey participants to be impacting local health and wellbeing, with depression/anxiety the most prevalent self-reported condition (44.2%), predominantly affecting women (72%). The community pharmacist and regional secondary data provided additional support for the prioritization of mental illness. Depression/anxiety was associated with delays/avoidance of prescription medicine due to cost (p=.002), poor self-rated health (p=.012), worsening health over the past year (p<.001), seeking advice from a pharmacist about health or medicines (p=.03), and receipt of emergency care in the past year (p=.001). The lack of a local general practitioner, social isolation, and environmental issues also impacted health and wellbeing. The PRECEDE-PROCEED model identified mental health as the greatest health priority in the community, using multiple data sources and participatory methods. Using this model provides insight into the development of tailored community pharmacy interventions that address health priorities such as mental health needs in a community.

Global Scope of Hospital Pharmacy Practice: A Scoping Review.

The pharmacy profession has undergone tremendous changes over the past few decades. Pharmacists’ roles have expanded their boundaries to encompass more patient-centered services. However, the degree to which these roles are practised may vary. This scoping review is aimed at describing the extent and range of the professional pharmacy services offered in hospital pharmacies across different countries and the barriers underlying inappropriate or incomplete implementation of these services. Studies published in the English language between 2015 and 2019 were retrieved from the following databases: PubMed, CINAHL, Scopus, EBSCO Discovery Service, and Web of Science. A thematic analysis across the included studies produced two main themes. “Scope of practice” comprised three subthemes: pharmaceutical care practice, clinical pharmacy practice, and public health services and “Multiple levels of influence” comprised five subthemes: individual, interpersonal, institutional, community, and public policy-related factors. The hospital pharmacy services across countries ranged from traditional drug-centered pharmacy practice to a more progressive, clinically oriented practice. In some countries, there is an apparent inadequacy in the clinical pharmacy services provided compared to other clinical settings. Understanding the current pharmacy practice culture across different health care systems is an essential step towards improving the profession.

Sustainability of innovations in healthcare: A systematic review and conceptual framework for professional pharmacy services.

Implementation science emerged to address the challenges associated with the incorporation of evidence-based innovations into practice. Once the challenge is overcome, the ultimate goal is to achieve the sustainability of innovations to promote their continuity and long-term integration. Conceptual approaches and assessment tools have been designed to assess the sustainability of innovations in research and practice environments. However, the variability of approaches and tools available becomes a challenge for policymakers, researchers and practitioners, particularly when deciding how to evaluate the sustainability of innovations. To identify conceptual approaches and assessment tools for the sustainability of healthcare innovations and to develop a specific discipline-based framework for the sustainability of professional pharmacy services. A systematic literature review was conducted in January of 2019 using PubMed, Scopus, and Web of Science. General information regarding the conceptual approaches (based on Nilsen's classification), assessment tools and the factors affecting the sustainability of the healthcare innovations was retrieved. From 3123 articles screened, 132 articles were selected from which 106 conceptual approaches and 26 assessment tools were identified. Several key factors moderating the sustainability of the innovations in healthcare were identified (e.g. funding, adaptation). A framework for the sustainability of professional pharmacy services is proposed based on these factors. It presents three performance domains influencing the service sustainability (i.e. environment, social and economic). The identified approaches in different healthcare settings have allowed the adaptation and design of a specific framework for pharmacy. The core factors included in the proposed framework are moderators of the sustainability process and should be considered in sustainability studies and evaluations. This framework will guide pharmacy practice researchers and practitioners to measure and achieve the sustainability of professional pharmacy services. Furthermore, the adaptation of this framework will allow its application to other healthcare settings. (Registration number CRD42018092160).