Community Pharmacy Services Research Articles

Effectiveness of community pharmacies in improving seasonal influenza uptake-an evaluation using the Donabedian framework.

Community pharmacies are now commissioned nationally in England to provide a seasonal influenza vaccination service. However, there is little evidence about the effectiveness of a pharmacy-based immunization service in improving uptake. The Donabedian framework was used to evaluate a community pharmacy service in the West Midlands from a commissioning perspective. A mixed methods approach was adopted, including provider and patient surveys, data from the national influenza vaccination returns and an electronic pharmacy data recording system. Patient satisfaction with the service was high. There was no increase in uptake rates. Impact on reaching new patients was limited. The service had an appropriate information system to record activity. Promotion and signposting for the service was weak. Poor engagement with stakeholders led to dissatisfaction and General Practitioner complaints. Commissioners responded to emerging issues to ensure the pharmacies' set up was compliant with the Service Level Agreement. Improvements in convenience and choice for patients did not result in an increase in uptake rates. With a national pharmacy influenza programme, local arrangements to optimize the service may be limited. Clear arrangements for activity transfer and recording, partnership working and a good communications strategy are crucial in achieving a positive outcome.

A cross-sectional study using freedom of information requests to evaluate variation in local authority commissioning of community pharmacy public health services in England

ObjectivesThis study aims to provide a national picture of the extent and nature of public health services commissioned by local authorities (LAs) from community pharmacies across England in financial year...

Customers Perception Towards The Quality Of Services in Community Pharmacies in Amman-Jordan

The purpose of this study was to measure customers perception towards the quality of services in community pharmacies in Amman-Jordan , through 30 community pharmacies were selected conveniently in Amman and were treated confidentially the quality of the services provided in these pharmacies was measured using the International Pharmaceutical Federation (FIP) working group standards by using face to face cross-sectional a questionnaire .the Results revealed good perception toward these services, high compliance with stage 1 FIP standards. Females perception was higher than males. More work is needed by our community pharmacies on stages 2 and 3 standards in order to increase customer perception. Also the study show. In stage 1, the researcher’s measurement was 79% lower than the pharmacist (91%) with a difference of (12%). In stage 2 the results were 66% and 76% respectively with a difference of 11% in measurement. In stage 3 the results were 62% and 70% respectively with a difference of 8%.On other hand we measure the customers perception of quality of services in these pharmacies by using adapted servqual scale, in convenient sample of 100 customers (52 female, 48 male) the results show a good perception by average of 76%.( 78% female and 73% male), respectively. Implementation of online services and domiciliary services as well as participating in research projects and increasing the attention on behalf of Para pharmaceutical sections appeared to be useful.

P036 Improving larc uptake: a retrospective study into the role and impact of enhanced sexual health services in community pharmacies

IntroductionUnwanted pregnancies and low uptake of LARC continues to be problematic in 15–44 year olds in an East London Borough. Between April 15 and March 16, 45 pharmacies were commissioned, as part of the local enhanced sexual health service (LES) to provide emergency hormonal contraception (EHC) and contraception advice with the aim of increasing LARC uptake in <25s and others at high risk of unwanted pregnancy. Pharmacies taking part in the pilot received PGD and safeguarding training and pathways into LARC were refreshed.MethodsAnalysis of self-sample STI tests via the Doctor’s Laboratory and consultations documented via PharmOutcomes, and corresponding search of PreView for attendances for contraceptive/LARC care during time period.Results35/45 pharmacies (77.8%) dispensed 324 Levonorgestrel (1500 microgram) doses to women resident in the borough >13 years (average age 24.9 years; range 14.2-49.6 years). 100% of <16s had Fraser competency assessed (4). 6.2% (20/324) women had >1 attendance for EHC. 16 women (4.9%) subsequently attended local CaSH/GUM services for LARC; 8 (2.5%) for implant; 4 (1.2%) for injectable; 4 (1.2%) for IUD.DiscussionPharmacy delivered EHC and signposting to LARC services in primary and secondary care is feasible. There were limitations in the ability to gather data regarding women accessing LARC in primary care following contact with pharmacy so these numbers may under report the actual figures of those accepting LARC following pharmacy contact. Online booking systems should be accessible to pharmacists to facilitate LARC referral. Further work looking at acceptability of this strategy should be conducted.

Assessment of Patient Satisfaction with Pharmaceutical Services in Community Pharmacies in Bayelsa State South- South of Nigeria

Today, contemporary pharmacy practice exhibits an evolving paradigm shift from traditional medication dispensing to more active and expanded clinical roles, such as clerking of patient on medication, counseling, screening prescriptions, dispensing and any other management work related to the stocking of medications activities. This study was set out to evaluate patient satisfaction with pharmaceutical services. About 300 respondents agreed to participate after they were made to understand the full details of the study. The questionnaire captured demographic data, drug information provided and how satisfied patients were with the pharmaceutical services provided. 60% of respondents reported that information on adverse effects of drugs/side effects was provided. 60% reported that information on food not to be taken with drugs was provided, 54% reported that information on drug-drug interactions was provided, 59% reported that information on what to do when adverse effects of drugs/side effects occur was provided, 59.5% reported that information on how to store their medications was provided, 74.5% reported that information on importance/need for adherence to medication was provided, 70.5% reported that instructions on the need for follow-up was provided.

Testing evidence routine practice: Using an implementation framework to embed a clinically proven asthma service in Australian community pharmacy.

Community pharmacists are well placed and evidence clearly demonstrates that they can be suitably trained to deliver professional services that improve the management of asthma patients in clinical, economic and humanistic terms. However the gap between this evidence and practice reality remains wide. In this study we measure the implementation process as well as the service benefits of an asthma service model. Using an effectiveness-implementation hybrid design, a defined implementation process (progression from Exploration through Preparation and Testing to Operation stages) supporting an asthma service (promoting asthma control and inhaler technique) was tested in 17 community pharmacies across metropolitan Sydney. Seven pharmacies reached the Operation stage of implementation. Eight pharmacies reached the Testing stage of implementation and two pharmacies did not progress beyond the Preparation stage of implementation. A total of 128 patients were enrolled in the asthma service with 110 patients remaining enrolled at the close of the study. Asthma control showed a positive trend throughout the service with the overall proportion of patients with 'poor' asthma control at baseline decreasing from 72% to 57% at study close. There was a statistically significant increase in the proportion of patients with correct inhaler technique from 12% at Baseline (Visit 1) to 33% at Visit 2 and 57% at study close. Implementation of the asthma service varied across pharmacies. Different strategies specific to practice sites at different stages of the implementation model may result in greater uptake of professional services. The asthma service led to improved patient outcomes overall with a positive trend in asthma control and significant change in inhaler technique.

Tele-pharmacy in rural Scotland: a proof of concept study.

Technology enables medical services to be provided to rural communities. This proof of concept study assessed the feasibility and acceptability of delivering community pharmacy services (CPS; including advice, sale of over-the-counter products and dispensing of prescriptions) by tele-technology (the Telepharmacy Robotic Supply Service (TPRSS)) to a rural population in Scotland. Data collection included the following: postal surveys to local residents; focus groups/ interviews with pharmacists, other healthcare professionals (HCPs) and service users, at baseline and follow-up; TPRSS logs. Interviews/focus groups were audio-recorded, transcribed and thematically analysed. Descriptive statistics were reported for survey data. Qualitative results: Pre-installation: residents expressed satisfaction with current pharmacy access. HCPs believed the TPRSS would improve pharmacy access and reduce pressure on GPs. Concerns included costs, confidentiality, patient safety and 'fear' of technology. Post-installation: residents and pharmacy staff were positive, finding the service easy to use. Quantitative results: Pre-installation: almost half the respondents received regular prescription medicines and a third used an over-the-counter (OTC) medicine at least monthly. More than 80% (124/156) reported they would use the TPRSS. There was low awareness of the minor ailment service (MAS; 38%; 59/156). Post-installation: prescription ordering and OTC medicine purchase were used most frequently; the video link was used infrequently. Reasons for non-use were lack of need (36%; 40/112) and linkage to only one pharmacy (31%; 35/112). Community pharmacy services delivered remotely using tele-technology are feasible and acceptable. A larger study should be undertaken to confirm the potential of the TPRSS to reduce health inequalities in rural areas.

Drug use and drug related problems in three nursing homes in rural municipalities in Norway

Participatory approaches involving stakeholders across the health care system can help enhance the development, implementation and evaluation of health services. These approaches may be particularly useful in planning community pharmacy services and so overcome challenges in their implementation into practice. Conducting a stakeholder analysis is a key first step since it allows relevant stakeholders to be identified, as well as providing planners a better understanding of the complexity of the health care system.The main aim of this study was to conduct a stakeholder analysis to identify those individuals and organizations that could be part of a leading planning group for the development of a community pharmacy service (CPS) to prevent cardiovascular disease (CVD) in Australia.An experienced facilitator conducted a workshop with 8 key informants of the Australian health care system. Two structured activities were undertaken. The first explored current needs and gaps in cardiovascular care and the role of community pharmacists. The second was a stakeholder analysis, using both ex-ante and ad-hoc approaches. Identified stakeholders were then classified into three groups according to their relative influence on the development of the pharmacy service. The information gathered was analyzed using qualitative content analysis.The key informants identified 46 stakeholders, including (1) patient/consumers and their representative organizations, (2) health care providers and their professional organizations and (3) institutions and organizations that do not directly interact with patients but organize and manage the health care system, develop and implement health policies, pay for health care, influence funding for health service research or promote new health initiatives. From the 46 stakeholders, a core group of 12 stakeholders was defined. These were considered crucial to the service's development because they held positions that could drive or inhibit progress. Secondary results of the workshop included: a list of needs and gaps in cardiovascular care (n = 6), a list of roles for community pharmacists in cardiovascular prevention (n = 12) and a list of potential factors (n = 7) that can hinder the integration of community pharmacy services into practice.This stakeholder analysis provided a detailed picture of the wide range of stakeholders across the entire health care system that have a stake in the development of a community pharmacy service aimed at preventing CVD. Of these, a core group of key stakeholders, with complementary roles, can then be approached for further planning of the service. The results of this analysis highlight the relevance of establishing multilevel stakeholder groups for CPS planning.

Development and validation of a modified Korean version of the Pharmacy Services Questionnaire (PSQ-K) for the quality assessment of community pharmacy services.

Patient-reported outcome (PRO) measures and validated instruments have become integral in assessing the quality of healthcare delivery, including pharmaceutical care services. The Pharmacy Services Questionnaire (PSQ) measures patient satisfaction with pharmaceutical care. In this study, we developed a modified Korean version of the PSQ (PSQ-K) and evaluated its validity and reliability. The PSQ-K was developed using a strict translation and cultural-adaptation procedure. A validation study was performed in six community pharmacies in Korea. A total of 300 respondents completed three questionnaires (a brief questionnaire for social demographics and clinical characteristics, the PSQ-K, and the 5-level EuroQoL Group’s 5-dimension [EQ-5D-5L]). Standard validity and reliability analyses were performed. The internal consistency of the PSQ-K was high for all scales (Cronbach’s α > 0.9). The PSQ-K indicated good discriminant and divergent validity. Known-group comparisons revealed that the PSQ-K was able to distinguish between respondents differing in socio-demographic characteristics, such as gender, level of education, and household income. In conclusion, the PSQ-K is a highly reliable and valid PRO instrument for assessing the level of satisfaction with community pharmacy services.

Using an array of implementation strategies to improve success rates of pharmacist-initiated medication therapy management services in community pharmacies.

With the introduction of the Centers for Medicare and Medicaid Services Stars Measure program has come a greater expectation of Medication Therapy Management (MTM) services from community pharmacies. To meet the growing demand of these services, pharmacies have sought out various methods of engaging pharmacists to provide MTM. Barriers for completing MTM include inadequate time to complete the services, insufficient staffing, lack of sufficient compensation, billing difficulty, lack of interest among patients (including refusing MTM services when offered), inadequate training/experience, and lack of support from management. To evaluate the impact of a financial incentive alone versus the incentive plus a package of individualized implementation strategies on the success rate of MTM services. To increase MTM completion rates, The Kroger Company implemented a financial incentive for pharmacists in one of its market services areas. The following year the incentive was continued and an array of training and support strategies were implemented. The numbers of MTM claims and success rates for 2013 (no intervention), 2014 (financial incentive alone), and 2015 (incentive plus required training and ongoing support) were compared. A total of 7038 claims were extracted from 2013 to 2015. The number of completed claims had increased from 1385 in 2013 to 3265 in 2015. The total MTM success rates rose significantly from 42.9% in 2013 to 49.0% in 2014 (p=0.001) and to 64.0% in 2015 (p<0.001). A financial incentive plus a package of individualized implementation strategies increases success rates of MTM services compared to a financial incentive alone.

Quality improvement of community pharmacy services: a prioritisation exercise.

ObjectivesEffective strategies are needed to translate knowledge (evidence) into practice to improve the quality of community pharmacy services. We report the first step of a novel knowledge translation process which involved the systematic identification and prioritisation of community pharmacy services in Scotland which were perceived to require improvement and/or guideline development.MethodsThis process involved three stages and a stakeholder group comprising community pharmacists, policy makers, lay and pharmacy organisation representatives. A modified nominal group technique (NGT) was used for topic generation (August 2013) followed by an electronic Delphi survey (eDelphi), October–December 2013) and topic rationalisation (December 2013) based on feasibility, acceptability, and potential impact for practice improvement.Key findingsIn total, 63 items were identified during the modified NGT which were categorised into 20 topics to form the starting point of the eDelphi. In total, 74 individuals (mostly community pharmacists) indicated an interest in the eDelphi, which achieved response rates of 63.5%, 67.6%, and 70.3%, respectively in Rounds 1, 2, and 3. Consensus was achieved with six topics: promoting the appropriate sale and supply of over‐the‐counter medicines; patient counselling for prescribed medication; pharmaceutical care to promote medication adherence; promotion and delivery of a Minor Ailment Scheme; pharmaceutical care of vulnerable patients; and effective use of community pharmacy workforce. Of these, the priority topic selected for the next stage of the programme was promoting the appropriate sale and supply of over‐the‐counter medicines.ConclusionsThis study adopted a systematic, inclusive, and rapid approach to identify priorities for community pharmacy practice improvement in Scotland.

Towards the implementation of breastfeeding-related health services in community pharmacies: Pharmacists' perspectives.

The scope of community pharmacy practice has expanded over the years. Pharmacists are now involved in the provision of a range of professional services. Pharmacists have regular contact with breastfeeding women, and are perceived as easily accessible, trusted health advisors. There is limited information on factors needed to be considered when implementing breastfeeding-related services in pharmacies to meet the needs of this population group. This study aimed to explore community pharmacists' perspectives on the implementation of breastfeeding-related services, the factors to consider and the required implementation strategies in community pharmacies. The study involved semi-structured interviews with 30 community pharmacists practising in Western Australian. Interviews were audio-recorded and transcribed verbatim to facilitate analysis. NVivo® Version 10.0 was used to aid organisation of qualitative data and thematic analysis. Responses to closed-ended questions were summarised using the descriptive approach. Participants' perceptions about their role in providing breastfeeding-related services in community pharmacies were generally favourable. Participants reported receiving regular enquiries from the public about the use of various medicines during breastfeeding, in particular non-prescription medicines. Most of their knowledge regarding the use of medicines in breastfeeding and breastfeeding in general was a culmination of day-to-day work experience, self-directed continuing professional development, personal or close-contact breastfeeding experience, and university training. Multifaceted efforts including public and professional education, research and development, and government initiatives were identified as essential to facilitate quality use of medicines in breastfeeding, and to increase pharmacists' support of breastfeeding women. Based on the needs and demand, appropriate training and continuing development is warranted so that pharmacists are well-equipped with knowledge regarding the use of medicines in breastfeeding, and breastfeeding in general. There appear to be opportunities for pharmacists to expand their professional services and contribute towards improved care and support of breastfeeding women at primary care level.

Review of community pharmacy services: what is being performed, and where are the opportunities for improvement?

ObjectiveThe aim of this review was to assess pharmacist and pharmacy services being provided and identify opportunities to improve patient satisfaction.MethodsStudies published between January 2006 and July 2016 examining patient satisfaction with pharmacy and pharmacist services, which were written in English, were identified in PubMed. Studies were excluded if they only looked at pharmacy student-provided services.Key findingsA total of 50 studies were ultimately included in the review. Of these studies, 28 examined services traditionally provided by community pharmacists such as dispensing and counseling, while 16 examined a new in-person service being offered by a pharmacy, and the remaining six involved a new technology-assisted service. While study findings were generally positive for patient satisfaction of pharmacy services, several opportunities were identified for pharmacies to improve.ConclusionOverall, patient satisfaction is high across pharmacy services; however, this satisfaction is related to prior patient exposure to services and their level of expectation. Pharmacists have multiple opportunities to improve the services they provide, and there are additional services pharmacists may consider offering to expand their role within the health care system.

Implementing an integrated care management program in community pharmacies: A focus on medication management services

ObjectivesTo describe the initiation of a community pharmacy medication management service within a statewide integrated care management program. SettingOne hundred twenty-three community and community health center pharmacies in 58 counties of North Carolina. Practice descriptionIndependent and community health center pharmacies offering medication management as part of an integrated care management program to Medicaid, Medicare, dually eligible Medicare-Medicaid, and NC Health Choice beneficiaries in North Carolina. Practice innovationCommunity pharmacies joined an enhanced service network created by Community Care of North Carolina to provide medication management services as part of an integrated care management program. EvaluationDuring the first 3 months of the program, 41% of pharmacies consistently documented the medication management services. Interviews were conducted with pharmacists from the inconsistent pharmacies to drive program improvements. ResultsPharmacists at 73 community and community health center pharmacies were interviewed. The majority of pharmacists reported that challenges in “initiating services” and “documenting” were due to increased intensity of service and documentation compared with Medicare Part D medication therapy management requirements. Program changes to improve participation included revision of documentation requirements, authorization of technicians to transcribe pharmacists’ interventions, additional documentation templates, workflow consultations, and feedback on documentation quality. ConclusionCommunity pharmacies are capable of providing medication management integrated with care management. Some pharmacies have more difficulty initiating new services in the current workflow landscape. To facilitate implementation, it is important to minimize administrative burden and provide mechanisms for direct feedback. Pharmacy owners, managers, and leaders in pharmacy policy can use these findings to aid implementation of new services in community pharmacies.

Quality indicators of pharmacists' services in community pharmacies in Paraná State, Brazil

Pharmacists and their pharmacies have been evolving in their roles as health promoters in Brazil. Some examples are the recent legislation reaffirming the role of Brazilian pharmacies as health institutions, rather than having only a commercial profile, giving greater clarity to pharmacists about their roles as health care providers. This evolution came with the recognition that is already seen in other developed countries, confirming the need for the pharmacist as a health promoter, and not simply a dispenser of drugs in society. This study has obtained the profile and activities of community pharmacists, as well as the quality indicators of private community pharmacies throughout the State of Parana through the application of an online survey sent to pharmacists in the state. Out of all pharmacists surveyed, 533 were part of the final analysis, being the pharmacists to complete the survey in full. Participants were mostly female (69.4%) and were, on average, 35.2 ± 9.2 years old. Of these, 60% worked in pharmacy chains and just 37% of all pharmacist respondents were issuing the Declaration of Pharmaceutical Services. The current study showed that many pharmaceutical services are not adopted by pharmacies as these services bring no significant financial reward. Regarding the structure, the Parana State showed that pharmacies present a good overall structure. The kind of pharmacy (chain or independent) influenced the pharmaceutical services provided and the available structure, where the independent pharmacies provide a wider range of services and have better structure. This study was able to identify the profile and behaviors of pharmacists and also the quality indicators of pharmacies in Parana State.

Assessment of patient's satisfaction with pharmaceutical care services in community pharmacies in the United Arab Emirates

Objective: To determine some aspects of patient's satisfaction of pharmaceutical services provided by the community pharmacist. To assess consumer's attitude towards the services provided in the community pharmacy. Methods: An anonymous pre-piloted questionnaire-based study was conducted in the various Emirates of the United Arab Emirates. Data were analyzed using SPSS and results were expressed as frequency and percentage of respondents. Results: The response rate was 93.8% with more female than male respondents. The majority of participants were Arabs (80.5%) of young age and with no medical background. Slightly more than half of the respondents (198, 52.8%) visited the pharmacy to collect prescriptions, and 50.5% of them were able to collect the prescriptions straight away. Only 31.7% of respondents visited the pharmacy to purchase items and of these group 289 (77.1%) were satisfied with the pharmacist's help. When asked to describe their usual pharmacist, “experienced,” “trustworthy,” and “confident” were the descriptions given by 27.7%, 22.9%, and 67.9% respondents, respectively. The majority (74.1%) of respondents agreed that the pharmacist delivers their medicines in a polite way, and 43.7% agreed that the instructions were clearly labeled by the pharmacist on each medication and 24.5% agreed that the pharmacists provided them with information on drug storage. About 38.4% agreed that the place of pharmaceutical counseling respects their privacy. Conclusion: Results of the present study showed a general patient's satisfaction of the help provided by the community pharmacist. However, the pharmacist needs to fully practice his/her role to the advantage of the patients and the latter needs to be aware of what to expect and demand from the community pharmacist.

Purchase of prescription and OTC medicines in Slovakia: factors influencing patients' expectations and satisfaction

Slovakia is a country where the purchase of OTC (over the counter) medicines outside the pharmacy is not allowed by the government. This study aimed at evaluating patients' satisfaction and acceptance of community pharmacists. Customer's behaviour and expectations influencing the purchase of prescription and OTC medicines were analyzed. A structured questionnaire having 15 multiple-choice questions was used to analyze the descriptive parameters. Data collection lasted from January to February 2014. The sample size consisted of 357 high-school educated individuals under 40 years of age. The survey showed that the prescription and OTC medicines were bought equally. The participants reported a 96.0%, 96.3% and 90.2% satisfaction rate with willingness and approach of the community pharmacist, pharmacy services and provision of drug information respectively. As for the OTC medicines, 89.5% people considered the pharmacist an expert: 88.2% purchased medicines with pharmacist's recommendation, 97.8% needed a professional counselling and 97.2% required a pharmacist's guidance. As for the prescription drugs, only 72.1% considered the pharmacist an expert: 96.3% suggested that physician's prescription was significant and 88.3% considered pharmacist's guidance in the process of selection of prescription medicines nonessential. A comprehensible and respectable conversation was highly expected in regards to both the OTC and prescription medicines.

Community pharmacy services to be cut owing to reduced public spending, says King's Fund

Community pharmacy services to be cut owing to reduced public spending, says King's Fund

Beyond the four walls: an exploratory survey of location, employment and roles of pharmacists in primary health care.

INTRODUCTION Recognition of the need to reduce harm and optimise patient outcomes from the use of medicines is contributing to an evolution of pharmacy practice in primary health care internationally. This evolution is changing community pharmacy and leading to new models of care that enable pharmacist contribution beyond traditional realms. There is little information about the extent of these changes in New Zealand. AIM The aim of this study was to investigate emerging roles of pharmacists in primary health care. METHODS A 10-question electronic survey was used to collect quantitative data about location, employment and roles of pharmacists practising in primary health care. RESULTS There were 467 survey responses. Although most pharmacists are employed by (78%, n = 357/458) and located in (84%, n = 393/467) community pharmacies, small numbers are dispersed widely across the primary health care sector. Of the 7% (n = 31/467) working in general practices, most are employed by Primary Health Organisations or District Health Boards. Limited cognitive pharmacy service provision is evident in the sector overall, but is much greater for pharmacists spending time located within general practices. DISCUSSION The large proportion of pharmacists practising in community pharmacies emphasises the importance of the Community Pharmacy Services Agreement in facilitating increased cognitive pharmacy service provision to optimise patient outcomes. The small numbers of pharmacists located elsewhere in the primary health care sector suggest there is scope to improve collaboration and integration in these areas. Flexible funding models that promote innovation and support sustainable practice change are key.

Murray review of community pharmacy services will ‘direct’ government policy, says health minister

Murray review of community pharmacy services will ‘direct’ government policy, says health minister