Community Pharmacy Services Research Articles

Qualitative assessment of patients\u2019 perspectives and needs from community pharmacists in substance use disorder management

BackgroundNon-medical use of psychoactive substances is a common harmful behavior that leads to the development of Substance Use Disorders (SUDs). SUD is a significant health concern that causes adverse health consequences and elevates the economic burden on the health care system. SUD treatment plans that utilize a patient-centered approach have demonstrated improved treatment outcomes. It is essential for health care providers, including community pharmacists, to understand patients’ needs and prioritize them. Therefore, this study was conducted to explore the perspective of patients living with SUDs or who used substances non-medically regarding community pharmacist services and the delivery of services in a community pharmacy setting. The study took place in Saskatoon, a small urban center of Saskatchewan, Canada.MethodsQualitative methodology was used for this research inquiry. Four focus groups were conducted, with a total of 20 individuals who had experienced substance use and accessed community pharmacy services. The discussion of the four focus groups was transcribed verbatim and analyzed independently by two researchers. Agreement on the emergent themes was reached through discussion between the two researchers.ResultsData analysis resulted in four themes that described participants’ perspectives about community pharmacists. The four emergent themes are: 1) conflicted experiences with community pharmacists, 2) lack of knowledge concerning community pharmacists’ extended services, 3) negative experiences in Opioid Agonist Therapy (OAT) program, and 4) needs from community pharmacists.ConclusionThere is significant potential for the patient-pharmacist relationship to address the varying needs of patients who use substances and improve their overall health care experience. Patients who use substances are receptive to pharmacists’ services beyond dispensary; however, respectful communication, provision of drug-related information, and counseling are among the primary demands. Future research should focus on studying the impact of meeting the needs of patients on their treatment outcomes.

Public Perception Regarding Practice, and Barriers towards Pharmacist Counseling in the Community Pharmacy

Background: The role of the pharmacist includes an effective informative counseling with the patient. Pharmacists should practice delivery of patient-centered services and patients should know their rights for proper counseling. Objectives: To assess patient’s perception and attitude towards counseling in the community pharmacy. Methods: The cross sectional study employed an anonymous questionnaire with closed ended questions, written in English and Arabic and posted online. Results: Only 362 participants responded within the specified period. The majority (314, 86.7%) of participants were females, age range of 17-24 years (238, 66%), Arabs (354, 98%), and single (234, 64.6%). Participant’s visits to the pharmacy were 2-4 times (120, 33.1%) and > 10 times (107, 29.6%) annually. The main reason of these visits was to obtain medications (248, 68.5%). Large number of participants ask about the dose (278, 77%) and frequency of administration and duration of use (238, 65.7%), while only 91 (25.1%) of participants ask about side effects. Surprisingly, 182 (50.3%) of the participants admitted not asking about side effects. Reasons of participants not asking for information include getting these from the prescribing physician (204, 56.4%) and having earlier experience (175, 48.3%) with the medication. Sources of information were mainly the physician (262, 72.4%) followed by the pharmacist (220, 60.8%). Participants who consult a physician when feeling ill comprised 146 (40.3%) and a few consult the pharmacist (64, 17.7%). Conclusion: In UAE, the usual practice in most community pharmacies is product- rather than patient-centered and such a perception negatively influences patient’s satisfaction with community pharmacy services.

AVALIAÇÃO DE PROBLEMAS RELACIONADOS A MEDICAMENTOS EM PACIENTES POLIMEDICADOS

Apesar de ter como objetivo a melhora da qualidade de vida, a polimedicação está diretamente associada ao aumento da probabilidade de o paciente desenvolver problemas relacionados a medicamentos (PRM), podendo assim comprometer a eficácia e segurança do tratamento. Com isto, o presente estudo teve como objetivo realizar o seguimento farmacoterapêutico em pacientes polimedicados usuários de um serviço de farmácia comunitária. Trata-se de um estudo prospectivo, de caráter quantitativo, realizado em uma farmácia escola localizada na cidade de Campo Mourão, PR. Foram incluídos 26 pacientes portadores de doenças crônicas e em tratamento com cinco ou mais medicamentos. O seguimento farmacoterapêutico foi realizado com base na metodologia proposta pelo método Dáder. Foram utilizados o Drugdex®, o Dynamed e o bulário eletrônico da ANVISA para avaliar as terapias. Os PRM foram classificados de acordo com Rovers e Currie e os critérios de Beers foram utilizados para identificação de medicamentos inapropriados para idosos. A maioria dos pacientes eram idosos (80,8%), portadores de três ou mais enfermidades e em uso contínuo de oito medicamentos em média. Foram observados 108 PRM (média: 4,9 PRM/paciente), os quais resultaram em 76 propostas de intervenções farmacêuticas aos pacientes. Dentre os PRM identificados destacaram-se os relacionados à segurança (40,7%), efetividade (35,2%) e reações adversas (27,8%). Entre os fatores que podem ser apontados como predisponentes para a elevada incidência de PRM, destacam-se a polimedicação, a idade avançada e a presença de doenças crônicas.

Advancing Mental Health Provision in Pharmacy (AMPLIPHY)

IntroductionImprovement of mental health is a priority in the NHS Long Term Plan (1), and pharmacists and their teams could provide enhanced support for people who take medicines for anxiety or depression, two of the most common mental health problems in the UK. However, a recent Cochrane review (2) identified no community pharmacy services focused on mental health.AimWe aimed to pilot a mental health support service, in community pharmacy: Advancing Mental Health Provision in Pharmacy (AMPLIPHY) to assess its feasibility and potential benefitMethodsThe AMPLIPHY service was codesigned through a workshop involving people with lived experience, pharmacists and researchers. The resultant programme is a series of consultations, beginning at the presentation of the qualifying prescription for an antidepressant, after a further 1–2 weeks and then as further prescriptions are presented, up to 3 months. People are eligible to enter the service if they are newly prescribed antidepressants for depression or anxiety, or have a change in medication, dose or quantity. Pharmacists and their teams identified people who met this criterion and invited them to participate. The service was intended to be patient-led, with the pharmacist helping the patient to define tangible aims and/or outcomes that they wanted to focus on, and providing sign-posting where required. Following brief one-day training, the pilot ran across ten pharmacies in Greater Manchester from November 2019 through March 2020. We triangulated results from: a) quantitative analysis of consultation data; b) content analysis of consultation records; and c) template analysis of semi-structured interviews with participating pharmacists at the start and end of the service. We aimed to obtain feedback from people on exit from the AMPLIPHY service, but this was curtailed due to the coronavirus pandemic. Consultations were recorded via the Pharmoutcomes system (a,b) and interviews were recorded and transcribed, with NVivo used to manage the interview dataset (c).ResultsSeventy-six patients participated in the service, across 9 of the 10 pharmacies. Seventy-five percent of patients had just one consultation. The median age was 39 (IQR 28–47) and 62% of patients were women. Most patients entered the service due to new prescription of antidepressant (74%), 17% due to a change in dose and the remainder due to change in medication or quantity. Sertraline was the most commonly prescribed medication (46%). The content analysis is indicating that consultations centred around one of five areas: health (n=31), lifestyle (n=62), medication (n=45), support (n=37) and patient’s descriptions of their feelings (n=31).ConclusionAMPLIPHY was accessed by a range of people, mainly on initiation of a new antidepressant. Parallels might be drawn with the New Medicines Service in England, but this does not currently extend to antidepressants. Consultations were not restricted to health and medication, but extended to other social and lifestyle aspects thus indicated that participants felt comfortable to disclose their personal situations to the pharmacist. This could support tailored interactions. However, more work is warranted to understand why most patients did not attend multiple consultations, and the immediate/ long-term impact from the patient’s perspective.

Drawing out experience: Arts-informed qualitative research exploring public perceptions of community pharmacy services.

In many countries around the world, people go to community pharmacies to receive primary health care services. Awareness of public views and experiences may help to identify opportunities for greater uptake of primary health care services provided by pharmacists and ways to improve care. Arts-informed research offers the possibility to provide additional insights into public perceptions of community pharmacy services. The purpose of this exploratory study is to describe the process and results of an arts-informed research project using an adapted version of the draw and write technique in combination with focus group interviews to explore public perceptions of community pharmacy services. The draw and write technique was introduced as an introductory activity to evoke a visual expression of participants' perceptions and experiences with community pharmacy services. Participants were invited to answer the question, "What do community pharmacy services mean to you?" in the form of a drawing and words. They were then prompted to discuss their drawings in a focus group interview. This approach resulted in rich visual and textual data. Analysis consisted of a combination of manual sorting of the visual data and examination of the focus group interview data that were transcribed verbatim, anonymized, and analyzed using an inductive comparative approach. NVIVO version 12 software was used to code and manage all data. Use of the draw and write technique elicited initial, fresh perspectives about community pharmacy services prior to discussions with participants in the focus group interviews. This approach allowed researchers to access a diverse range of experiences and perspectives.

Patient and public perception and experience of community pharmacy services post-discharge in the UK: a rapid review and qualitative study

ObjectivesTo investigate the perception and experience of patients and the public (PP) about community pharmacy (CP) services and other primary care services after hospital discharge back home.Design and settingA rapid...

Using journey mapping to understand the patient experience with selecting a Medicare part D plan using a pharmacy consultation service

BackgroundPatient experience with community pharmacy services can be informed by human-centered design principles and approaches. Pharmacy services may benefit from detailed evaluations of consumer experience and patient-centered service design. ObjectivesTo use an online journey mapping platform to understand the patient experience with selecting a Medicare Part D plan for individuals that did, and did not, use a free, pharmacy-led, Medicare Part D consultation service. MethodsThis was a two-group cross-sectional survey study in a single, rural community pharmacy. Surveys consisted of 7 demographic items, 30 Likert-type items, and 7 open-ended response items. The pharmacy used purposeful convenience sampling to distribute a paper survey to individuals 65 years of age and older currently enrolled in Medicare Part D between June and August 2019. Surveys were distributed to 36 patients currently enrolled in a Medicare Part D plan, with 18 surveys distributed to patients who had previously used a pharmacy-led Medicare Part D consultation service and 18 surveys distributed to patients who did not use the service. Surveys were uploaded to an online journey mapping platform, producing data visualizations for each group. Multiple choice survey items were analyzed using descriptive statistics, wth service user and nonuser groups compared using Mann-Whitney U tests. Open-ended survey responses were coded by the research team using an inductive approach. ResultsIn total, 36 surveys were returned to the community pharmacy for a response rate of 100%. The journey map platform generated Persona, Empathy, and Current Journey outputs, which mapped Good Experiences and Bad Experiences within the Medicare Part D plan selection experience. Personas differed in their median household incomes ($25,000–$39,999 for service users compared to $50,000–$74,999 for nonusers). Empathy and Current Journey outputs showed that service users had a wider variety of emotions compared to non-users. Mann-Whitney U tests yielded 5 items with statistically significant differences (p-values <0.05) in the plan-selection experience, with both groups similarly uncertain about their plan decision. Qualitative responses indicate patient trust was universally important to a complex decision-making process. ConclusionsAn online journey mapping platform provided insight into how patients experience a pharmacy service that extends beyond satisfaction. For community pharmacies providing Medicare Part D plan consultation services, pharmacies should consider how they can improve the service experience through communication style and patient-centered service design.

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.

Implementation of a Pharmacogenomic Testing Service through Community Pharmacy in the Netherlands: Results from an Early Service Evaluation.

Community pharmacy services have evolved to include medical and pharmaceutical interventions alongside dispensing. While established pharmacogenomic (PGx) testing is available throughout the Netherlands, this is primarily based in hospital environments and for specialist medicines. The aim of this work was to describe how best to implement PGx services within community pharmacy, considering potential barriers and enablers to service delivery and how to address them. The service was implemented across a selection of community pharmacies in the Netherlands. Data were captured on test outcomes and through a pharmacist survey. Following testing, 17.8% of the clinical samples were recommended to avoid certain medication (based on their current medicines use), and 14.0% to have their dose adjusted. Pre-emptive analysis of genotyped patients showed that the majority (99.2%) had actionable variants. Pharmacists felt confident in their operational knowledge to deliver the service, but less so in applying that knowledge. Delivering the service was believed to improve relationships with other healthcare professionals. These results add to the evidence in understanding how PGx can be delivered effectively within the community pharmacy environment. Training pharmacists in how to respond to patient queries and make clinical recommendations may enhance service provision further.

Assessing community pharmacists' involvement and clients' opinion on HIV/AIDS services in community pharmacies in Nigeria: a cross-sectional survey.

The World Health Organization is promoting community-based services to end HIV/AIDS by 2030. In Nigeria, studies on community pharmacists' involvement in HIV testing services (HTS) and antiretroviral (ARV) medication therapy management (MTM) are scarce, and no study had evaluated the clients' opinion on community pharmacy HTS. We assessed the community pharmacists' involvement in HIV/AIDS services and clients' opinions of community pharmacy HTS. Semi-structured questionnaires on a five-point Likert scale were administered to 701 selected community pharmacists and 5840 clients in southwest Nigeria in 2019. Data were analyzed with descriptive and inferential statistics. Response rates were 68.6% and 69.8% for community pharmacists and clients, respectively. Only 18.5% of community pharmacists offered rapid HTS and 30% refills of ARV. The total score of their involvement on the HTS was 20.94 ± 17.521 (range 8-40; midpoint 24) and on ARV/MTM was 22.98 ± 19.61 (range 9-45; midpoint 27), while 91% were willing to participate in training. Barriers to integrating services into practice were lack of clinical tools (46.8%), lack of collaboration with other healthcare professionals (39.1%), and lack of training on HIV/AIDS services (36.2%) among others. Also, 77% of the clients were willing to participate in community pharmacy HTS, and about 83% of them responded that knowing their HIV status will help them to take necessary precautionary actions. Community pharmacists' involvement in HIV/AIDS services was low. However, they showed willingness to participate in training to improve services. Also, clients were willing to receive community pharmacies HTS to know their status.

Co-design and feasibility of a pharmacist-led minor ailment service

BackgroundCommunity pharmacies provide an appropriate setting to deliver minor ailment services (MASs). Many community pharmacy services have been developed previously without stakeholder involvement. As a result, implementation of services may fail to produce the expected impact. The aim of this research was to co-design and test the feasibility of an Australian MAS for minor ailment presentations.MethodsThis study used co-design methodology which included two phases: (1) a focus group with stakeholders to allow the conceptualization of the service and agreement on service elements; (2) a literature review of clinical guidelines and three working meetings with a team of editors and general practitioners for the development of treatment pathways. Following this, a study evaluating the feasibility of the co-designed service was undertaken. The qualitative part of the methodology associated with the feasibility study comprised semi-structured interviews with MAS pharmacists, observation and completion of a tool by change facilitators identifying barriers and facilitators to service delivery. Qualitative data obtained for all phases were analysed using thematic analysis.ResultsThe developed service included the following components: (i) an in-pharmacy consultation between the patient and pharmacist, (ii) treatment pathways accessible to pharmacists on the internet to guide consultations, (iii) existing digital communication systems used by general practice to exchange patient information, (iv) training, and (v) change facilitation. As a result of feasibility testing, twenty-six implementation factors were identified for practice change, with the main change being the simplification of the pharmacist-patient consultation and data collection processes.ConclusionsAn Australian MAS was generated as a result of co-design, while testing revealed that the co-designed service was feasible. As a result of integrating the views of multiple stakeholders, the designed MAS has been adapted to suit healthcare practices, which may increase the acceptance and impact of MAS when implemented into practice.

Public perceptions and experiences of the minor ailment service in community pharmacy in Scotland.

Background:The Minor Ailment Service (MAS) in Scottish community pharmacy allows eligible people to gain improved access to care by providing free treatment for self-limiting conditions.Objective:To determine the perceptions and experiences of individuals using MAS and to quantify the potential impact on usage of other healthcare services.Methods:A cross-sectional survey was conducted of patients accessing MAS across Scotland during June and July 2018. Questionnaire items included reasons for choosing treatment through MAS, which other services they may have accessed had MAS not been available, experiences of consultation, overall satisfaction, and perceived effectiveness of treatment. Those accessing MAS were given a study pack including an information sheet, pre-piloted questionnaire, and pre-paid return envelope. Participants had the option to consent to an optional one-week follow up questionnaire that focused on perceived effectiveness of treatment after seven days and any further access to healthcare services such as general practice, emergency departments or repeat pharmacy visits.Results:There were 1,121 respondents to the initial questionnaire. Most reported ‘convenient Location’ as the main reason for their access to community pharmacy (n=748; 67.1%). If MAS had not been available, 59% (n=655) of participants reported that they would have accessed general practice for treatment of their minor ailment. Experience of consultations was also rated highly with all ten outcome measures scoring ‘Excellent’ overall. Satisfaction was reported positively with most participants reporting full satisfaction with the overall experience (n=960; 87.2%). At one-week follow up, 327 participants responded, over 85% (n=281) did not require further access to care to treat their minor ailment and 99.7% (n=326) said they would use MAS again.Conclusions:Positive perceptions and experiences of those using MAS demonstrate a highly regarded service in terms of satisfaction and experience of consultation. The capacity for MAS to impact on the use of higher-cost healthcare services is evidenced through the number of participants who reported these services as a point of access to care should community pharmacy not be available. This national evaluation demonstrates MAS to be a positively experienced service and outlines the factors determining access for treatment of minor ailments.

Assessing Patient Satisfaction with Community Pharmacy Services in Yogyakarta, Indonesia

Assessing Patient Satisfaction with Community Pharmacy Services in Yogyakarta, Indonesia

More than 90% of lung disease patients say community pharmacy services are vital, survey finds

A survey by the Taskforce for Lung Health has found that 95% of people living with lung disease in England, who use community pharmacies, rated pharmacy services as valuable, essential or something they “could not live without”. The taskforce, a coalition of organisations including the Royal Pharmaceutical Society (RPS), Asthma UK and the Cystic Fibrosis […]

Measuring patient perspectives on community pharmacy quality: psychometric evaluation of a brief survey.

BACKGROUND: Measuring patient perspectives of the quality of health care delivery is an essential component of building a patient-centered model of care, which has garnered increasing emphasis under value-based payment models. Although measurements of patient perspectives of physician practices are common, few validated measures are currently available to assess patient perspectives of pharmacy quality. OBJECTIVE: To assess the reliability and validity of a brief measure that assesses patient experiences with the quality of community pharmacy services, referred to as the "patient experience" measure. METHODS: This article focuses on the second phase of a 2-phase survey development study. In the second phase, a convenience sample of 400 adult patients with chronic health conditions completed the final 7-item version of the patient experience measure via an online survey. An exploratory factor analysis was performed to determine the number of factors underlying the patient experience measure. Internal consistency reliability was assessed with Cronbach's alpha, and construct validity was evaluated by examining relationships between the patient experience measure, a quality of pharmacy services item, and patient demographic variables. RESULTS: Eigenvalues and scree plots suggested a 1-factor solution, with this single factor explaining 64% of the variance in the patient experience measure. Cronbach's alpha indicated excellent reliability (α = 0.90). Individuals with more positive patient experience scores rated the quality of their pharmacies' services significantly higher (Pearson r = 0.73, P < 0.001). Mean patient experience scores for those who had gone to their pharmacies for 7-11 months (mean = 3.66) were significantly lower than for those who had been going to their pharmacies for 5 or more years (mean = 4.22). CONCLUSIONS: The patient experience measure demonstrated excellent reliability and was correlated with patient perceptions of pharmacy quality. The measure also differentiated between individuals based on the length of time they had been going to their pharmacies. The scale could be used to quickly assess patient experience with community pharmacy services. DISCLOSURES: This work was supported by the National Community Pharmacists Association Innovation Center through a grant from the Community Pharmacy Foundation. Farley reports an unrelated grant from AstraZeneca and fees from Takeda for expert testimony. The other authors have nothing to disclose. This work was presented as a virtual poster at the American Pharmacists Association (APhA) Annual Meeting & Exposition, March 2020, Washington, DC.

Patients' Satisfaction with the Community Pharmacy Services in Iran.

Objective:This study aimed to measure patient satisfaction with community pharmacy in Isfahan, Iran, in 2019.Methods:In this cross-sectional study (2019), we selected 104 pharmacies located in the second largest city of Iran (Isfahan) based on systematic random sampling and at least five clients at different times of a day who finished the process of obtaining medications from the pharmacies were randomly selected for a short and structured interview using the Persian version of the MacKeigan and Larson questionnaire for measuring patients' satisfaction with pharmacy services.Findings:The reliability of the questionnaire was confirmed after distributing 520 among the patients (r = 0.958). No significant difference was observed between sex, marital status, housing status, and total satisfaction score based on the results. In addition, there was a significant difference between educational levels, location, job status, insurance status, real income, and total score of satisfaction (P < 0.05). Our results revealed acceptable satisfaction in some aspects, such as paying attention to pharmacists, the general condition of the pharmacy, and their technical competence. On the other hand, the patients were not satisfied enough in different aspects, for example, counseling, accessibility to their needed drugs, and expenses.Conclusion:Patient satisfaction needs to be improved and enhanced in the case of counseling the patients on their medications, and drug accessibility and expenses remain the primary source of dissatisfaction in the studied population, which should be noted by the Iranian Food and Drug Organization and other related authorities.

Feasibility of cardiovascular risk screening in Portuguese community pharmacies.

Background:Cardiovascular disease (CVD) remains the leading cause of human mortality. As highly accessible and qualified health professionals, community pharmacists can be included in the early detection of patients at risk for CVD by implementing CVD screening programs.Objective:To assess the feasibility of CVD risk screening services in Portuguese community pharmacies from the evaluation of customers acceptability.Methods:A cross-sectional study was conducted in a community pharmacy in Portugal. The purpose of entering the pharmacy was recorded for all customers. Afterwards, the customers were invited to be interviewed by the pharmacist, who registered their willingness to participate and collected the participants’ data and biochemical and physical parameters to assess their CV risk by applying the Systematic COronary Risk Evaluation (SCORE) model. For the participants who were not eligible for the SCORE-based risk assessment, the pharmacist considered the major modifiable CVD risk factors - hypertension, dyslipidemia, smoking habits, obesity, impaired fasting glucose and sedentary behavior - according to the ESC guidelines.Results:Picking up medication was the most prevalent reason 69.8% (n=1,600) for entering the pharmacy, and among the contacted customers, 56.4% (n=621) agreed to have their CVD risk assessed. Of the 588 participants, 56.6% (n=333) were already on CV pharmacotherapy and were therefore not eligible for screening. Of the 43.4% (n=255) CV pharmacotherapy-naïve participants, 94.9% (n=242) were screened with at least one CVD risk factor; 52.9% (n=135) were not eligible for the SCORE assessment, of which 92.6% (n=125) presented CVD risk factors. Of the 120 SCORE eligible participants, 80.0% (n=96) were at least at moderate risk of CVD.Conclusions:We determined the feasibility of CVD risk screening in Portuguese community pharmacies, as we found high customer acceptability, noted the reasons for nonattendance, and found a high prevalence of CVD risk factors in at-risk patients. This is an opportunity for Portuguese community pharmacists to take a leading role in the early detection of CVD.

The Pharmacists’ and pharmacy technicians’ scopes of practice in the management of minor ailments at community pharmacies in Indonesia: a cross-sectional study

Background:Managing minor ailments in community pharmacy is an evolving pharmacy service in developing countries. Defined scopes of practice for pharmacy staff are essential for the safe management of minor ailments. Limited research exists regarding the perceptions of Indonesian pharmacists’ and pharmacy technicians’ scopes of practice in providing minor ailments management services.Objective:To evaluate pharmacists’ and pharmacy technicians’ understanding of their scopes of practice, perceived competency and factors influencing the delivery of minor ailments services in Indonesian community pharmacies.Methods:Cross-sectional surveys were conducted during January-February 2020 of pharmacists and pharmacy technicians attending seminars conducted by relevant Indonesian Associations in Central Java, Indonesia. Percentage of common responses (PCR) described similarity of perceived scopes of practice for pharmacists and pharmacy technicians. Univariate and multivariate analyses identified associations of scopes of practice with pharmacy characteristics.Results:A total of 185 pharmacists and 142 pharmacy technicians participated. Pharmacy technicians performed minor ailment consultations, however, if considered beyond their scope of practice, they referred the patient to the pharmacist (T=120/142, 84.5%). Vaginal thrush, bacterial conjunctivitis, gastro-oesophageal reflux disease, and acute pain were minor ailments perceived only within a pharmacist’s scope (PCR above 60%). Of 34 minor ailments, 11 showed PCR values between 40-60% overlapping pharmacists and pharmacy technicians perceived scopes of practice (allergy/rash, back pain, cold sores, dermatitis, diarrhoea, eczema, hayfever, haemorrhoids, rheumatism, sore throat, and superficial wounds). Back pain, cold sores, dermatitis, and sore throat associated pharmacists’ scope of practice with years of practice experience (p-value<0.05). Pharmacy technicians perceived their scopes of practice to be wider than perceived by pharmacists.Conclusions:Discordance between pharmacists’ and pharmacy technicians’ perceived scopes of minor ailments management highlights the need for clearly defined scopes of practice for each professional group. Each professional group must practise within their competence to ensure safe pharmacy practices.

Coping with COVID-19 pandemic: reflections of older couples living alone in urban Odisha, India.

We explored the 'coping reflections' of elderly couples living alone (without any other family members) during the COVID-19 pandemic in urban Odisha, India. Evidence worldwide suggests that older people are at increased risk from COVID-19 adverse outcomes and experience greater stress. In our previous community-based study urban dwelling, particularly elderly participants, and living alone reported higher pandemic-associated health care challenges than their rural and residing-with-family counterparts. We intended to explore how the elderly couples living alone coped through this challenging yet stressful situation during the COVID-19 pandemic and what were their key strategies adopted toward this. We conducted telephonic in-depth interviews (IDIs) with 11 urban elderly couples living alone in Bhubaneswar city of Odisha, India using a semi-structured interview guide. All IDIs were digitally recorded, transcribed into the original language, and translated to English. We used a thematic approach for analysis. Four themes emerged: (1) Risk appraisal and feeling vulnerable; (2) Safeguarding against COVID-19; (3) Managing routine health care and emergency; and (4) Pursuing mental and psychological well-being. Although fear, anxiety, and loneliness were continuing stressors, many of them learnt to adapt and emerge resilient with the evolving situation. Various elements at the individual, family, community, and organizational levels were conducive to better coping. The companionship and complementary support of spouse, self-health literacy, and digital efficacy, virtual connectedness with family and friends, availability of community pharmacy and diagnostic services in the vicinity, support of neighbors, reengaging with creative leisure time activity, and assurance of a responsive administration at the time of emergency helped them to cruise through the pandemic. Furthermore, watching the re-telecast of prime time serials made these elderly fondly remember their own youth time memories. Self-health monitoring, indoor physical exercise, spiritual practices, continuation of previous prescription, telephonic advice of physicians were add-on strategies that facilitated their physical and psychological well-being during the pandemic.

Primary health care policy and vision for community pharmacy and pharmacists in Estonia.

Estonia, with a population of 1.3 million, is the smallest country in the three Baltic States. As a post-soviet country, Estonia over the past 30 years has built up a new health care system, including the pharmaceutical sector. The GDP allocated to cover health care costs is significantly lower in Estonia compared to the EU average. Despite this, Estonia has excelled in the development of digital e-services in healthcare at both the domestic and international levels. The development and integration of the Estonian community pharmacy sector into primary health care has been influenced and affected by the liberalization within pharmaceutical policy and the lack of cooperation with the rest of the health care sector. Community pharmacy ownership and location matters have been prevalent. The promotion of the pharmacy services has mostly taken place on the basis of a professional initiative, as cooperation with the state has not been active. Possibly the professional fragmentation of the pharmacy sector may have played a negative role. The community pharmacy network in Estonia, especially in cities, enables fast and convenient access to the pharmacy services. Community Pharmacy Service Quality Guidelines support the harmonization of the provided services and patient-centered concept to enhance the patient role and involvement in their care. In recent years, community pharmacies in Estonia have also offered various extended services that are more or less integrated with the primary health care system. New developments may be affected by frequent changes in legislation and a shortage of professional staff in community pharmacies. The ownership reform of pharmacies in 2020 has so far not had a significant impact on the operation of pharmacies or the quality of services provided.