How to enhance public health service utilization in community pharmacy?: General public and health providers' perspectives

BackgroundCommunity pharmacists (PHs) in England are increasingly providing a range of public health services. However, the general public view pharmacists as drug experts and not experts in health, and therefore, services may be underutilized.ObjectivesTo explore experiences and views of 4 groups of participants, the general public, PHs, general practitioners (GPs), and other stakeholders (STs) on pharmacy-based public health services, and identify potential factors affecting service use.MethodsThe study was undertaken in a locality of North West England. Three focus groups were conducted with the general public (n = 16), grouped by socioeconomic status. Fourteen semistructured interviews were undertaken with PHs (n = 9), GPs (n = 2), and STs (n = 3). Discussions/interviews were audio recorded, transcribed verbatim, and analyzed thematically.ResultsAll 4 groups of participants agreed that community pharmacies are a good source of advice on medicines and minor ailments but were less supportive of public health services. Six factors were identified affecting utilization of pharmacy services: community pharmacy environment, pharmacist and support staff, service publicity, general public, GP services, and health care system and policies. Crucial obstacles that could inhibit service utilization are perceptions of both the general public and other health providers toward pharmacists' competencies, privacy and confidentiality in pharmacies, high dispensing workload, and inadequate financial support. Networking between local health professionals could enhance confidence in service delivery, general awareness, and thus utilization.ConclusionsCommunity pharmacy has the potential to deliver public health services, although the impact on public health may be limited. Addressing the factors identified could help to increase utilization and impact of pharmacy public health services.     

Exploring the relationship between pharmacists' job satisfaction, intention to quit the profession, and actual quitting

BackgroundTo date there has been no published research on the link between job satisfaction and intentions to quit the profession among pharmacists.ObjectiveTo explore job satisfaction, intentions to quit the profession, and actual quitting among pharmacists on the Royal Pharmaceutical Society of Great Britain Register.MethodsJob satisfaction of pharmacists was measured as part of a workforce census using a validated satisfaction scale. Pharmacists were asked about their intentions to quit pharmacy within the next 2 years and follow-up was done using secondary analysis to see if they had quit within this timescale. Mean values for the satisfaction scale items were recorded and regression techniques were used to explore factors affecting job satisfaction and intentions to quit. The workforce census questionnaire was completed by 32,181 pharmacists (response rate = 76.6%). This article considers the job satisfaction and intentions to quit of pharmacists under state pension age who were working in the community, hospital, and primary care sectors (n = 21,889).ResultsOverall, pharmacists appeared to be satisfied with their work, although female pharmacists were more satisfied than their male counterparts. Pharmacists working in the community sector were less satisfied than those in other sectors. Remuneration was consistently ranked as 1 of the aspects of their work that pharmacists found least satisfying, regardless of age, sex, or sector of practice. Strength of desire to practice pharmacy was a predictor of both job satisfaction and intentions to quit pharmacy.ConclusionsSeveral factors were found to affect pharmacists' intentions to quit the profession including sex, age, job satisfaction, and strength of desire to practice pharmacy. However, only a relatively small proportion of pharmacists who expressed an intention to leave the profession appeared to have done so, suggesting that intentions may not be translated into action in this group of pharmacists.     

Development of a scale to measure pharmacists' self-efficacy in performing medication therapy management services

BackgroundMeasuring community pharmacists' self-efficacy in performing medication therapy management (MTM) services can be useful for tailoring interventions and predicting participation.ObjectiveTo identify relevant survey constructs related to the Wisconsin Pharmacy Quality Collaborative (WPQC) MTM program and to evaluate scale validity.MethodsThe 31-item MTM self-efficacy scale was developed using previous research, identifying critical program components, and beta testing. After administration to pharmacists in the 53 WPQC pilot sites, summary statistics and exploratory factor analysis (EFA) were conducted. Parallel analysis was used to determine the optimal number of factors. Internal consistency reliabilities were calculated.ResultsBaseline participation rate was 94% (N = 76). The 11-point scale (0-10) item means ranged from 2.83 ± 3.05 to 7.82 ± 2.19. Parallel analysis produced a 3-factor solution, accounting for 56% of the variance. Low-factor loadings or unacceptably high cross loadings resulted in 17-item deletions. The final EFA on the remaining 14 items retained the original 3-factor solution and increased the proportion of explained variance (72%). The factors relate to MTM tasks (alpha = 0.92), personal interactions (alpha = 0.86), and goal setting (alpha = 0.84). Overall Cronbach's alpha = 0.90.ConclusionConstructs for measuring self-efficacy were identified that may aid in future research predicting whether pharmacists engage in and persist in providing MTM services.     

A randomized trial evaluating 2 approaches for promoting pharmacy-based referrals to the tobacco quitline: Methods and baseline findings

BackgroundDespite the fact that individuals who smoke are at an increased risk for disease and therefore require frequent visits to pharmacies for medications, most community pharmacies do not integrate tobacco cessation activities into routine practice.ObjectiveThe objective of this report is to describe the methods and baseline findings for a 2-state randomized trial evaluating 2 intervention approaches for increasing pharmacy-based referrals to their state's tobacco quitline.MethodsParticipating community pharmacies in Connecticut (n = 32) and Washington (n = 32) were randomized to receive either (1) on-site education with an academic detailer, describing methods for implementing brief interventions with patients and providing referrals to the tobacco quitline or (2) quitline materials delivered by mail. Both interventions advocated for pharmacy personnel to ask about tobacco use, advise patients who smoke to quit, and refer patients to the tobacco quitline for additional assistance with quitting. Study outcome measures include the number of quitline registrants who are referred by pharmacies (before and during the intervention period), the number of quitline materials distributed to patients, and self-reported behavior of cessation counseling and quitline referrals, assessed using written surveys completed by pharmacy personnel (pharmacists, technicians).ResultsPharmacists (n = 124) and pharmacy technicians (n = 127), representing 64 participating pharmacies with equal numbers of retail chain and independently owned pharmacies, participated in the study. Most pharmacists (67%) and half of pharmacy technicians (50%) indicated that they were not at all familiar with the tobacco quitline. During the baseline (preintervention) monitoring period, the quitline registered 120 patients (18 in Connecticut and 102 in Washington) who reported that they heard about the quitline from a pharmacy.ConclusionNovel tobacco intervention approaches are needed to capitalize on the community pharmacy's frequent interface with tobacco users, and these approaches need to be evaluated to estimate their effectiveness. Widespread implementation of brief, yet feasible, pharmacy-based tobacco cessation efforts that generate referrals to a tobacco quitline could have a substantial impact on the prevalence of tobacco use.     

Collaborative prescribing: A qualitative exploration of a role for pharmacists in mental health

BackgroundCollaborative prescribing has been proposed as an extension of practice for advanced pharmacist practitioners. A lack of research investigating how pharmacists might be most effective as prescribers in mental health was identified.ObjectiveTo explore health professionals’ and consumers’ attitudes and beliefs that relate to the role of specialist mental health pharmacists working as collaborative prescribers within their advanced scope of practice in secondary care.MethodsSemistructured interviews were conducted with key informants in the New Zealand mental health sector. Participants were selected via a purposive sampling method, including health professionals (n = 9) and consumers (n = 3). NVivo software was used to analyze data, using a thematic analysis approach to develop a series of key themes from the interviews. Common themes were extracted, which were used to gather results and draw conclusions.ResultsThe key findings include a widespread acknowledgment of the role of specialist pharmacists as collaborative prescribers in mental health and as integral members of the multidisciplinary team; however, consumers were unaware of pharmacists’ role in secondary care. The role was seen to extend current practice particularly in medication management after assessment and diagnosis by a medical practitioner. Concerns regarding demonstrating competence, practitioner role/boundary confusion, insufficient training and workforce development, hesitancy by pharmacists to extend role, consumer awareness, and public perception of the traditional pharmacist role were identified. Solutions discussed included education by the profession; relationship building, training, and robust competency assessments; and a structured framework for implementing a collaborative prescribing model.ConclusionsThis study suggests there was recognition and acceptance of the role that specialist pharmacist practitioners could play in contributing to the care of mental health consumers as collaborative prescribers; their medication expertise being regarded highly. Further research is necessary to investigate how current resource constraints will allow for collaborative prescribing to be implemented within the context of mental health practice.     

Factors influencing pharmacists’ clinical decision making in pharmacy practice

BackgroundPharmacists’ clinical decision-making is considered a core process of pharmaceutical care in pharmacy practice, but little is known about the factors influencing this process.ObjectiveTo identify factors influencing clinical decision-making among pharmacists working in pharmacy practice.MethodsSemi-structured interviews were conducted with pharmacists working in primary, secondary, and tertiary care settings in the Netherlands between August and December 2021. A thematic analysis was conducted using an inductive approach. The emerged themes were categorized into the Capability–Opportunity-Motivation–Behaviour (COM-B) model domains.ResultsIn total, 16 pharmacists working in primary care (n = 7), secondary care (n = 4) or tertiary care (n = 5) were interviewed. Factors influencing pharmacists' capability to make clinical decisions are a broad theoretical knowledge base, clinical experience, and skills, including contextualizing data, clinical reasoning, and clinical judgment. The pharmacy setting, data availability, rules and regulations, intra- and interprofessional collaboration, education, patient perspectives, and time are mentioned as factors influencing their opportunity. Factors influencing pharmacists’ motivation are confidence, curiosity, critical thinking, and responsibility.ConclusionsThe reported factors covered all domains of the COM-B model, implying that clinical decision-making is influenced by a combination of pharmacists' capability, opportunity, and motivation. Addressing these different factors in pharmacy practice and education may improve pharmacists’ clinical decision-making, thereby improving patient outcomes.     

The corporatization of community pharmacy: Implications for service provision,the public health function,and pharmacy's claims to professional status in the United Kingdom

BackgroundPharmacy has experienced both incomplete professionalization and deprofessionalization. Since the late 1970s, a concerted attempt has been made to re-professionalize pharmacy in the United Kingdom (UK) through role extension—a key feature of which has been a drive for greater pharmacy involvement in public health. However, the continual corporatization of the UK community pharmacy sector may reduce the professional autonomy of pharmacists and may threaten to constrain attempts at reprofessionalization.ObjectivesThe objectives of the research: to examine the public health activities of community pharmacists in the UK; to explore the attitudes of community pharmacists toward recent relevant UK policy and barriers to the development of their public health function; and, to investigate associations between activity, attitudes, and the type of community pharmacy worked in (eg, supermarket, chain, independent).MethodsA self-completion postal questionnaire was sent to a random sample of practicing community pharmacists, stratified for country and sex, within Great Britain (n = 1998), with a follow-up to nonresponders 4 weeks later. Data were analyzed using SPSS (SPSS Inc., Chicago, IL, USA) (v12.0). A final response rate of 51% (n = 1023/1998) was achieved.ResultsThe level of provision of emergency hormonal contraception on a patient group direction, supervised administration of medicines, and needle-exchange schemes was lower in supermarket pharmacies than in the other types of pharmacy. Respondents believed that supermarkets and the major multiple pharmacy chains held an advantageous position in terms of attracting financing for service development despite suggesting that the premises of such pharmacies may not be the most suitable for the provision of such services.ConclusionsA mixed market in community pharmacy may be required to maintain a comprehensive range of pharmacy-based public health services and provide maximum benefit to all patients. Longitudinal monitoring is recommended to ensure that service provision is adequate across the pharmacy network.     

Pharmacists’ Views of Patient Counseling: Pharmacists believe that patient familiarity with a medication and the seriousness of possible outcomes from its use are important considerations in counseling.

The goal of this study was to assess whether pharmacists rate eight elements of counseling of equal importance in different dispensing situations. A sample of 708 pharmacists was asked to complete a pretested questionnaire about patient counseling; 697 provided usable responses for a response rate of 98%. Using multivariate analysis of variance, analysis of variance, we found significant differences (p < 0.01) in pharmacists' ratings of the importance of counseling patients in different situations. Pharmacists used patient familiarity with the medication and the perceived seriousness of potential consequences to the patient to determine the importance of each element of counseling.     

Change in public satisfaction with community pharmacy services in Tartu,Estonia, between 1993 and 2005

BackgroundThe health care systems of Estonia and other Baltic States underwent major reforms between restoration of independence from the USSR and admittance to the European Union. These reforms included changes to the regulations regarding the ownership, location, and number of community pharmacies.ObjectivesThe objective of this study was to analyze changes in access to, image of, and satisfaction with community pharmacy services in Tartu, Estonia, between 1993 and 2005.MethodsA survey instrument was mailed to a stratified random sample of 713 Estonians aged 20-69 years living in Tartu in 1993 and again to 1000 Estonians aged 20-69 years living in Tartu in 2005. Completed survey instruments were returned by 448 (63%) respondents in 1993 and 386 (39%) respondents in 2005.ResultsRespondents in 2005 reported more frequent visits to pharmacies than respondents in 1993 (P = .012) and were more likely to indicate that pharmacies have more appropriate locations and opening hours (P < .001). In 2005, 71% of respondents reported always visiting the same pharmacy compared to 35% in 1993. The perceived trustworthiness of pharmacists remained constant. Respondents believed that the role of the pharmacist as a provider of drug information should be expanded; however, demand for extended community pharmacy services was low.ConclusionPostindependence reforms to health care and pharmacy systems in Estonia have coincided with greater utilization of community pharmacy services. Higher rates of utilization and continued good standing within the community suggest that pharmacies are potentially well placed to make additional contributions to the evolving primary health care system in Estonia.     

Variation in patients' and pharmacists' attribution of symptoms and the relationship to patients' concern beliefs in medications

BackgroundThe process by which symptoms are identified and characterized is related to adverse drug event reporting. Patient and pharmacist symptom attribution may differ and be related to certain patient characteristics.Objectives(1) To compare attribution of symptoms to a cause for patients and pharmacists; (2) to quantify the association between patients' concern beliefs and patient-pharmacist agreement on patients' symptom attribution to medications; and (3) to identify any associations between patients' propensity to agree with pharmacists' assessments of symptom attribution with various clinical and/or sociodemographic characteristics.MethodsAn Internet survey of Medicare beneficiaries was administered by Harris Interactive^®. The survey elicited information on health symptoms that subjects experienced and to whom they reported these symptoms. If subjects did not experience symptoms and did not report them, the reasons for not reporting were elicited. A clinical expert panel reported ratings about respondents' (1) likelihood of the symptom experienced being attributed to a medication and (2) probability of the symptom being attributed to the reason the patient stated. Frequencies of unreported symptoms for each reason/category were examined. Chi-square and Fisher's exact test analyses examined the variations between patients' and pharmacists' ratings of symptom attribution to medications and associations between attribution and patient sociodemographic and clinical characteristics, such as the number of medications used. Independent sample t tests examined how attributions were related to concern beliefs.ResultsMost patients thought their symptom(s) were the result of their disease, something other than medications or age. There was no statistically significant difference between patients' and pharmacists' symptom attribution (χ² = 1.376, P = .24). Individuals whose symptom attributions differed from pharmacists were likely to have stronger concern beliefs in medication (t = ?3.03, P < .01).ConclusionsPatients' concern about their medications may be related to their symptom attributions. Older adults may not consider these concerns when asked about their symptom attributions.     

Pharmacists’ Expectations for Entry-level Practitioner Competency

Objective. To determine if defined subgroups of pharmacists’ have variability in their expectations for competency of entry-level practitioners.Methods. Rating scale data collected from the 2009 National Pharmacy Practice Survey were analyzed to determine to what extent pharmacists'' degree, practice setting, and experience as a preceptor were associated with the ratings they assigned to 43 competency statements for entry-level practitioners. The competency statements determine the content on the North American Pharmacist Licensure Examination (NAPLEX).Results. Pharmacists with a doctor of pharmacy (PharmD) degree rated the co mpetency statements higher in terms of criticality to entry-level practice than did those with a bachelor of science (BS) degree (p< 0.05). Pharmacists working in inpatient settings gave slightly higher ratings to the competency statements than did pharmacists working in outpatient settings, pharmacists without direct patient care responsibilities, and those in academia. However, there were no significant differences among practitioner subgroups'' criticality ratings with regard to practice setting. Preceptor pharmacists'' criticality ratings of the competency statements were not significantly different from those of non-preceptor practitioners. Conclusion. Pharmacists exhibited a fair amount of agreement in their expectations for the competence of entry-level practitioners independent of their practice sites and professional roles. As the pharmacy profession embraces patient-centered clinical practice, evaluating practicing pharmacists’ expectations for entry-level practitioners will provide useful information to the practitioners and academicians involved in training future pharmacists. Stakeholders in pharmacy education and regulation have vested interests in the alignment of the education of future practitioners with the needs of the profession.     

Upscaling the pharmacy profession: Knowledge and willingness of the Lebanese pharmacists to practice the administration of dermal fillers

BackgroundThe rapid global development of the pharmacy profession has led pharmacists to enter the cosmetic industry by administering injectable dermal fillers (DFs) to those in need. However, there is no clear indication that the Lebanese pharmacists are familiar with these procedures or are willing to do so.ObjectivesWe aimed to investigate the Lebanese community pharmacists' knowledge about DFs and their willingness to administer them.MethodsA self-administered questionnaire was sent to 461 randomly selected pharmacists who agreed to participate in the study after a phone call. A scoring system for the knowledge about DFs was employed.ResultsOnly 31.4 % of participants reported formal education as the source of knowledge about DFs, and 3.7 % of them reported practicing them on patients. The mean score of knowledge was 5.9 ± 2.5 (out of 14). High level of knowledge was observed in only 25 % of the participants, where females, older and experienced pharmacists, and those working in Beirut region were more significantly knowledgeable. Around 67 % of participants were willing to be trained in this field to expand their field of practice and improve their income.ConclusionsLebanese community pharmacists are not yet ready for this new dimension in the career. Legislative procedures, training, licensing, and developed pharmacy curriculum must precede the practice of DFs by pharmacists in Lebanon.