Exploring stakeholders' perspectives on the quality of services provided through community pharmacies

IntroductionIt is important to understand the factors impacting the quality of services provided through community pharmacies. Exploring how key stakeholders perceive good quality in these services is a logical first step. This could also inform the development of quality measures, such as quality indicators (QIs).AimTo identify key stakeholders' perspectives on the quality of services provided through community pharmacies in Norway, specifically by exploring their experiences and perceptions about what constitutes good service quality.MethodsA convenient sampling approach was used to recruit participants for five semi-structured focus groups from Facebook, pharmacy chains, and patient organizations. The interviews with twenty-six participants were conducted via Microsoft Teams. Interviews were transcribed verbatim, and an inductive thematic analysis with a reflexive approach was used.ResultsFour main themes emerged from the analysis; 1) sufficient and substantively suitable information to cover individual needs, 2) communication skills and relationships with the pharmacy professionals, 3) customer satisfaction with knowledgeable employees and conveniently located pharmacies, and 4) factors that affect the pharmacy working environment.ConclusionThis study has identified areas that pharmacy professionals and customers regard as essential to define good quality of community pharmacy services. Effective communication skills, appropriate provision of information, customer satisfaction, and working environment are all essential factors when developing quality metrics for community pharmacies.     

Validation of a patient satisfaction questionnaire for services provided in Spanish community pharmacies

Background The concept of Pharmaceutical Care (PC) is being gradually developed, and it??s impact in health care should be measured using a quality tool. Objective The aim of this study was to describe and assess the psychometric properties of a patient satisfaction questionnaire (PSQ) for PC services in community pharmacies in Seville, Spain. It was based on a previous questionnaire in Spanish. Methods The face and content validity were assessed using the items of a validated questionnaire developed by Traverso et al. and adapted to the Seville pharmacy patient population. The PSQ was designed for use in the community pharmacy setting by a panel of seven pharmacists with expertise in both PC and questionnaire design. The result, was a ??draft PSQ?? which comprised of 27 multidimensional items, with responses recorded on a five-point ??Likert-type scale??. The validity and reliability of the ??final PSQ?? was carried out using a cross-sectional and analytical study. Eighteen community pharmacies agreed to participate in the study. The draft PSQ was a self completion questionnaire distributed to patients by pharmacists following selection criteria. The survey response rate was assessed. The validity was determined by establishing the distribution of the PSQ??s items and dimensions of the PSQ through factor analysis, and the reliability was evaluated with Cronbach??s alpha coefficient (??). Results Two-hundred and twenty-three patients took part in the study.The factor analysis with varimax rotation established a ??final PSQ?? with 24 items over two dimensions: Medication Therapy Management (MTM) and General satisfaction with the pharmacy/staff and services (GSP/SS) which extracted 63.5% of the variance. The internal consistency by ?? was 0.964 for the PSQ and 0.959 and 0.916 for the two dimensions, respectively. The median (mode) score for GSP/SS was 5.0 (5.0) and 4.0 (5.0) for MTM. The Wilcoxon-test indicated that the difference between these scores was statistically significant (P < 0.001). Conclusion Our results suggest that the PSQ is a two dimensional instrument with psychometric properties able to assess patient satisfaction in community pharmacies. However, its validity and reliability need to be further confirmed in different PC settings and its sensitivity to measure changes in satisfaction over time also needs to be established.     

Characterizing specialized compounding in community pharmacies

BackgroundCompounding is a traditional role of pharmacists that declined with the availability of manufactured medicines. Compounding is now increasingly offered by community pharmacies as a specialized service, and there are calls for regulatory and practice standard changes. However, the characteristics of specialized compounding are not well understood.ObjectivesThe objective of this study was to conduct an in-depth exploration of the motivations, experiences, and practices of pharmacists who deliver “specialized compounding services” in Australian pharmacies.MethodsIn-depth interviews of 18 pharmacists responsible for compounding in pharmacies offering specialized compounding were conducted using a semistructured interview guide based on an organizational framework. Participants were selected using purposive sampling. Characteristics of specialized compounding practice compared with routine compounding and routine dispensing were explored. Interviews were audiotaped and transcribed verbatim, then analyzed using the method of “constant comparison” to identify emergent themes.ResultsPharmacists providing specialized compounding reported that compared with their prior routine practice, they used a greater variety of ingredients and dosage forms for more clinical conditions, used different equipment and processes, and had upgraded facilities for handling compounded products. Patient and physician interactions were more involved and in the case of physicians, more collaborative compared with routine dispensing. Participants reported feeling more empowered in their roles, with improved professional satisfaction.ConclusionsPharmacists in specialized compounding pharmacies report greater collaboration and interaction with prescribers and patients compared with their routine compounding and dispensing. This contributed to perceptions of empowerment and increased professional satisfaction. Specialized compounding may also be an avenue for reprofessionalization. The organization of compounding as a specialized service should be considered in proposed changes to compounding regulations and practice standards.     

The relevance of political prestudies for implementation studies of cognitive services in community pharmacies

BackgroundStudies of cognitive services implementation in the pharmacy sector traditionally focus on individual and/or organizational factors to explain why some pharmacies are successful and others are not. The social and political context of the origins of these services is rarely part of the analysis. Researchers and practitioners in the field of pharmacy practice research are increasingly being encouraged to take into account the specific political and societal climate which often plays a defining role in the success or failure of cognitive services implementation in community pharmacies.ObjectiveThe aim of this article is to argue for the inclusion of political pre-studies as part of the study design for implementation studies on reimbursed services in community pharmacy.MethodsA political pre-study of the Inhaler Technique Assessment Service (ITAS) introduced in Denmark in 2004 serves as an example of this approach and is described in detail. Documentary analysis was used in order to gain knowledge of the political background of the ITAS.ResultsPolitical pre-studies provide a more precise understanding of the background of the cognitive services and the way they are being performed, thereby supporting more valid results for subsequent implementation studies.ConclusionPolitical pre-studies were shown to be a useful prerequisite when designing implementation studies of cognitive services in community pharmacies and can provide valuable insight into the ultimate success or failure of these services.     

Sequential screening for diabetes—evaluation of a campaign in Swiss community pharmacies

Objective For early detection of persons at risk for type 2 diabetes, a combination of risk factor assessment and glucose measurement could be a promising approach and an opportunity for health promotion. The object of this study was to develop a sequential screening concept and to evaluate it in a national pharmacy based screening campaign.Method Community pharmacies of the German speaking part of Switzerland participating in the national Self Care campaign “Stop diabetes-test now” offered a free of charge “sequential screening” with (a) diabetes risk assessment, (b) consecutive capillary blood glucose measurement and (c) assessment of the motivation for lifestyle change based on the Transtheoretical Model (TTM) of behaviour change. A 35 items data sheet served as a structured screening protocol and enabled quick and reliable documentation of all relevant data. Outcomes measures were: age, sex, cigarette smoking, total score of the ADA diabetes risk-factor questionnaire, family history of diabetes, body mass index, insufficient physical activity, blood pressure, capillary blood glucose, motivation for lifestyle change, counselling activities and triage decisions of the pharmacy team.Results During the 5 weeks of spring 2002, 530 pharmacies screened a total of 93,258 persons (33.1% male, mean age 60.9 years ± 14.1 (SD)). Risk profile: family history of diabetes 26.4%; BMI ≥ 25 kg/m² 49.3%; low physical activity 27.2%; elevated blood pressure 45.7%. Stratification into risk groups: < 2 risk factors 21.6%; ≥ 2 risk factors 71.5%; borderline glycaemia (FG 5.3–6.1 mmol/l, confirmed in a second measurement) 2.5% and hyperglycaemia (FG ≥ 6.1 mmol/1 or NFG ≥ 11.1 mmol/1) 4.4%.Of all persons screened, 6.4% were referred to a physician and 73.7% got targeted advice with respect to physical activity and/or nutrition based on their specific risk profile.Conclusion The screening campaign attracted an important part of Swiss German speaking adults (2.4%). The sequential screening could successfully be implemented into pharmacy practice. Of the generally elderly persons screened, 6.9% were detected with suspicion for diabetes type 2 and 71.5% had at least two risk factors. This provided an opportunity to initiate targeted counselling regarding therapeutic lifestyle change.     

Review of services provided by pharmacies that promote healthy living

Background The recognition that community pharmacies have the potential to make a greater contribution to promoting public health has led to a new concept, called the Healthy Living Pharmacy (HLP). These are designed to meet public health needs through a tiered commissioning framework delivering health and well being services through community pharmacy, tailored to local requirements for tackling health inequalities. Aim To search the literature for quality evidence to support the inclusion of services in the HLP portfolio and suggest areas where more evidence is required. Method A systematic review of the research literature covering the period January 1990?CAugust 2011 inclusive, using MEDLINE, EMBASE, Pharmline, NHS Evidence and the Cochrane databases. On-line searching of the grey literature (e.g. conference proceedings) was also carried out. Standard methods of assessing quality were employed. Results A total of 377 papers were included. Over time, there was a marked increase in frequency of publications reflecting a growing pharmacy interest in the public healthcare agenda; over a third (35?%) of papers appeared in the last three-year study period. The body of research had a wide geographical basis; contributions were as follows: UK (51.5?%), US (20.4?%), Australia/New Zealand (9.8?%), Europe (7.7?%) and Canada (7.2?%). The topics of contraception, cardiovascular disease prevention, diabetes and smoking cessation accounted for 40?% of included papers. The literature supports the introduction of specific community pharmacy services, targeted at customer groups, both with and without pre-existing diseases. Good evidence exists for smoking cessation, cardiovascular disease prevention, hypertension and diabetes. Some good evidence exists for interventions on asthma and heart failure. The evidence supporting weight management, sexual health, osteoporosis detection, substance abuse and chronic obstructive pulmonary disease is weak and needs development. Conclusion There is strong evidence for the role of community pharmacy in a range of services, not only aimed at improving general health, but also maintaining the health of those with existing disease. In other areas, the evidence is less strong and further research is required to justify their inclusion in a HLP portfolio.     

A novel educational approach for improving medication-related problems in community pharmacies

BackgroundCommunity pharmacists have the responsibilities of identifying and resolving medication-related problems (MRPs), thereby improving patient safety.ObjectivesTo deliver a series of clinical case scenarios using WhatsApp and assess the impact of this method on the ability of pharmacists to identify MRPs.MethodsThis study was conducted in 104 community pharmacies in the United Arab Emirates (UAE) over a period of six months. Recruited pharmacies were randomly allocated to either intervention or control groups using a 1:1 allocation ratio. Senior experts in clinical pharmacy created a series of clinical case scenarios based on their clinical practice and based on previous published studies related to MRPs. WhatsApp®, a well-known messenger application, which has been proven to be an efficient platform to improve communication between learners and educators, was used to deliver clinical scenarios-based educational interventions to pharmacists. Then, pharmacists from both groups filled a standardized data reporting form. The clinical importance of pharmacist recommendations was assessed by a multidisciplinary expert panel.ResultsThe total number of patients with MRPs across the intervention and control groups was 492 versus 194 (p = 0.01). While the number of MRPs identified, the mean time needed to resolve MRPs for patients with major polypharmacy, and physicians' acceptance of pharmacist recommendations across the intervention and control groups were 492 versus 194, 1589 versus 255, 6.82 (±3.86) versus 10.78 (±6.38), and 1065/1284 (82.94%) versus 125/201 (62.18%), respectively, all with p < 0.05. Efficacy-related problems (27.56%) and safety-related problems (28.44%) were the most commonly identified MRPs by pharmacists in the intervention group. Clinically significance of pharmacist recommendations was a significant predictive factor for physicians’ acceptance of pharmacist recommendations.ConclusionClinical case scenarios delivered by WhatsApp may be useful for improving the ability of pharmacists to identify MRPs and for shortening the mean time needed to resolve MRPs.     

药师在糖尿病患者教育中的作用及工作方法

目前我国糖尿病患者人数逐年上升,糖尿病患者教育越来越受到重视.本文介绍了我国糖尿病患者教育的现状,分析了药师在糖尿病患者教育中的作用和优势,探讨了药师开展糖尿病患者教育的工作方法.     

Pharmaceutical care services available in Danish community pharmacies

International Journal of Clinical Pharmacy - In recent years, increased longevity of the Danish population has resulted in a growing segment with age-related and chronic health conditions. This,...     

HIV medication therapy management services in community pharmacies

ObjectivesTo present a rationale and a proposed structure to support pharmacist-delivered medication therapy management (MTM) for human immunodeficiency virus (HIV ) diseaseand to outline challenges to implementing and sustaining the service.Data sourcesProfessional literature.SummaryHistorically, the effect of pharmacy services for HIV-infected persons has been demonstrated in inpatient and clinic-based settings. Developing similar programs adapted for community pharmacists could be a model of care to improve patient adherence to antiretroviral therapy and retention in care. Initiation of antiretroviral therapy and regular monitoring of CD4+ cell count, HIV RNA viral load, adverse drug events, and adherence form the backbone of successful medical management of HIV infection. Support for these services can be provided to HIV-infected patients through pharmacist-managed HIV MTM programs in community pharmacy settings in collaboration with primary providers and other health care professionals.ConclusionCommunity pharmacists can help meet the growing need for HIV care through provision of MTM services. Although resources have been developed, including the general MTM framework, challenges of adequate training, education, and support of community pharmacists need to be addressed in order for HIV MTM to be a successful model.