Exploring the dissonance between business and public health policy: pharmacy and the provision of opioid pharmacotherapies and clean needles in rural settings

Objective To ascertain, by interview of rural community pharmacists, how well public health policies relating to the provision of clean needles and opioid pharmacotherapies fit with the imperatives of business. Previous research investigating the provision of opioid pharmacotherapies focused predominantly on metropolitan community pharmacists and their experience with servicing methadone clients. Furthermore, there had been no exploration as to whether dissonance exists between community pharmacy business imperatives and the public health policy underpinning these programmes. Method Fifteen rural community pharmacists were interviewed in three focus groups. Experienced interviewer and researcher EH facilitated all three focus group interviews. The questioning path was developed following review of the literature. Thematic analysis identified common themes and issues within the qualitative data collected. Setting All three focus group interviews were conducted in rural South Australia. Key findings Professional obligation played a key role in motivating rural community pharmacists to be involved with service provision. Dissonance existed between the sense of fulfilment by participating in a major public health initiative and the recognition of the mainly negative financial impacts. Financial gain was limited, due to difficulty in fee collection, and inadequate remuneration. Other difficulties included lack of support from allied health services, and restricted access to training due to geographical isolation. Conclusion Some of the difficulties experienced in the servicing of opioid‐dependent clients and its clash with business imperatives are universal and not specific to a rural environment. For the provision of opioid pharmacotherapy services to have fruitful business outcomes and simultaneously deliver effective services, appropriate remuneration and support programmes are needed. Future initiatives should aim at improving pharmacist communications with allied health services and prescribing doctors, as well as greater training opportunities to address problems associated with geographical isolation. Training on realistic outcomes of opioid treatment, the philosophy of treatment, and whether the role should include reducing client doses to assist clients become ‘drug free’ were identified as relevant training issues.     

Development,implementation and evaluation of a pilot project to deliver interventions on alcohol issues in community pharmacies

Objective The aim was to evaluate the feasibility and acceptability of the provision of brief interventions on alcohol misuse in community pharmacies. The objectives were to: train community pharmacists to initiate discussion of alcohol consumption with targeted pharmacy clients and screen, intervene or refer as appropriate; and to explore with pharmacists and clients the feasibility, acceptability and perceived value of screening and delivering the intervention. Setting Eight community pharmacies in Greater Glasgow. Method After a two‐day training course for pharmacists (n = 9) and one day for pharmacy assistants (n = 13), the eight pharmacies recruited clients over 3 months. Standardised protocols were prepared to screen clients for hazardous or harmful drinking using the Fast Alcohol Screening Tool (FAST) and to guide the intervention. Clients were recruited from specific target groups and via posters highlighting the service. Following completion of the recruitment phase, pharmacists and clients were followed up by the research team, using a combination of focus groups and semi‐structured telephone interviews. Key findings During the study period 70 clients were recruited, 30 screened as drinking hazardously (42.9%) and 7 (10%) screened positive for harmful drinking. Interventions commonly included explanation of sensible drinking and units in clients' preferred drinks (n = 33), feedback on screening and risks to health (n = 27) and discussion of pros and cons of current drinking pattern and link with presenting issue (n = 23). Of the 40 clients agreeing to be followed up, 19 could be contacted and most were generally positive about the experience. On follow‐up the pharmacists were positive and felt the project worthwhile and, importantly, noted no strong negative reactions from clients. Conclusion This project has been successful in training community pharmacists to discuss alcohol with 70 clients. Further work is required to test the generalisability of our findings and to measure the impact on alcohol consumption.     

Dispensing opioid substitution treatment: practices, attitudes and intentions of community-based pharmacists

INTRODUCTION AND AIMS: Community-based pharmacists (CPs) play a pivotal role in the provision of opioid substitution treatment (OST). This study examined practices, experiences, attitudes and intentions of a sample of South Australian pharmacists involved with the provision of OST. DESIGN AND METHODS: A random sample, stratified by geographic location, of 50 SA CPs were administered a telephone survey. The survey included pharmacist and pharmacy details, current practices, problems experienced, attitudes towards and future intentions in relation to the provision of OST. RESULTS: Pharmacists indicated high levels of support for the OST programme and most (98%) intended to continue providing OST. Sixty-four per cent of all pharmacists, and significantly more rural pharmacists (90%), indicated that they were willing to take on additional clients. Metropolitan pharmacists dosed greater numbers of OST clients (median = 7) than rural pharmacists (median = 4). There was a strong positive correlation between number of regular clients seen and problems experienced by pharmacists. Seventy per cent of pharmacists reported detecting no diversion of pharmacotherapy medication. DISCUSSION AND CONCLUSIONS: Despite reports to the contrary, pharmacists appear to be generally positively predisposed to providing OST. Policies aimed at retaining pharmacists, particularly in resource poor rural areas, could consider embracing a shared-care approach between general practitioners and pharmacists.     

Managing obesity in pharmacy: the Australian experience

Objective To explore pharmacists’ opinions about the provision of weight management services in community pharmacy and their attitudes towards the establishment of an accredited training course in weight management in pharmacy. Setting Interviews were conducted with practising pharmacists on site in various community pharmacies in metropolitan Sydney, Australia. Method In-depth, semi-structured interviews with twenty practising pharmacists were conducted. Of the twenty interviewed pharmacists, sixteen were involved in the provision of one or more pharmacy based weight management programs in their pharmacies. Interviews were audio-recorded, transcribed and analysed using the grounded theory approach. Main outcome measure The data were thematically analysed to identify facilitators and perceived barriers to the provision of high quality services, and pharmacists’ willingness to undertake training and accreditation. Results Participants clearly perceived a role for pharmacy in weight management. Key facilitators to provision of service were accessibility and the perception of pharmacists as trustworthy healthcare professionals. The pharmacists proposed collaboration with other healthcare professionals in order to provide a service incorporating diet, exercise and behavioural therapy. A program that was not-product-centred, and supported by ethical marketing was favoured. Appropriate training and accreditation were considered essential to assuring the quality of such services. Barriers to the provision of high quality services identified were: remuneration, pharmacy infrastructure, client demand and the current marketing of product-centred programs. Conclusion Australian pharmacists believe there is a role for pharmacy in weight management, provided training in accredited programs is made available. A holistic, evidence-based, multi-disciplinary service model has been identified as ideal.     

Evaluation of online training for the provision of opioid substitution treatment by community pharmacists in New Zealand

Introduction and Aims. The role of community pharmacists in the provision of opioid substitution treatment (OST) is pivotal and integral to addiction treatment. An online training program for pharmacists in OST management was piloted in New Zealand in 2010, following recognition of the difficulty in recruitment and retention of community pharmacists to provide OST services. Our aim was to evaluate the OST online training that was made available for any community pharmacist in New Zealand and to establish the feasibility and acceptability of this format of training for community pharmacists. The evaluation explored participants' attitudes, skills and knowledge both pre‐ and post‐training in OST. Design and Methods. All pharmacists registering to participate in the training program were asked to complete an evaluation questionnaire immediately before (pre) and immediately after (post) completing the training. Participants were also invited to participate in a brief 10 min structured telephone interview about their training experience. Results. In the first 4 months 190 pharmacists commenced the training; 101 completed both evaluations. Improvements in the confidence and skills of pharmacists were demonstrated through both the quantitative and qualitative analyses. Statistically significant changes in attitudes were also demonstrated. Overall the OST training was well received and the online format was feasible and highly acceptable. Discussion and Conclusion. Online training is an appropriate and economical method of improving pharmacists' clinical skills with respect to this client group, and has the potential to reach a wider audience of pharmacists. Further research is required to investigate OST client experiences in community pharmacy.[Walters C, Raymont A, Galea S, Wheeler A. Evaluation of online training for the provision of opioid substitution treatment by community pharmacists in New Zealand. Drug Alcohol Rev 2012;31:903–910]     

‘At the moment it is just a couple of eccentrics doing it’: concordance in day‐to‐day practice

Objectives To assess the feasibility and acceptability of concordance in pharmacy practice through examination of communication between customers and pharmacists in two community pharmacies in consultations for over‐the‐counter medicines. Method A qualitative pilot study involving data drawn from six sources: audiotaped training session with all the pharmacists involved, observational field work in the pharmacies, audiotaped consultations with pharmacists and customers, debriefing interviews with pharmacists after the consultation, and semi‐structured interviews with customers a few days after their consultation. Setting Two community pharmacies that concentrate their services on medicine advice and dispensing, one in a deprived inner‐city area, the other in a more affluent suburban area of London. Key findings The pharmacists developed a personal understanding of concordance which informed their practice. Customers reported a high level of satisfaction with services they received from the respective pharmacists. Their accounts of the consultations verified the pharmacists' patient‐centredness in their day‐to‐day practice. Conclusion The implementation of a concordance model was possible through the development of a personalised, patient‐centred model which drew on the model of concordance but was adapted in accordance with both structural constraints as well as the personal style of the pharmacists involved.     

The changing roles of pharmacists in community pharmacies: perception of reality in India

Aim of the review To summarise the state of community pharmacy in India including: the provision of patient care, pharmacy education, the pharmaceutical market, healthcare delivery, community pharmacy services, the professional role of community pharmacists, and future developments. Method Medline, Scirus, and Google Scholar databases and the journals “Indian Journal of Pharmaceutical Sciences” and “Indian Journal of Hospital Pharmacy” were searched up to the end of December 2008. In addition to these, other available sources were used to identify relevant articles. Results India has a fast growing pharmaceutical industry sector and a need for well educated pharmacists. Domestic sale of medicines is estimated to be $5 billion during 2006 and increasing. The supply of medicines to the population is undertaken by privately owned community pharmacies and sometimes also by hospital pharmacies. Community pharmacists are involved only in dispensing medicines. Community pharmacists have an opportunity to improve healthcare of the population, particularly of the disadvantaged section of the society that does not have the resources to visit clinics (both the poor and rural population). However, important barriers to the provision of pharmaceutical care exists, including lack of proper education and training of pharmacists, weak implementation of existing laws, and lack of recognition of the pharmacy as a profession by the other healthcare professionals. Conclusion The healthcare services in community pharmacies, currently insignificant, must undergo reforms to meet the changing needs of modern medicines users. The pharmacist’s role in patient care is expected to grow as professional and educational standards develop. Although pharmacists’ contributions to health care are not yet recognized, there is every reason to be optimistic toward making patient care in community pharmacy setting a success. For this, the educational system for pharmacists has to be adapted.     

Pharmacists' perceptions of their role in asthma management and barriers to the provision of asthma services

Objectives Few studies have explored pharmacists' perceptions of their potential role in asthma management. This study aimed to investigate community pharmacists' perceptions of their role in the provision of asthma care, to compare the perceptions of metropolitan and regional pharmacists with regards to their role, to identify barriers to the provision of asthma management services and to explore their level of inter‐professional contact. Methods A 29‐item questionnaire was mailed to a convenience sample of community pharmacists. Items included pharmacists' perceptions of their role in asthma management, barriers to pharmacy asthma services and inter‐professional contact. The setting was community pharmacies in metropolitan and rural New South Wales, Australia. Key findings Seventy‐five pharmacists (63% male, 69% in metropolitan pharmacies) returned completed questionnaires (response rate 89%). Pharmacists perceived their role in asthma management along three major dimensions: ‘patient self‐management’, ‘medication use’ and ‘asthma control’. Regional pharmacists described a broader role than metropolitan pharmacists. Most participants perceived time and patient‐related factors to be the main barriers to optimal asthma care with pharmacist's lack of confidence and skills in various aspects of asthma care less important barriers. Almost 70% indicated that they would like more inter‐professional contact regarding the care of patients with asthma. Conclusions Community pharmacists perceived a three‐dimensional role in asthma care with regional pharmacists more likely to embrace a broader role in asthma management compared to metropolitan pharmacists. Pharmacists identified time and patient‐related factors as the major barriers to the provision of asthma services. Future research should explore barriers and facilitators to expansion of the pharmacist's role in asthma management in a holistic way.     

Perspectives on privacy in the pharmacy: The views of opioid substitution treatment clients

BackgroundMany pharmacists practise in settings in which protecting privacy can be difficult. To address this, some community pharmacies are rearranging their retail space to provide private areas for clinical consultations. Such facilities are deemed particularly important when dealing with clients who have sensitive medical conditions, such as opioid dependence.ObjectiveTo explore Opioid Substitution Treatment (OST) patients’ perceptions of privacy in a community pharmacy setting, with a particular focus on the layout of the community pharmacy.MethodsWe conducted semi-structured interviews with OST clients. Recruitment and the interviews were conducted at state government drug and alcohol clinic. The interviews were audio recorded and transcribed verbatim. The data were analysed in NVivo using the framework approach.ResultsWe interviewed fourteen OST clients. Most participants were concerned about privacy and considered that the pharmacy layout could enhance or hinder privacy. However, they disagreed about exactly which pharmacy layout was most privacy-protecting. In addition, a small group of clients interviewed who had a very positive relationship with pharmacists believed that the relationship contributed to their confidence that their privacy was protected.ConclusionsThere is little consensus amongst consumers about how to protect privacy in the community pharmacy. The range of views expressed by clients in this study may reflect the lack of consensus about the nature of privacy in health ethics. Attention to the meaning of and rationales for privacy protections may be helpful when designing pharmacy layouts to meet the needs of a broad range of consumers. An enclosed or screened private area which can be used as a consultation area for all private pharmacy discussions, including for OST dosing, could be a solution to addressing these varying views on privacy in the pharmacy. Further attention to enhancing the pharmacist and client relationship may assist in reducing sensitivity about privacy.     

Factors associated with the intensity of government remunerated and unremunerated service provision in community pharmacies

BackgroundMany community pharmacies provide medication and disease state management services with and without specific remuneration. Availability of these services is often reported, however little is known about factors influencing the intensity of their provision.ObjectiveTo investigate factors associated with the intensity of provision of selected government remunerated and unremunerated community pharmacy services in Western Australia (WA).MethodsA questionnaire was mailed to a random sample of 421/628 (67%) community pharmacies in WA. The first dependent variable was intensity of government remunerated MedsCheck and Diabetes MedsCheck service frequencies per month. The second was the intensity of the sum of government unremunerated asthma screening, blood glucose testing, cholesterol testing and smoking cessation disease state management service frequencies per week. Principal Component Analysis defined attitudinal components influencing service provision. Linear regression with bootstrap confidence intervals determined variables associated with intensity of provision of the selected services. The variables were: pharmacist; pharmacy setting characteristics; and, attitudinal factors.ResultsThe questionnaire yielded a response rate of 49.2%. Attitudinal components that facilitated service provision were: general practitioners (GPs) willingness to collaborate; pharmacists are capable and ready; and pharmacists require further training. Staff capability and low return on investment were barriers to increased service provision. The intensity of government remunerated services was independently associated with pharmacies having pharmacy interns, fewer dispensary technicians, and being capable and ready to provide the services. Higher intensity of the provision of the unremunerated disease state management services was independently associated with the intensity of provision of MedsCheck and Diabetes MedsCheck services.ConclusionsImproved pharmacy workflow, achieved by the availability of pharmacy interns, and pharmacists being capable and ready, were important factors in the intensity of MedsCheck and Diabetes MedsCheck services. Intensity of the provision of government remunerated services facilitated a higher prevalence of disease state management services provision.     

Barriers to the provision of needle‐exchange services: a qualitative study in community pharmacies

Objective To investigate the attitudes of pharmacists to the provision of needle‐exchange services (NES) at community pharmacies and, if barriers exist, explore means by which they may be overcome. Setting Twenty‐one community pharmacies across Grampian in North East Scotland during May and June 2005. Method Semi‐structured face‐to‐face interviews conducted with 24 pharmacists. Key findings Newly identified barriers included the negative influence of security staff, a local policy against NES provision and a lack of awareness of other services available for drug users. Conclusion Training packages for all health professionals working with drug users and awareness training for security staff are required if the identified barriers are to be overcome. ‘Hands‐on’ training and experience of NES for pharmacists and their staff should be available. Suggestions made by pharmacists for NES provision in general practitioner surgeries or community hospitals and the development of automated services should be considered.     

Analysis of the information and support needs generated by a community pharmacy‐based methadone treatment programme

Background — Methadone treatment has been provided in Ireland since 1998 under the methadone protocol scheme. Two liaison pharmacists were employed by the Eastern Health Board to interface between pharmacists dispensing methadone in primary and tertiary care. Objective — To analyse and review the inquiries received and addressed by one liaison pharmacist in the first year of operation of a community pharmacy‐based methadone treatment scheme. Method — Inquiries received were recorded by the pharmacist using a standard data collection form. Using content analysis, key themes were identified and each inquiry was classified. Data were analysed using standard computer software. Key findings — Two primary categories of liaison inquiry were addressed: “patient‐related” inquiries, requiring the organisation of community pharmacy‐based methadone dispensing services for patients, and “pharmacy‐related” inquiries, which were requests from community pharmacists for information or support. Two thirds of the inquiries were “patient‐related.” The primary users of the liaison service were prescribers employed by the addiction services and community pharmacists. Conclusion — The liaison pharmacy service handled diverse inquiries, with an emphasis on the facilitation of the provision of pharmaceutical care for patients requiring community pharmacy‐based methadone dispensing services. The liaison service had a significant secondary role in the provision of support and information for community pharmacists. The study findings are of relevance to those involved in developing and introducing primary care‐based services for drug misusers.     

Consumer attitudes towards community pharmacy services in Saudi Arabia

Objective The purpose of this study was to determine consumer attitudes towards community pharmacy and their preferences for the introduction of new services. Methods A self‐completion questionnaire was developed and 1,144 consumers in 55 community pharmacies were invited to complete it. The questionnaire covered consumers' choice of pharmacy; their perceptions of, and actual interactions with, community pharmacists; advice from pharmacists about general health and prescribed medicines; and privacy in the pharmacy. Respondents were asked for their views about five possible new services. Setting The study was based in community pharmacies in Riyadh City, Saudi Arabia. Key findings The response rate was 79.6%. Fifty‐nine per cent of respondents often or sometimes visited a particular pharmacy. One‐quarter of respondents perceived community pharmacists as having a good balance between health and business matters, while 56.1% thought pharmacists were more concerned with the business. The majority of respondents (69.7%) said they felt comfortable asking the pharmacist for advice. Just under half (44.8%) felt that pharmacists allowed them enough time to discuss their problem fully and listened well. In addition, 58.5% of respondents indicated that their pharmacists showed sensitivity to privacy by speaking more quietly across the counter. In 14.4% of situations pharmacists were reported to use a private area within the pharmacy when discussing personal or private matters. Most respondents (65.2%) indicated that their pharmacist was willing to discuss their health problems and tried to understand their feelings. Consumers' priorities for new services were: monitoring blood pressure; measuring weight, height and temperature; monitoring blood sugar; and monitoring cholesterol. Conclusion This study showed that most pharmacy customers feel comfortable seeking advice from their pharmacist. Although many pharmacists were reported to show sensitivity to a possible lack of privacy in the pharmacy, few respondents reported that their pharmacy had a private area for discussion. Customers' views on possible new services were generally positive, with the exception of patient medication records.     

Point-of-care testing for infectious diseases: Opportunities,barriers, and considerations in community pharmacy

ObjectivesTo identify opportunities to perform point-of-care (POC) testing and/or screening for infectious diseases in community pharmacies, provide an overview of such tests and how they are used in current practice, discuss how the Clinical Laboratory Improvement Amendments of 1988 (CLIA) affect pharmacists performing POC testing, and identify and discuss barriers and provide recommendations for those wanting to establish POC testing for infectious diseases services in community pharmacies.Data sourcesPubMed and Google Scholar were searched from November 2012 through May 2013 and encompassed the years 2000 and beyond for the narrative review section of this article using the search terms rapid diagnostic tests, POC testing and infectious diseases, pharmacy services, CLIA waiver, and collaborative drug therapy management. All state boards of pharmacy in the United States were contacted and their regulatory and legislative websites accessed in 2012 and January 2013 to review relevant pharmacy practice laws.Data synthesisPOC testing for infectious diseases represents a significant opportunity to expand services in community pharmacies. Pharmacist education and training are addressing knowledge deficits in good laboratory practices and test performance and interpretation. Federal regulations do not define the qualifications for those who perform CLIA-waived tests, yet few pharmacists perform such services. Fewer than 20% of states address POC testing in their statutes and regulations governing pharmacy.ConclusionPOC testing for infectious diseases could benefit patients and society and represents an opportunity to expand pharmacy services in community pharmacies. Existing barriers to the implementation of such services in community pharmacies, including deficits in pharmacist training and education along with state regulatory and legislative variance and vagueness in statutes governing pharmacy, are not insurmountable.     

Consumer perspectives of pharmacist‐delivered healtn information and screening services

Objective — Community pharmacy has been increasing its involvement in health promotion, especially information provision and screening, over the past decade. Little is known about how consumers view these services and there is a need to evaluate the level of consumer endorsement of this role. The aim of this study was to evaluate consumer attitudes towards pharmacist‐delivered health information and screening services over time and with personal experiences of these services, as part of a standardised pharmacy programme. Method — A validated instrument was administered in 1994 (n=98) and 2000 (n=58) to consumers who had not experienced a pharmacist health information and screening programme, and to a population in 2000 (n=159) who had received such a service. Comparisons of consumer attitudes were made between the unexposed 1994 and 2000 populations to test for the influence of time, and between the exposed and unexposed samples in 2000 to test for the effect of personal experience of the service. Setting — Data were collected in seven community pharmacies in various non‐metropolitan regions of New South Wales, Australia. Key findings — Even after accounting for demographic variation between cohorts, consumers had a more positive attitude towards pharmacist screening over time, and towards both health information and screening after personal experience of these services. Conclusion — Community pharmacists should be encouraged to participate more in health information provision and screening in order to take advantage of and further promote consumer endorsement of these pharmacist services.     

Evaluating the feasibility of pharmacist-facilitated tobacco cessation interventions in independent community pharmacies in rural Appalachia

BackgroundSmoking rates in the United States are the highest in underserved rural regions. Thus, more points of contact are needed to link smokers to evidence-based cessation programs.ObjectivesThe purpose of this study was to conduct an evaluation to determine the feasibility, acceptability, and interest among rural pharmacists in implementing a pharmacist-facilitated smoking cessation program in independent community pharmacies in rural Appalachian communities in Virginia, North Carolina, Tennessee, and West Virginia.MethodsThis study utilized a complementary sequential mixed-methods approach to explore independent community pharmacists and technicians’ experiences and beliefs about implementing a tobacco cessation program in their pharmacy.ResultsThere were 49 pharmacists or technicians who completed the survey and 7 pharmacists who participated in the interviews. Four main findings emerged from the data: 1) pharmacies can help fill the gap in tobacco cessation services in rural communities, 2) under current practice, tobacco cessation resources when offered by independent community pharmacies are not always formalized, 3) there are known barriers, such as reimbursing for services, that need to be addressed to provide tobacco cessation in an independent pharmacy setting, and 4) the Ask-Advise-Connect model is a feasible tobacco cessation approach in a pharmacy.ConclusionAlthough pharmacists may be ideally situated to build capacity for smoking cessation in rural areas, smoking cessation interventions need to use existing approaches that compensate pharmacists for their time spent counseling patients. Furthermore, simple documentation and billing systems are needed to maximize utilization of tobacco cessation products and services provided in the pharmacy.     

The role of the pharmacist in the prevention and management of HIV/AIDS: an exploratory study of the establishment of AIDS Resource Centres in pharmacies

Objective The magnitude of the HIV/AIDS epidemic in South Africa, particularly its rapid growth and the inability of existing health structures to respond to the rising needs for treatment, has had a profound impact on South African society. The epidemic has specifically affected the healthcare services, in that it calls for greater involvement of all health professionals, including pharmacists. There is undoubtedly potential for community pharmacists to be involved in the prevention and treatment of HIV/AIDS, and the fact that many community pharmacies already have private areas for consultation and a designated professional to offer advice renders them an ideal space for these activities. The objective of the study was to explore the role played by pharmacists in the prevention and management of the epidemic. Methods The paper synthesises data from three sources: documentary analysis of official reports; a telephone survey of 112 community pharmacies in Johannesburg; and interviews with three key informants from pharmaceutical organisations and pharmacists involved with the governmental anti‐retroviral programme. Key findings The South African Pharmacy Council (SAPC) and the Pharmaceutical Society of South Africa (PSSA) embarked on the process of establishing AIDS Resource Centres in pharmacies. Six months later 55% of the pharmacists interviewed had heard about it and 33% of these knew very little about it. The SAPC and the PSSA have developed strict criteria for the accreditation of pharmacists and AIDS Resource Centres, so that the consumer can be assured of a high quality of service. At the time of the survey, 40% of pharmacists said they intended to apply for accreditation at this stage. Most pharmacists (82%) reported that they were already involved in some HIV/AIDS‐related activities, without having acquired additional training and specific accreditation. This paper analyses pharmacists' readiness and ability to develop these services and discusses possible barriers to successful implementation of the programme. Conclusion The HIV/AIDS epidemic generally, and in South Africa in particular, poses challenges for all health professionals. This paper demonstrates the willingness of the professional pharmacy establishment in South Africa to co‐operate with the government in order to confront the epidemic and respond to national needs; it also highlights the potential difficulties inherent in the process. Given the nature of the epidemic in South Africa, pharmacy is potentially in a position to rise to the challenges presented and place itself at the centre of the professional team. However the findings of this study show that achieving this will require substantial adjustments in pharmacists' practice, good communication skills between pharmacists and their customers, and considerable goodwill among pharmacists on the ground.