The feasibility of providing community pharmacy‐based services for alcohol misuse: A literature review

Objectives Excessive consumption of alcohol is a major public health concern. The use of community pharmacies and pharmacists as sources of public health information and services is gaining greater recognition. The objective of this review was to provide an overview of the evidence on the feasibility, effectiveness and acceptability of providing community pharmacy‐based services to address the excessive consumption of alcohol. Methods Electronic databases were searched for the period 1996–2007 to identify relevant evidence. Searches were also conducted of relevant pharmacy and addiction journals. Information was sought from key contacts in pharmacy and alcohol research. Studies were included if they were conducted in a community pharmacy setting. Key findings The review comprised three feasibility studies which included 14 pharmacies and 500 customers. Non‐significant reductions in alcohol consumption were reported with two studies following brief interventions by pharmacists. Between 30% and 53% of pharmacy customers were identified as having hazardous or harmful drinking behaviour. Customer opinion of the pharmacy‐based alcohol services was not reported. Conclusions There has been little empirical evaluation of the effectiveness of community pharmacy‐based services for alcohol misuse. The evidence presented in this review suggests that community pharmacy‐based screening is feasible. Organisations and individuals involved with tackling excessive alcohol consumption should consider the inclusion of community pharmacies and pharmacists as part of their strategies to address this problem. Large‐scale studies are needed to evaluate the short‐ and long‐term effects and cost‐effectiveness of community pharmacy‐based interventions to reduce excessive alcohol consumption, as well as to explore the acceptability of the service to users.     

Effects of educational interventions on the smoking cessation service provided by community pharmacists: A systematic review

ObjectiveThis systematic review aimed to evaluate the effectiveness of educational interventions on the smoking cessation service provided by community pharmacists.MethodsA systematic literature search was performed in May–July 2021, in electronic databases, which included PubMed (MEDLINE), Embase, and Web of Science. Studies were included in this systematic review if they were original articles published in English language from 2010 to 2021 and evaluated the effect of any types of educational interventions intended to improve the ability of community pharmacists to provide smoking cessation services.ResultsIn total, 12 studies were included for this systematic review. The effectiveness of the educational interventions across the included studies was measured using a range of outcomes, which can be broadly categorized into 3 categories, namely changes in pharmacists' self-efficacy, knowledge, and attitude toward providing smoking cessation service, changes in pharmacists' smoking cessation practices, and changes in the effectiveness of community pharmacy based smoking cessation services. Included studies reported that educational interventions can improve pharmacists' self-efficacy, knowledge, and attitude toward smoking cessation, as well as pharmacists’ smoking cessation practices. Though the evidence is limited, improvement in the effectiveness of community pharmacy based smoking cessation services has also been observed.ConclusionAny form educational interventions can positively impact improve community pharmacists' self-efficacy, knowledge, and attitude toward smoking cessation, as well as pharmacists’ smoking cessation practices, but it is currently uncertain whether these outcomes are able to translate into higher effectiveness of the community pharmacy based smoking cessation services.     

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.     

The management of asthma in adult patients in the community pharmacy setting: Literature review

BackgroundAsthma poses a public health concern, with an estimated 235 million people currently living with the condition globally. The provision of evidence-based, patient-centred services for adult asthma patients in community pharmacy which involves collaboration across the multidisciplinary team could improve their asthma control.ObjectivesA literature review was conducted to examine the evidence of asthma management in community pharmacy setting.MethodsFive databases were searched to identify relevant articles published before February 2021. Screening of the potential studies was performed to remove articles that did not comply with the inclusion criteria. Relevant data from all included studies was collected using a data extraction form to ensure consistency throughout the review.ResultsTwenty studies were included in the review; all were conducted in community pharmacy settings in the period of 2001–2020, in different countries. The studies included randomised controlled trials, controlled trials and observational studies. Several successful community pharmacy-based services that were provided to asthma patients to improve their asthma management were highlighted in this review. These interventions consisted of one or more components and included: patient education, inhaler technique improvement, patient counselling, self-management plans, development and provision of asthma action plans and referral to other health care practitioners. None of the studies involved medication or dosage changes by community pharmacy.ConclusionsThe evidence discussed in this review showed that community pharmacists are well-placed to deliver services to asthma patients and many studies were conducted in the community pharmacy to improve asthma control in adult patients. However, further research could be conducted to explore further opportunities for community pharmacy to enhance asthma patients management of their condition.     

Community pharmacist-led interventions for patients with type 2 diabetes in low-income and middle-income countries: A scoping review

BackgroundStudies assessing community pharmacist-led interventions conducted in high-income countries indicate that community pharmacists are successful in taking opportunities to support diabetes management. It is not yet clear as to what extent this is also true for low-income and middle-income countries.ObjectivesTo provide an overview of the types of interventions performed by community pharmacists and available evidence about their effects on patients with type 2 diabetes mellitus in low-income and middle-income countries.MethodsPubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for (non) randomized controlled, before-and-after, and interrupted time series design studies. There was no restriction on publication language. Interventions to be included had to be delivered by community pharmacists in a primary care or community setting. Study quality was assessed using the National Institute of Health tools, with results analyzed qualitatively, and the review itself was conducted in accordance with guidelines for scoping reviews.ResultsTwenty-eight studies were included, representing 4,434 patients (mean age from 47.4 to 59.5 years, 55.4% female) from community pharmacies (16 studies), primary care centers (8 studies) or community setting (4 studies). Four studies were single-component and the remaining represented multi-component interventions. Face-to-face counseling of patients was the most common intervention, often combined with the provision of printed materials, remote consultations, or conducting medication reviews. Generally, studies showed improved outcomes in the intervention group, including clinical, patient-reported and medication safety outcomes. In most studies, at least one domain was judged to be of poor quality, with heterogeneity among studies.ConclusionsCommunity pharmacist-led interventions on type 2 diabetes mellitus patients showed various positive effects but the quality of the evidence was poor. Face-to-face counseling of varying intensity, often combined with other strategies and representing a multi-component intervention, was the most common type. Although these findings support the expansion of the community pharmacist's role in diabetes care in low-income and middle-income countries, better quality studies are needed to evaluate the impact of specific interventions.     

The impact of pharmacy computerised clinical decision support on prescribing,clinical and patient outcomes: a systematic review of the literature

Objectives Computerised clinical decision support systems (CDSSs) are being used increasingly to support evidence‐based decision‐making by health care professionals. This systematic review evaluated the impact of CDSSs targeting pharmacists on physician prescribing, clinical and patient outcomes. We compared the impact of CDSSs addressing safety concerns (drug interactions, contraindications, dose monitoring and adjustment) and those focusing on medicines use in line with guideline recommendations (hereafter referred to as Quality Use of Medicines, or QUM). We also examined the influence of clinical setting (institutional versus ambulatory care), system‐ or user‐initiation of CDSS, prescribing versus clinical outcomes reported and use of multi‐faceted versus single interventions on system effectiveness. Methods We searched Medline, Embase, CINAHL and PsycINFO (1990–2009) for methodologically adequate studies (experiments and strong quasi‐experiments) comparing a CDSS with usual pharmacy care. Individual study results are reported as positive trends or statistically significant results in the direction of the intentions of the CDSS being tested. Studies are aggregated and compared as the proportions of studies showing the effectiveness of the CDSS on the majority (≥ 50%) of outcomes reported in the individual study. Key findings Of 21 eligible studies, 11 addressed safety and 10 QUM issues. CDSSs addressing safety issues were more effective than CDSSs focusing on QUM (10/11 versus 4/10 studies reporting statistically significant improvements in favour of CDSSs on ≥ 50% of all outcomes reported; P= 0.01). A number of QUM studies noted the limited contact between pharmacists and physicians relating to QUM treatment recommendations. More studies demonstrated CDSS benefits on prescribing outcomes than clinical outcomes (10/10 versus 0/3 studies; P= 0.002). There were too few studies to assess the impact of system‐ versus user‐initiated CDSS, the influence of setting or multi‐faceted interventions on CDSS effectiveness. Conclusions Our study demonstrated greater effectiveness of safety‐focused compared with QUM‐focused CDSSs. Medicine safety issues are traditional areas of pharmacy activity. Without good communication between pharmacists and physicians, the full benefits of QUM‐focused CDSSs may not be realised. Developments in pharmacy‐based CDSSs need to consider these inter‐professional relationships as well as computer‐system enhancements.     

Design of an algorithm to support community pharmacy dyspepsia management

Objectives To design a care pathway and referral documentation system to support dyspepsia management in the community pharmacy according to national guidelines. To explore attitudes of community pharmacists and general practitioners (GPs) towards the proposed model of care. Setting Focus group of four community pharmacists from one locality and one-to-one interviews with five GPs in each of their surgeries in different city localities. Method Literature review; design of a care pathway and referral system; qualitative analysis of focus group discussion and one-to-one interviews. Main outcome measure Modified design of documentation system; attitudes and barriers towards an extended role for pharmacists in a community pharmacy based model of individual care of patients with dyspepsia. Results The care pathway and documentation system was modified to make it simple to use and to assure appropriate referral and reporting to GPs. All participants agreed that the SIGN guideline for Dyspepsia and local dyspepsia guidelines provide an opportunity to extend the role of pharmacists to prescribe therapeutic doses of H₂ receptor antagonists, test for Helicobacter pylori in the pharmacy and prescribe eradication therapy. Perceived advantages to patients included better convenience and reduced waiting times for H. pylori testing. Current barriers to this model identified were: medico-legal issues, budgetary issues, limited access to patient data, lack of privacy to talk to patients, inadequate time and remuneration, no patient registration, patients describing vague symptoms and patient confidence in pharmacists. Conclusion The proposed model of care and documentation system for community pharmacy based dyspepsia management generated a favourable response and design contributions from community pharmacists and GPs. Barriers were identified which have to be overcome prior to implementation and evaluation of the model. This study was conducted by the lead author when based in NHS Lothian, Scotland to undertake an MSc in Clinical Pharmacy at University of Strathclyde, Glasgow.     

A consensus model for delivery of structured pharmaceutical care for the patient with type 2 diabetes mellitus by Scottish community pharmacists

Objective To generate a model of pharmaceutical care for the patient with type 2 diabetes mellitus in primary care, from a consensus determined among community pharmacists in Scotland. Setting Community pharmacists within Scotland already involved in providing structured pharmaceutical care. Method The Delphi questionnaire was based on a validated multidisciplinary model of care for the patient with type 2 diabetes mellitus in primary care comprising 47 items under five themes: assessment, treatment plan, treatment administration, patient monitoring, confirmation/review. Seventy participants already participating in a pharmaceutical care model schemes initiative to encourage pharmaceutical care from community pharmacies and with an interest in diabetes mellitus were sent an initial questionnaire. Thirty‐seven participants agreed to enter two further rounds; response rates were 22/37 (59%) and 18/22 (82%). Final round cut‐off defining consensus was 80% scoring 6–7 from a seven‐point Likert scale. Key findings A model emerged from the achieved consensus. There was an early consensus achieved on the core functions that participants were already delivering to the patient with diabetes mellitus. These are functions that have been highlighted and delivered in previous studies within this disease state: receiving and sharing patient information, individualising treatment, identifying unsatisfactory treatment and monitoring and prescribing analgesia. Conclusions For service development and linked continued professional development a well‐defined service model for delivering pharmaceutical care to patients is required. This study proposes such a model based on consensus among a self‐selected group of community pharmacists leading diabetes pharmacy practice in Scotland.     

Mental health training programs for community pharmacists,pharmacy staff and students: A systematic review

BackgroundPrimary care is often the first point of contact for people living with mental disorders. Community pharmacists, pharmacy staff and students are increasingly being trained to deliver mental health care. However, there is still a gap in the literature exploring the characteristics of all available mental health training programs and their components and their influence on pharmacists, pharmacy staff and students’ outcomes.ObjectivesTo summarize the evidence evaluating mental health training programs completed by community pharmacists, pharmacy staff and students. More specifically, to explore the components of mental health training programs and identify those that facilitate significant improvements in outcomes.MethodsA systematic review was conducted following the Cochrane handbook and reported according to PRISMA guidelines. A search for published literature was conducted in three databases (PubMed, Scopus, and Web of Science) in July 2021. Eligible studies were included if they described and evaluated the impact of mental health training programs delivered to community pharmacists, pharmacy staff and pharmacy students regardless of design or comparator. The methodological quality of included studies was appraised using both the NIH quality assessment, to evaluate studies with an uncontrolled pre-post design, and the Cochrane EPOC risk of bias assessment, to evaluate studies with a controlled (randomized and non-randomized) study design.ResultsThirty-three studies were included. Most of the identified mental health training programs contained knowledge-based components and active learning activities. Changes in participants' attitudes, stigma, knowledge, confidence and skills were frequently assessed. An extensive range of self-assessment and observational instruments used to evaluate the impact of the training programs were identified. Positive improvements in participants’ attitudes, knowledge and stigma were frequently identified following participation in training programs.ConclusionsThis systematic review highlights the importance of mental health training programs in increasing pharmacists', pharmacy staff and pharmacy students’ skills and confidence to deliver mental health care in community pharmacy. Future research should build upon this basis and further focus on finding the most efficient measures to evaluate these training programs and assess their long-term effectiveness, allowing comparison between programs.     

Expanded roles of community pharmacists in COVID-19: A scoping literature review

BackgroundCoronavirus disease 2019 (COVID-19) has affected the world health care system adversely, but it has also brought out innovative roles for health care professionals to cater to growing health care needs. Community pharmacists provide community pharmacy services and can play a vital role in fighting the pandemic by taking on novel roles that complement their pre-existing roles.ObjectivesThis study aimed to provide a scoping review of current and emerging literature about the novel roles adopted by community pharmacists during the COVID-19 pandemic.MethodsOnline databases such as Google Scholar and PubMed were searched systematically using the keywords “COVID-19,” “pharmacist,” and “community.” Articles were selected based on availability of full text in English language, with time limit from December 1, 2019, to October 31, 2021; case reports, cross-sectional studies, literature reviews, qualitative studies, and systematic reviews were included, whereas commentary reviews and editorials were excluded from the search methodology. An independent review of the articles was conducted for inclusion based on relatability to study subject; those chosen were screened for references to find additional gray literature. Findings were arranged in themes, and the results were organized accordingly.ResultsNovel roles for community pharmacists were found in relation to maintenance of drug-supply chains, delivery of telepharmacy and telehealth services, provision of ambulatory pharmacy services, use of digital software to coordinate medication delivery for patients with chronic conditions, dispelling of misinformation, and roles in research and clinical trials. Roles in a post-COVID world regarding immunization of population and involvement in lifting lockdown strictures alongside other stakeholders were also explored.ConclusionAlthough COVID-19 has challenged the health care system, it has also provided an opportunity for development of novel and innovative roles that can ultimately have profound consequences for the health care system. Community pharmacists, despite facing multiple challenges in the community, should be facilitated to adapt with these new roles, which can be beneficial in achieving mass immunization and better health care in a post-COVID world.     

Professional development of pharmaceutical care in type 2 diabetes mellitus: a multidisciplinary conceptual model

Objective To generate a validated model of care providing a framework for continued professional development of the community pharmacist for patients with type 2 diabetes mellitus. Setting A purposive sample of medical, nursing and community pharmacist interviewees in 10 health boards in Scotland. Method Investigation, using a semi‐structured questionnaire approach, of the views held by 19 healthcare practitioners. Key findings A model of multidisciplinary diabetes care was generated to aid definition of pharmaceutical care provision. Processes emphasised in the model were: compliance monitoring, agreed multidisciplinary protocols and the continuity of patient education. Potential areas for community pharmacist contributions included the running of diabetes clinics, provision of patient education, near‐patient testing, repeat dispensing and identification of clinic defaulters. Conclusions Development of the community pharmacists' role for patients with type 2 diabetes mellitus requires extensions to current independently delivered patient‐centred services through working in partnership with other professionals. Methods of improved communication and attention to methods of referral, where appropriate, are important focal points. The targeting of this care and the care model that is best suited to particular settings will be subject to local variation. The generation of a diabetes care model offers pharmacists a means of matching learning opportunities to their needs. It is also a step towards the development of appropriate continued professional development tools and systems to equip community pharmacists for the future.     

Intervention research to enhance community pharmacists' cognitive services: A systematic review

BackgroundPositive impact of community pharmacists' cognitive pharmaceutical services (CPS) is well documented. However, community pharmacists have been slow to expand CPS roles. This systematic review explores how community pharmacy intervention research can help inform efforts to expand cognitive pharmaceutical service delivery.ObjectivesTo: 1) identify community pharmacy CPS intervention studies that report data on pharmacist behaviors, either as a final study outcome itself or as a fidelity measure in patient outcome studies, and 2) describe the state of this research to help frame future research agendas.MethodsEmpirical articles examining improvement or expansion of community pharmacist cognitive services published through December 2010 were searched using various search engines, bibliography searches and authors' libraries. Studies were included if they: 1) reported findings on pharmacist behaviors during cognitive service delivery, 2) employed a minimum of pre-post design or two study arms for pharmacists/pharmacies, and 3) were in community-based pharmacies.ResultsA total of 50 studies evaluated impact of community pharmacy based CPS delivery; however, only 21 included a pharmacist behavior outcome measure as a final outcome or as a fidelity measure. The majority (14 out of 21) of studies used a randomized controlled trial design. Nearly half (10 of 21) addressed asthma or tobacco cessation. Limited details were provided about interventions to prepare pharmacists for CPS delivery. The most frequent measures of pharmacist behavior were patient surveys and observation of pharmacists' behavior by secret shoppers; electronic data sets were rarely used.ConclusionsThere is a need for well-designed intervention research that evaluates how interventions impact on pharmacist cognitive service behavior. Positive findings from this review reinforce that planned interventions have the potential to improve and expand pharmacist cognitive service delivery; however, more detail is needed in study publications for this potential to be fully realized.     

Pharmaceutical care of the patient with diabetes mellitus: pharmacists' priorities for services and educational needs in Scotland

Objective To determine the extent of service provision by pharmacists in Scotland to patients with diabetes. Also, to investigate pharmacists' perceived education needs and their priorities for future service development to this patient group. Setting A random sample of pharmacists in Scotland who had previously participated in NHS Education for Scotland (NES) education. Method Questionnaire survey of pharmacists to estimate extent of provision of 28 defined aspects of diabetes care, educational needs and their professional aspirations. Key findings Approximately two‐thirds of community pharmacists who responded offered the following patient‐centred services for patients with diabetes and included education/advice on: lifestyle, smoking cessation, medicines administration times, footcare and self‐monitoring of glycaemia. Perceived need for further education was found to be linked with levels of service provision. Priorities for development of future services in this patient group were established, and preferred methods of educational support were also examined. Conclusion Pharmacists in Scotland are providing services for patients with diabetes although these are not consistent. The profession in Scotland also has clear ideas of future priorities in practice for this patient group. However there is a need to provide further training and education in order to support service development.     

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.     

Involvement and practice of community pharmacists in maternal and child health services: A systematic review

IntroductionCommunity pharmacists are pivotal in the provision of Maternal and Child Health (MCH) services, yet level of involvement, practice and barriers and facilitators in providing these services is largely unknown.ObjectiveThe objective of this review is to summarize available evidence on the involvement and practice of community pharmacists in MCH services.MethodsSeven electronic databases (PubMed, CINAHL, ProQuest Health, Cochrane library, Scopus, Embase, and Web of Science) were searched for articles published in English since inception of the database to November 30, 2019. Papers were included if they assessed involvement and practices of community pharmacists in maternal and child health services. Full articles identified and included for the final analysis were assessed for quality using the Mixed Method Appraisal Tool (MMAT) (2018) by all authors and data were extracted by one author and cross-checked by all authors.ResultA total of 2830 articles were identified. Following the assessment against the inclusion criteria, 14 full text articles were included for the final analysis. In eight studies, community pharmacists were reported to have involvement in maternal health services, in terms of providing breastfeeding guidance, counselling about the benefit of vitamins during pregnancy, provision of emergency contraception advice, and responding to illness symptoms such as back pain. In three studies, community pharmacists were providing advice in managing acute diarrhea in children. Medication use services and counselling about medication for children were also reported in three studies. Perceived consumer attitudes, problem with insurance coverage, lack of time among pharmacists and lack of incentives for the services provided were reported by pharmacists as the main barriers to service provision.ConclusionCommunity pharmacists were involved in various MCH services in community pharmacy settings. However, the extent of practices was not as per the joint International Pharmaceutical Federation (FIP)/World Health Organization (WHO) guidelines on good pharmacy practice in some services such as management of diarrhea.     

The Transformation of Pharmacy Concepts into Building and Organization

Objective of the study: To explore the transformation of soft systems pharmacy concepts, with a special attention for pharmaceutical care, into hard systems properties of building and organization in community-based pharmacy practice in The Netherlands. Method:The applied methods for data-collection were interviews. The interviews were conducted at eight community pharmacies and four architectural firms. The central topics in the questionnaire were the building and the design process. The role of the architect was included in the questions for the pharmacist and the role of the pharmacist was included for the architect. The data were completed with simple observations, relevant documents, designs, photographic material and bills of quantities of best, ordinary and worst case practices. The data were used to address the coherence between pharmacy, building, and organization. Main outcome measure:The main outcome measure was the relevance for the objective of the study. Data-selection was based upon its supposed connection with the transformation of soft into hard systems. The main focus was on documentation, classification, and derivation that would improve the current understanding of the transformation of a pharmacy concept, especially pharmaceutical care, into building and organization. No further data-selection was made. Results:The results show that architectural and organizational designs are actually used in the support of pharmaceutical care. A large variety of soft and hard systems were observed. However, pharmacists seem to agree on the use of the soft systems key words ‘professional’, ‘accessible’, and ‘transparent’, and also on the activities with respect to the provision of information and the cooperation with other disciplines. Although most observed transformations appear sensible, hard evidence provided by the pharmacist is very poor. The full impact of the implemented changes on pharmaceutical care or other concepts remains a mystery. There is a large variety of different hard properties in building and organization, reflecting different (but still related) soft pharmacy concepts. The connections in building and organization are regarded as the resources that make the provision of care possible. Observed were resources to support the provision of written and oral information, the conversation setting, and the cooperation with other professionals. Potentially important developments for pharmaceutical care are the separate consultation room, the multi-disciplinary health centre, and robotization. Conclusion:This study has revealed some of the interdisciplinary relations between pharmaceutical, architectural, and organizational designs in Dutch community pharmacy practices. From this study we can conclude that interventions in building and organization are actually used in the support of pharmacy concepts, specifically of pharmaceutical care. However, the hard evidence of supposed improvements remains poor and mostly absent.