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.     

Meeting the challenge of public health information delivery in the digital age

ObjectiveTo discuss the current status of public health messaging and how pharmacists can become more active participants.SummaryPublic health needs can be addressed by using Internet videos as a model to disseminate medical information. Introducing student pharmacists to new ways of developing and delivering targeted public health messages can increase their awareness that public health intervention is part of the emerging scope of practice.ConclusionFor pharmacy to affect change in public health at the local and national level, pharmacists should consider providing public health advocacy messages through virtual platforms.     

Views, attitudes and self-assessed training needs of Scottish community pharmacists to public health practice and competence

Objective To assess the education and training needs of community pharmacists to support the delivery of an expanded public health role. Setting Community pharmacy in Scotland. Method Two focus groups of community pharmacists (n = 4 in each) in geographically distinct regions of Scotland explored issues of public health function, competencies and education and training. Findings from thematic analysis were used to develop a draft postal questionnaire. Following piloting, pharmacist managers from a random sample of 500 community pharmacies in Scotland were contacted by telephone to ascertain the number of pharmacists working in each pharmacy in the following 14-day period. A survey pack containing questionnaires for each identified pharmacist working in the study period was sent by post to the pharmacist manager in each pharmacy. The questionnaire contained items on: demographics; views and attitudes towards: public health; competencies for public health practitioners; and education and training needs. One postal reminder was sent 2 weeks later. Main Outcome Measures Main themes identified from focus group discussions; questionnaire response rate; views and attitudes towards public health competencies and education and training. Results Four hundred and fifteen managers agreed to participate, providing 904 potential participants. The response rate was 25% (223/904). Most (n = 179, 80%) were aware of the term ‘pharmaceutical public health’. While a majority saw the importance of public health to their practice (n = 177, 79%) agreeing/strongly agreeing, they were less comfortable with the term ‘specialist’. Respondents viewed competencies relating to health promotion (n = 192, 86%) more relevant than surveillance (n = 70, 31%), risk management (n = 29, 13%) and strategic developments (n = 12, 5%). Responses indicated a desire for education and training with more than half (n = 121, 54%) agreeing/strongly agreeing that they had a need now, with 69% (n = 153) expressing a future need. Conclusion Results should be interpreted with caution due to the response rate. However, this research highlights the self assessed gap in competence related to pharmaceutical public health for community pharmacists in Scotland.     

Clinical impact of a community pharmacy-based health and wellness introductory pharmacy practice experience

ObjectiveTo assess the clinical impact of an intensive community pharmacy-based Health and Wellness Introductory Pharmacy Practice Experience (IPPE) completed by second-year (P2) student pharmacists.DesignThe Health and Wellness IPPE was a 1-week rotation developed to provide P2 student pharmacists with opportunities to provide clinical services to patients within the community pharmacy setting. Student pharmacists administered immunizations, performed blood pressure screenings and blood glucose measurements, and provided education to patients under the guidance of licensed pharmacist preceptors.Setting and participantsSecond-year student pharmacists completing a required Health and Wellness IPPE rotation in the community pharmacy setting.Outcomes measuredStudent pharmacist interventions were assessed to determine the course’s clinical impact, and preceptors were surveyed regarding the feasibility of student pharmacists performing clinical services at their training sites.ResultsA total of 147 student pharmacists completed the IPPE at 89 community pharmacy training sites and administered 9392 injections, 90% of which were influenza vaccinations. Student pharmacists performed 3458 patient health assessments, including measuring patients’ blood pressure and blood glucose and reviewing patient education materials. Most preceptors indicated that core activities were feasible during the experience.ConclusionThis study found that implementing a concentrated IPPE focused on immunizations and health screenings allowed student pharmacists to enhance their clinical skills and fulfill a large public health need, improving patient outcomes. Future studies should explore utilizing student pharmacists in community pharmacy settings to expand clinical services offered beyond these 2 services, such as diabetes risk tests, influenza point-of-care testing, and smoking cessation counseling.     

Impact of a health literacy assignment on student pharmacist learning

BackgroundThe average American adult reads at the 8th grade level while most written health information materials, including medication guides, are written at the 12th grade level. To assist students with health literacy-sensitive communication, pharmacy schools should incorporate educational activities addressing health literacy competencies.ObjectivesThe objectives of this study were to evaluate the impact of a health literacy assignment on student pharmacists' perceptions of: 1) learning about health literacy; 2) ability to write health literacy level-appropriate patient education material; and 3) the use of these skills in future pharmacy practice.MethodsThird professional year student pharmacists were asked to rewrite a patient medication information sheet at the 5th grade reading level, altering it from the 12th grade level. Following assignment completion, students responded to a 4-item open-ended questionnaire on what they learned from the activity, what information components were the most difficult to rewrite and reason for the difficulty, key strategies to accomplish the assignment, and their perception of the impact this assignment had on their future practice. Content analysis of the reflections was performed using QSR NVivo to identify themes grounded in the students' responses.ResultsReflections were completed in 2009 (n = 159) and 2010 (n = 144), for a total of 303 completed reflections. Predominant themes included greater understanding about the challenges, importance, and methods of health literacy level-appropriate communication and greater awareness of the role of pharmacists in presenting information clearly to patients.ConclusionsStudents indicated the activity increased their understanding of the complexity of patient information, the educational needs of patients, and the importance of providing information that is understandable. Student pharmacists learned methods of effective communication with patients and should be better prepared to communicate in a health literacy-level appropriate manner.     

Developing consensus around the pharmaceutical public health competencies for community pharmacists in Scotland

Objective The new community pharmacy contract in Scotland will formalise the role of pharmacists in delivering public health services. To facilitate assessment of education and training needs it is necessary to define the relevant public health competencies for community pharmacists. The objective of this research was to define and develop consensus around such competencies. Methods The “Skills for Health National Occupational Standards for Public Health Practitioners” was used to define an initial set of competencies. A two stage Delphi technique was undertaken to develop consensus. An expert panel, representing public health and pharmacy stakeholders, rated their agreement with the importance of each competency, with the agreement level set at 90%. Main outcome measures Level of agreement (%) with each public health competency; those competencies achieving more than 90% agreement with importance for community pharmacy practice. Results Ten organisations (83% of those invited) and a total of 30 members (88%) agreed to take part in the process. In round 1 of the Delphi, responses were received from 25 (83%) individuals and 22 (73%) in round 2, with consensus being achieved for 25/68 (37%) competencies in round 1 and a further 8/68 (12%) in round 2. Conclusion Public health competencies for community pharmacists achieving consensus predominantly focused on health improvement activities at individual and local community levels and ethical management of self rather than those relating to surveillance and assessment and strategic development. There is a need to research community pharmacists’ views of these competencies and to systematically assess their education and training needs     

Strengthening pandemic preparedness through pharmacy and public health collaborations: Findings from a facilitated discussion exercise

BackgroundCommunity pharmacists are key partners to public health agencies during pandemics and other emergencies. Community pharmacy and public health agencies can establish memoranda of understanding (MOUs) for dispensing and administering medical countermeasures and providing related services to affected population(s) during a public health incident.ObjectiveThe objective of this facilitated discussion exercise was to identify the strengths and opportunities associated with the activation of a statewide pharmacy–public health agencies MOU with community pharmacists on the basis of a simulated pandemic influenza event.MethodsA facilitated discussion exercise was held in the Puget Sound region of the State of Washington in May 2017. The participants included pharmacists from 2 community pharmacy organizations, emergency preparedness officials from 2 local health departments and the state health department, staff of the state pharmacy association, and faculty from a school of pharmacy. The evaluators recorded the discussions and observations, augmented by a postexercise telephone call with participants from each of the participating community pharmacy organizations. Key themes from the exercise are reported.ResultsFive themes were identified during the facilitated discussion exercise. Two themes described the strengths of the MOU and its operational plan: (1) collaboration strengthens preparedness and response planning, and (2) an MOU provides a framework for effective collaboration. Three themes acknowledged the opportunities to optimize activation of the existing MOU: (1) early and active engagement between health department personnel and community pharmacists, (2) establishing pharmacy policies and procedures to support readiness and response, and (3) addressing the training or other educational needs of community pharmacists.ConclusionThis exercise provided community pharmacists and public health agency personnel an opportunity to better plan for responding to a pandemic. The open dialogue in this facilitated discussion allowed the exercise participants to identify the strengths, priorities, and perspectives as well as the gaps in the MOU operational plan. The lessons learned in this exercise can inform the community pharmacy and public health response to the coronavirus disease pandemic.     

Using qualitative,community-based input to steer post–coronavirus disease 2019 pharmacy practice in substance use

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has had a disproportionately negative impact on individuals with a substance use disorder (SUD). A rapidly changing public health and treatment environment has resulted in increased needs for pharmacist engagement in SUD-focused patient care.ObjectivesThis study used semistructured interviews of SUD professionals to evaluate where they believe pharmacy practice could better support people at risk of or having SUD in light of challenges posed by the COVID-19 pandemic.MethodsProfessionals dedicated to the care of individuals with SUD were recruited from a large community substance use coalition to participate in a qualitative study examining how pharmacists could take a more active role in SUD prevention, intervention, recovery, and harm reduction (HR). A consensual qualitative research approach was used in data analysis.ResultsDomains identified in analysis included pharmacists as educators of patients and communities, pharmacists as educators of health care providers, pharmacists as advocates for individuals with SUD, the need for increased pharmacist engagement owing to COVID-19 challenges for individuals with SUD, the need for expanded pharmacy practice interventions, and the need for pharmacist self-development.ConclusionIncreased medication counseling, HR practices, addressing stigma, and community-level education focused on SUD were among the most commonly reported areas for pharmacy practice development. In addition, the urgent need to adjust pharmacy practice in response to the COVID-19 pandemic was also identified by interviewees.     

Expanding pharmacists’ roles: Pharmacists’ perspectives on barriers and facilitators to collaborative practice

ObjectiveThe pharmacy profession is shifting from transactional dispensing of medication to a more comprehensive, patient-centered model of care. Collaborative practice agreements (CPAs) extend the role of a pharmacist to initiate, monitor, modify, and discontinue drug therapies and provide other clinical services. Although collaborative practice has been shown to improve health system efficiency and patient outcomes, little is known about how pharmacists perceive CPAs. To explore pharmacists’ perspectives of CPAs, including barriers and facilitators to CPA implementation.MethodsSemistructured key informant interviews were used to elicit information from licensed pharmacists practicing in a variety of settings in Arizona. Thematic analysis was used to identify key qualitative themes.ResultsSeventeen interviews of pharmacists with (n = 11, 64.7%) and without (n = 6, 35.3%) CPAs were conducted in April-May 2019. The pharmacists saw their role in CPAs as supportive, filling a care gap for overburdened providers. A heightened sense of job satisfaction was reported owing to increased pharmacist autonomy, application of advanced knowledge and clinical skills, and ability to have a positive impact on patients’ health. Challenges to the implementation of CPAs included liability and billing issues, logistic concerns, some experiences with provider hesitancy, and lack of information and resources to establish and maintain a CPA. The barriers could be overcome with conscious team-building efforts to establish trust and prove the worth of pharmacists in health care teams; strategic engagement of stakeholders in the development of CPAs, including billing and legal departments; and mentorship in the CPA creation process.ConclusionsThe pharmacists in this study enjoyed practicing collaboratively and had overall positive perceptions of CPAs. As health worker shortages become more dire and pharmacy practice evolves to expand the role of pharmacists in providing direct patient care, CPAs will be an important tool for restructuring care tasks within health systems.     

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.     

Community pharmacy-based injectable naltrexone service delivery models and best practices

BackgroundOpioid use disorder (OUD) is a major public health issue in the United States. Medications for OUD (MOUD), which combines the use of approved medications with counseling and behavioral therapies, represents an evidence-based approach to treat individuals living with an OUD. However, MOUD has not kept up with increased demand and new treatment approaches are needed. One approach is injectable naltrexone, an approved and effective MOUD treatment, provided by pharmacists, who are more geographically accessible and have legal authority to administer it in some states.ObjectivesTo explore how different community pharmacists provide injectable naltrexone treatment and identify best practices.MethodsAn exploratory sequential mixed-methods design was used to investigate pharmacy-based naltrexone injection practices, involving a pharmacist questionnaire and interviews with pharmacists, prescribers, and community stakeholders. An inductive/iterative content analysis approach, guided by an initial straw model, was used to identify and explore conceptual categories for the interviews.ResultsThe final sample included 68 pharmacy surveys and 14 total interviews with pharmacists (n = 9), prescribers (n = 3), and community stakeholders (n = 2). Pharmacies providing naltrexone injections reported administering over 700 injections in the past year. Interviews revealed benefits and barriers to pharmacist-provided injections and the importance of the prescriber-pharmacist relationship in OUD treatment. Three pharmacy treatment delivery models were identified, compared to the initial straw model, and informed development of a best practices checklist for community pharmacies interested in establishing or expanding a naltrexone injection service.ConclusionsThe study demonstrates how community pharmacies developed and implemented a naltrexone injection service. Pharmacists' and prescribers' feedback clearly suggests an untapped interest, as well as resources, in realizing pharmacists’ roles as providers of injectable naltrexone treatment. Implementation research could inform the development and evaluation of an intervention based on these best practices to further explore the utility of community pharmacy-based naltrexone injection services.     

An evidence-led review of the FIP global competency framework for early career pharmacists training and development

BackgroundThe International Pharmaceutical Federation (FIP) Global Competency Framework (GbCF) for early career pharmacists is an evidence-driven guide for pharmacist professional development. First published in 2012, the FIP GbCFv1 contains a structured assembly of competencies for pharmacists in four broad areas: pharmaceutical public health; pharmaceutical care; organisation and management; and professional/personal. FIP is committed to support the advancement of pharmacy around the world, and in light with the expansion of the type of services that pharmacists may provide to their patients and the advances in technology and therapeutics, revising and updating the GbCF is imperative.ObjectiveThe aim of this project was to revise and update the first published iteration of the FIP GbCFv1 (2012) to ensure currency and continued relevance.MethodsThis is a qualitative study that employed four rounds E-Delphi method. A group of international experts (n = 29) was convened to revise the GbCFv1 through an iterative approach with repeated and synchronised rounds of analysis and revision focusing on the currency of the competency areas and associated behavioural statements. The revision was conducted between January to August 2020.ResultsThe number of behavioural statements increased from 100 to 124 behavioural statements, with 23 competency domains, but remain structured within the competency clusters. Three new competencies were added to the GbCF (emergency response, digital literacy, and interprofessional collaboration) and one competency was renamed from self-management to leadership and self-regulation.ConclusionsThe process undertaken to revise the GbCFv1 are described, resulting in a valid and transnationally relevant GbCFv2. In the GbCFv2, the number of competencies and associated behavioural statements increased due to important additions including emergency response, digital literacy, interprofessional collaboration and an expansion of leadership and self-regulation. This process provides an assurance of relevancy and currency for a ‘fit for purpose’ early career competency development framework for global implementation.     

Community pharmacy in Australia: A health hub destination of the future

BackgroundRates of chronic illness are rising in Australia and as medications are frequently used in the management of a range of chronic conditions, community pharmacists are in an ideal position to better assist these consumers. There is currently limited information as to how pharmacy can do this from the perspective of consumer health organizations, health advocates and professional support organizations.ObjectivesTo explore new roles, opportunities and any associated barriers for community pharmacy to better assist consumers with chronic illnesses.MethodsRepresentatives of non-government consumer health organizations (n = 10) were interviewed from the key health priority areas emphasized by the Australian government. Health advocates (n = 3), innovative health care professionals (n = 4) and representatives of health care professional organizations (n = 4) from pharmacy and medicine also participated. Interviews were analyzed via thematic analysis.ResultsTwenty-one in-depth interviews were conducted. The core finding was the potential for community pharmacies to become a health hub destination, whereby pharmacy staff assist consumers with chronic conditions to: navigate the health system (e.g., provide information on support services), manage their medications, and provide health advocacy. Participants expressed their concern that consumers may not be aware of the breadth of the pharmacist's expertise and that further collaboration is needed with non-government consumer health organizations and other health providers. Emphasis was placed on the improvement of the pharmacist's current role, particularly in the area of medication advice and accessibility, with the current pharmacy remuneration model identified as a barrier to becoming a health hub destination.ConclusionThe eventual progression toward a health hub destination was seen to be important to better assist consumers with chronic conditions. This focuses on a more proactive approach to care encompassing simple advice, referrals to consumer health organizations and ultimately, health advocacy. However, further research is required into how community pharmacy can become a health hub given that this is a new concept and there are existing professional barriers.     

执业药师报考资格的药学与中药学专业互为认定相关专业的初探

目的：对国家执业药师职业资格考试报考专业进行研究，进一步明确考试报名资质，完善执业药师职业资格制度。方法：采用文献研究法和数据分析法。通过检索国家药品监督管理局执业药师资格认证中心、教育部与相关高等学校网站，查阅国家执业药师职业资格考试成绩数据库，研究药学专业与中药学专业的差异。结果：除了药事管理与法规作为公共科目之外，药学专业与中药学专业无论是在资格考试科目的设置、国家专业目录的规定，还是学生培养方案方面，以及在具体的专业知识结构和实践技能方面，二者都分属于两个独立的专业类别。结论：在执业药师职业资格考试的报名条件中，除了认定医学类专业、化学类专业、生物学类专业为相关专业之外，还应当认定药学类专业报考中药学类执业药师和中药学类专业报考药学类执业药师互为相关专业。     

Exploring the role of the pharmacist in global health

ObjectiveThe objective of this commentary is to explore the potential role of the pharmacist in the field of global health by understanding the definition of global health and how it can be applied to the profession of pharmacy.SummaryWhile the role of the pharmacist in public health has been defined, the literature is limited with respect to the role of the pharmacist in global health. It is suggested that the “global” in global health should refer to the scope of a problem and not necessarily the geographic location. Through this lens, pharmacists have the opportunity to play an important role in both public health and global health. In particular, pharmacists can look at the varied global health careers established in medicine and use this as a framework to understand the potential role of the pharmacist within global health practice and program delivery, research, and policy.ConclusionsTo further define the role of the pharmacist in global health, pharmacists may have to change their perception of what services they can provide and where these services can be applied.