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.     

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     

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.     

The use of sublingual glyceryl trinitrate and aspirin in angina patients and enhancement of coronary heart disease databases

□ Audit involving 95 per cent of community pharmacists in one LHCC □ Data were gathered using a semi‐structured questionnaire □ A list of all participating patients was sent to each GP surgery in the locality to enhance their CHD database □ Not all appropriate angina patients are receiving aspirin □ Patients' knowledge of GTN management was poor and should be improved upon by input from healthcare professionals     

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.     

Evaluation of a new health centre pharmacy: a case study

Background — This case study describes the evaluation of a primary care intervention in the Isle of Wight, United Kingdom, arising from the decision to move a medical practice from its town location into a new health centre in a nearby village. The new centre incorporated a new community pharmacy within the practice. Aim — To determine stakeholders' views on whether there was any perceived benefit resulting from the location of a pharmacy within the new health centre, over and above that of supply. Method — The evaluation explored both process and outcome features by means of self‐completion questionnaires with patients and semi‐structured interviews with health centre staff. The first phase of the study was undertaken prior to the medical practice move into the new health centre in July, 1996, and the second phase 12 months after the move. An interim report was used to influence change by making recommendations to the health authority to provide support and resources for the new pharmacist. Key findings — Prior to the move: three‐quarters of medical practice patients surveyed expected to use the new pharmacy, and 55 per cent expected to receive a better service. The health centre staff and pharmacist were enthusiastic about the potential for service development in the pharmacy. The general practitioners (GPs) had the clearest ideas about possible additional services but there was no implementation strategy. Based on these findings, the evaluators made specific recommendations on action to be taken by the health authority. After the move: 88 per cent of patients surveyed had used the pharmacy and considered that the service was better. The perception was based on matters of convenience. Health centre staff and GPs considered that the pharmacy was providing services beyond supply and had raised awareness of prescribing issues. Conclusion — A pharmacy located within a health centre can, given appropriate support, enhance the pharmacist's contribution to primary health care over and above supply, and provide a mechanism for developing pharmaceutical support for the prescribing function. Evaluation can help to provide insight into ways of ensuring a more satisfactory outcome following organisational change.     

Pharmacy and public health: A pathway forward

ObjectiveTo identify a pathway forward for practicing pharmacists in supporting public health initiatives by applying the five core competencies of public health.SummaryThe pharmacist is well positioned to improve population health. Until now, increased impact of pharmacists has been based on the expansion of patient services rather than guided by a population approach to health. To increase their effectiveness and breadth of impact, pharmacists would benefit from applying the five core competencies of public health (social and behavioral science, health policy and administration, epidemiology, biostatistics, and environmental health sciences) to the practice of pharmacy. This article aims to explain how each of the core competencies applies to pharmacy practice and how pharmacists might apply public health skills in a more specific manner.ConclusionWith increased clarity of the role of public health, and mastery of the five core competencies of public health, pharmacists can make unique and valuable contributions to the health of the public.     

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.     

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.     

Pharmacists: A resource for general practice?

A postal questionnaire seeking the views of all Grampian general practitioners (n=314) to a proposed wider role for pharmacists obtained an 85 per cent response rate. The questionnaire consisted of prescribing related and general tasks compiled from the recommendations of the joint working party's report “Pharmaceutical care: the future for community pharmacy” and those identified by a local GP and pharmacist while working on a joint study. The overall opinion of GPs was in favour of increasing the role of pharmacists. They were most likely to support a routine service for the disposal of unwanted medicines, provision of compliance aids under the NHS and a formal system for pharmacists to report adverse drug reactions. GPs were least likely to support the selection of medicine and dosage by a pharmacist following agreed protocols, an NHS funded pharmaceutical adviser within surgeries to counsel patients on the use of medicines, or the provision of diagnostic and screening services by pharmacists. It is concluded that there is a potential for the integration of the community pharmacist within the traditional primary health care team. Roles have been identified that are acceptable to GPs and which could bring job satisfaction to pharmacists, whose specialist knowledge of drugs is currently under-utilised.     

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.     

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.     

Effectiveness and acceptability of community pharmacy‐based interventions in type 2 diabetes: a critical review of intervention design,pharmacist and patient perspectives

Objective It is generally accepted that greater use could be made of community pharmacy‐based interventions. Diabetes care has been proposed as an area for enhanced community pharmacy involvement. However there is no published structured review of available evidence of either effectiveness or acceptability. This review aims to identify and assess such evidence and to synthesise findings to inform the design and delivery of future community pharmacy‐based interventions in diabetes care. Method A systematic search of published literature was conducted using a defined search strategy, electronic databases and targeted hand searching of non Index Medicus journals. The search dates were 1990–2003. The scope was international and we included only articles in the English language. Key findings Seven experimental studies which tested community pharmacy‐based interventions were reviewed. Four different primary outcomes were studied: diabetes control (three studies), adherence (two studies), medication problems (one study) and patient knowledge (one study). Six studies showed positive outcomes, and the findings were statistically significant in two. The theoretical basis of the interventions was unclear. Only one study included a cost‐effectiveness analysis, and the interventions were provided free of charge to patients in all seven studies. Nine attitudinal studies were included, five involving pharmacists and four with patients. Members of the public do not currently expect community pharmacists to become involved in discussions about diabetes treatment and its monitoring, but when such services are offered they are well used by patients. Pharmacists were positive about the provision of services for people with diabetes. Patients' experiences indicated that community pharmacists overestimate their current provision of information and advice to people with diabetes. Conclusions There is limited evidence of effectiveness of community pharmacy‐based interventions in diabetes care. Components of pharmacy‐based intervention which appear to contribute to effectiveness include: elicitation and discussion of patient beliefs about their diabetes and its treatment; discussion of how patients are using their medicines; review of haemoglobin A_1c (HbA_1c) levels; and assessing and supporting necessary lifestyle changes. Further research is needed and future interventions need to incorporate evidence from the literature on patient and pharmacist perspectives on diabetes. The findings of this review will be useful to researchers and service planners involved in developing community pharmacy‐based diabetes care.     

South Australian rural community pharmacists and the provision of methadone,buprenorphine and injecting equipment

Objective To explore how the provision of opioid substitution treatment (OST) services and/or sterile injecting equipment impacts on community pharmacists. This will assist in identifying strategies to improve the provision of maintenance pharmacotherapy treatment programmes in South Australia. Setting Rural South Australia. Method Analysis of data obtained from earlier focus‐group interviews enabled compilation of key issues for the development of a semi‐structured questionnaire. Fifty‐one potential participants were contacted. Twenty‐five rural South Australian community pharmacists were interviewed through a 15–20‐min semi‐structured telephone questionnaire. Interview responses were manually recorded. Thematic analysis of the transcribed data by one researcher enabled determination of key issues. Key findings Fifty‐one potential pharmacies were contacted and 25 pharmacists were interviewed. All 25 pharmacists had experience in the provision of OST services, 22 sold sterile injecting equipment and 10 offered needle exchange. Exploration of service issues in the context of rural pharmacy practice found that the geographical closeness of a small community may improve rapport with local prescribers, as indicated by 15 of 25 pharmacists. Access to other allied health services was described by 13 of the 25 as difficult. Servicing OST clients can have a negative impact on pharmacy business, is not profitable for rural pharmacies and only seven of the 25 felt adequately remunerated for the provision of their services. Client debt was an identified issue and the practice of withholding doses because of lack of payment was supported by 10 participants and not supported by an equal number. Mentored practice was highlighted as a potential area for future training, as was managing clients' debts. In addition, pharmacy structural changes to provide a private dosing area would preserve confidentiality during supervised dosing. Conclusion Access to allied health services in regional areas could be better coordinated. Financial incentives for South Australian pharmacies, without increasing the cost of treatment for clients, requires further exploration.     

The Utrecht Pharmacy Practice network for Education and Research: a network of community and hospital pharmacies in the Netherlands

Practice-based networks can serve as effective mechanisms for the development of the profession of pharmacists, on the one hand by supporting student internships and on the other hand by collection of research data and implementation of research outcomes among public health practice settings. This paper presents the characteristics and benefits of the Utrecht Pharmacy Practice network for Education and Research, a practice based research network affiliated with the Department of Pharmaceutical Sciences of Utrecht University. Yearly, this network is used to realize approximately 600 student internships (in hospital and community pharmacies) and 20 research projects. To date, most research has been performed in community pharmacy and research questions frequently concerned prescribing behavior or adherence and subjects related to uptake of regulations in the pharmacy setting. Researchers gain access to different types of data from daily practice, pharmacists receive feedback on the functioning of their own pharmacy and students get in depth insight into pharmacy practice.