Supporting patients with mental illness: Deconstructing barriers to community pharmacist access

Objectives

To discuss the barriers faced by individuals with mental health conditions attempting to access their community pharmacists and to propose solutions toward deconstructing those barriers.

The role of the community pharmacist in drug abuse: a comparison of service provision between Northern Ireland and England/Wales

Aim: The aim of the present research was to establish the current extent of pharmacists' contact with illicit drug users in Northern Ireland, their willingness to provide services for this group and to compare the findings with data from a 1995 national survey of community pharmacies in England and Wales. Method:The questionnaire developed by the National Addiction Centre for research in England/Wales was used to collect data. It was mailed on two occasions (March and April 1999) together with a covering letter and a prepaid return envelope to all community pharmacies in Northern Ireland (n=507). A final reminder letter was included in the local wholesalers' medical delivery for the attention of the pharmacist in May 1999.Main Outcome measure: The extent to which Northern Ireland pharmacists had contact with and provided services to illicit drug users compared to pharmacists in England/Wales.Results: A response rate of 67.5% was achieved. Respondents in Northern Ireland were providing fewer services to drug users than those in England/Wales. Respondents reported dispensing methadone for the treatment of addiction/misuse to only 9 patients, while only 17 pharmacists had been asked to sell injecting equipment in the previous week and no pharmacist was participating in a needle exchange scheme. However, most respondents indicated their willingness to provide such services. Barriers towards the provision of services were, however, highlighted e.g. the need for training and the establishment of support systems. Conclusion: Pharmacists in Northern Ireland are in a position to contribute to the policy agenda in Northern Ireland for drug misuse, prevention, treatment and harm minimisation roles which the survey indicates they are willing to embrace. However, training programmes, support systems and adequate remuneration packages must be established before they will be in a position to participate fully.     

Potential role of the community liaison pharmacist: stakeholder views

Objective To determine the views of stakeholders regarding a community liaison pharmacy (CLP) service and to obtain their opinion about the risk of medication misadventure for patients in the immediate post‐discharge period. Setting The study was conducted with medical practitioners, community nurses, community pharmacy, hospital pharmacy, consumers and hospital administration from a division of general practice in Victoria, Australia. Method Semi‐structured interviews were conducted to address areas of: the discharge process, liaison between primary and secondary healthcare sectors and views of a CLP. A focus group was conducted with key informants from the interviews to explore the emergent themes. Key findings Themes from 23 interviews and the focus group explored the difficulties experienced with the discharge process and communication at the primary and secondary interface. Participants discussed the types of problems that patients face after hospital discharge and those potentially at risk of medication misadventure. The role of a liaison pharmacist was defined and logistics of implementation of a CLP service and ameliorable barriers were identified. Information from the focus group was utilised to develop a medication misadventure risk assessment tool for patients returning to community care from hospital. Conclusion Problems with the discharge process and communication at the primary and secondary interface often result in deficiencies in the continuum of care between hospital and the community. Most participants recognised the potential benefits of a CLP service that may bridge the gap in communications between the healthcare settings as well as educating and supporting some patients regarding their medications shortly following discharge from hospital.     

The advisory role of the community pharmacist in self-medication

A survey was carried out to determine the role of the community pharmacist in self-medication by the public. This included provision of advice on the use of medicines and on general health matters. Medicine sales during one trading day were recorded in 57 pharmacies in the Wellington area. 58.6 percent of customer requests for medicine or advice resulted in the sale of a medicine without additional advice. The remaining 41.4 percent of contacts were accompanied by advice from a pharmacist whether a medicine sale was made or not. Of the total advised contacts, 7.8 percent resulted in referral to seek medical advice and 9.8 percent were for general health advice with no sale of a medicine. The results of the survey suggest an important role for the community pharmacist as an adviser in self-medication and in the screening of minor illness.     

The role of the Danish community pharmacist: perceptions and future scenarios

In recent decades, dramatic changes of the role of the Danish community pharmacist have contributed to widespread uncertainty among professionals about the future content of their job. This case study, which is based on qualitative research interviews and documentary material, describes how key actors belonging to 10 different relevant social groups who have been influential in shaping the role of Danish community pharmacists have different perceptions of the pharmacy profession. These perceptions include: the community pharmacist as a provider of technical, standardised advice, the pharmacist as a drug expert, the pharmacist as a leader, and the pharmacist as a provider of individualised advice. Five future scenarios for the community pharmacist ranging from a role as a pharmacist with no future to a role as the provider of individualised information and future role developer are also described and analysed in the paper. The case study is theoretically based on a specific social constructivist theory, the Social Construction of Technology (SCOT).     

A qualitative exploration of the enablers and barriers to the provision of outpatient clinics by hospital pharmacists

Background

With increasing demands on the National Health Service (NHS), Scottish Government-led pharmacy strategy has prioritised the development and expansion of outpatient services. Pharmacist-led outpatient clinics have been shown to reduce hospital admissions and improve patient outcomes. However, expanding these contemporary models of care has proved challenging, and there are few qualitative data about the factors affecting the provision of these.

Aim

This study aimed to explore the enablers and barriers to hospital pharmacists providing outpatient clinics within the largest health authority in Scotland, NHS Greater Glasgow & Clyde (NHSGGC).

Method

Between August and October 2020, one-to-one semi-structured interviews were conducted virtually using the videoconferencing platform Microsoft Teams^®, with NHSGGC hospital pharmacists who did or did not provide clinics. Audio- and video-recordings of the interviews were transcribed verbatim and underwent thematic analysis.

Results

16 hospital pharmacists were interviewed; 50% were clinic providers and 50% were not. Analysis generated seven themes: clinical or service need, individual factors, clinic structure and processes, additional clinical skills and training, competing priorities, macro-level pharmacy working, and external stakeholder relationships. Many of these were interdependent and had the potential to be an enabler or a barrier to clinic provision, depending on the context or individual.

Conclusion

The enablers and barriers to hospital pharmacists providing outpatient clinics are multifaceted, incorporating individual, systematic and professional factors. The implementation of new national professional curricula may help address many of these factors, however prospective research needs to accompany this vision.

     

Pharmacists' role in smoking cessation: an examination of current practice and barriers to service provision

Objective This study addressed the potential role of pharmacists in helping their patients to quit smoking by providing a summary of their self‐reported levels of current activities, confidence, and readiness to change around the provision of brief advice and support for patients who smoke. In addition to investigating which barriers are perceived to be most important, this study also examined the relative importance of confidence, barriers and practice factors in relation to pharmacists' smoking cessation practices. Method A 58‐item questionnaire was mailed to 720 pharmacists. The questionnaire measured demographic and background variables, level of smoking cessation activity (asking, advising, assessing, assisting and arranging including follow‐up), confidence in undertaking smoking‐cessation activities, readiness to change, perceived importance of barriers to providing smoking‐cessation services, and further education or training in relation to smoking cessation. Setting Community pharmacists in South Australia. Key findings Respondents indicated high rates of activity in relation to assessing and assisting patients to quit smoking, with lower rates of advising and arranging including following up. Recording of smoking status was very low. Confidence emerged as the most important predictor of smoking‐cessation activities, with pharmacist barriers including fear of alienating patients approaching significance. Reported levels of smoking‐specific education and training were low. Conclusions South Australian pharmacists are contributing to the prevention of tobacco‐related harms. With additional support there is a greater scope for involvement. Results indicate a need for a team‐based, systematic and multifaceted approach to address barriers and enhance pharmacists' confidence. Further implementation research is required to assess the effectiveness of multifaceted pharmacy support programmes on the uptake and sustainability of smoking‐cessation services.     

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

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

Knowledge that people with intellectual disabilities have of their inhaled asthma medications: messages for pharmacists

Background Fifteen percent of Australians with intellectual disability (ID) are reported to have asthma. People with ID are at risk of poor health knowledge due to deficits in intellectual and adaptive functioning, but their medication knowledge has largely been ignored in research to date. Objective To explore the level of understanding of asthma medication use of people with ID who self-administer their inhaled medications, in order to inform future educational support. Setting The research was conducted in NSW, Australia, at the participants’ homes, the point of health care access, or the offices of relevant support organisations. Method In this qualitative study face-to-face interviews were conducted with people with ID using a semi-structured interview guide. The interviews were recorded, transcribed and thematically analysed. Main outcome Identification of barriers to asthma medication self-management by people with ID. Results Seventeen people with ID who self-administer their asthma medications were interviewed. Factors influencing their asthma medication knowledge and use included understanding of their illness and the need for medication; aspects of self-management and autonomy versus dependence. This sample of people with ID had a good understanding of the importance of using their inhaled asthma medications, as well as asthma triggers, and the difference between use of preventer and reliever medications. Both enablers and barriers to asthma medication self-management were identified in the domains of managing attacks, adherence, knowledge of side effects and sources of information on correct use of inhalers. The level of autonomy for medication use varied, with motivation to self-manage asthma influenced by the level of support that was practically available to individual participants. Conclusion This research investigated aspects of asthma medication self-management of people with ID. Based on the barriers identified, pharmacists should promote use of spacers and written asthma action plans as well as counsel people with ID about how to recognise and minimise side effects of asthma medications. Specific strategies for pharmacists when educating people with ID and their caregivers include active listening to determine understanding of concepts, exercising care with language, and working with the person’s known routines to maximise adherence with preventer medications.     

A qualitative synthesis of pharmacist,other health professional and lay perspectives on the role of community pharmacy in facilitating care for people with long-term conditions

Background

There is increasing interest in an enhanced role for community pharmacy (CP) in facilitating care for people with long-term conditions (LTCs). It is important to understand the perspectives of stakeholders in order to identify key issues that may impact on future development of the role and related services.

Assessment of the benefits of and barriers to HIV pharmacist credentialing

Objectives

To ascertain the reasons for, benefits of, and barriers to pursuing the American Academy of HIV Medicine (AAHIVM) HIV Pharmacist (AAHIVP) credential.

Factors influencing community pharmacist participation in clinical audit: a qualitative study of barriers and drivers of change

□ Community pharmacist participation in clinical audit is suboptimal □ The barriers and drivers specific to community pharmacist participation in clinical audit have received comparatively little attention □ This research identifies nine factors influencing community pharmacy audit participation: attitudes towards audit; time/manpower issues; communication and collaboration; pharmacist characteristics; support; resources; education; project management; local/national frameworks □ These factors must be addressed systematically if increased community pharmacist participation in clinical audit is to be realised.     

Community pharmacists in Australia: barriers to information provision on complementary and alternative medicines

Objective To determine, by surveying Australian community pharmacists, the perceived barriers to the provision of information about complementary and alternative medicines (CAMs) and suggestions for overcoming them. Method Anonymous, self-administered survey sent to a random sample of 701 pharmacists registered in three states of Australia in 2004. Main outcome measure Pharmacists’ perceived barriers to the provision of information about CAMs. Results A total of 344 questionnaires were returned by pharmacists (49% response) of which 211 (30%) were currently practising in community pharmacy. Ninety-five percent of surveyed community pharmacists indicated that they personally received enquires about CAMs, with fewer than 15% reporting they were “very confident” in answering queries about safety, interactions or benefits of CAMs. Frequently used CAM information sources were those from manufacturers and distributors, professional newsletters and journals and textbooks. Pharmacists’ perceived barriers to the provision of CAM information included a lack of suitable training (most training was informal), deficiencies in available information sources, a lack of managerial support, the need for regulatory changes, consumer beliefs about CAM safety and time constraints due to competing demands in daily practice. Pharmacists proposed improvements to overcome these barriers including improvements to training. Conclusion There is scope for pharmacy professional organisations and educational institutions to further support pharmacists in their practice through providing information on the best information sources available and training that meets the needs of undergraduate students, pharmacists and other pharmacy staff. There is a need to examine regulatory requirements concerning the provision of product information with CAMs in Australia and to implement mechanisms for increasing consumer awareness of regulatory procedures for these medicines.