Barriers to and facilitators of the implementation of pharmacist services in primary care clinics: a scoping review protocol

IntroductionInappropriate medication use is a leading cause of avoidable harm in health systems and is particularly severe in primary care settings. Evidence has shown that the integration of pharmacists into primary care clinics has favourable satisfaction and effectiveness in health outcomes. However, barriers to and facilitators of pharmacist services in these settings have not been comprehensively reviewed. Therefore, this scoping review aims to map and examine the literature available on the barriers to and facilitators of the implementation of pharmacist services in primary care clinics to guide future implementation research.Methods and analysisThis scoping review will be undertaken following the six-stage framework developed by Arksey and O’Malley and be guided by recommendations by Levac et al. Eight electronic databases (PubMed, Embase, Scopus, Web of Science, CINAHL, PsycINFO, CNKI and Wanfang) will be searched. Reference lists and related citations, and grey literature from websites will be searched manually. Available information that has been reported in Chinese or English up to 31 August 2021 will be included. Studies will be selected and screened by two reviewers independently. Findings from the included studies will be extracted by two independent reviewers and supervised by a third reviewer. A content analysis of the findings will be performed using MAXQDA 2020.Ethics and disseminationEthical approval will not be required for this scoping review, as all data and information will be obtained from publicly available literature. The findings of this scoping review will be shared with healthcare managers in primary care institutions and health authorities as well as disseminated via publication in a peer-reviewed journal.

STUDY OF PHARMACEUTICAL INVENTORY CONTROL SYSTEM IN SEVERAL PHARMACIES IN KARANGASEM, BALI

The control of pharmaceutical products is one of the pharmaceutical services at the Pharmacy that is regulated in Permenkes RI No. 73 of 2016. The pharmacy control of each pharmacy must always apply the principles stated in the Good Pharmacy Practice (GPP) guidelines. GPP is a pharmaceutical practice that responds to the needs of people who use pharmacist services to provide optimal and evidence-based care. This study aims to determine the system of one of the pharmaceutical service standards, namely the control of pharmaceutical products in several pharmacies in Karangasem, Bali. This type of research is observational descriptive. Data retrieval is carried out in a retrospective manner related to the pharmaceutical product control system in the form of an order or procurement, dispensing, and handling system. Most pharmacies are researched to apply the same control system in the procurement and spending of pharmaceutical products. Only the pharmaceutical product system for handling parts has a slight difference in each pharmacy.

Pharmacists’ and patients’ perceptions about the importance of pharmacist services types to improve medication adherence among patients with diabetes in Indonesia

Background Various pharmacist services are available to improve medication adherence, including consultation, brochure, etc. Challenges arise on which services are best implemented in practice. Knowledge about patients’ and pharmacists’ preferences can help to prioritize services. This study explores the pharmacists’ and patients’ perceptions about the importance of pharmacist services to improve medication adherence among patients with diabetes in Indonesia. Methods This questionnaire-based cross-sectional study involved adult outpatients with diabetes type 2 and pharmacists from community health centers (CHCs) and hospitals in Surabaya, Indonesia. Random sampling was used to identify 57 CHCs in the study. In addition, based on convenient sampling, three hospitals participated. All pharmacists working at the CHCs and hospitals, who were willing to participate, were included in the study. For patients, minimum sample size was calculated using Slovin’s formula. Patients and pharmacists were asked to rank five pharmacist service types (consultation, brochure/leaflet, patient group discussion, medication review, and phone call refill reminder) according to their importance to improve medication adherence. A face validity test of the self-developed questionnaire was conducted before the data collection. Rank ordered probit models were estimated (STATA 15th software). Results A total of 457 patients from CHCs, 579 patients from hospitals, and 99 pharmacists from both medical facilities were included. Consultation (CHC patients 56.0% vs hospital patients 39.7% vs pharmacists 75.2%) and brochure (CHC patients 23.2% vs hospital patients 27.5% vs pharmacists 11.9%) were the most preferred pharmacist services. Patients with experience getting medication information from pharmacists valued consultation higher than brochure and patient group discussions. Older patients ranked a brochure higher than other services. Patients without formal education in CHCs had a lower probability of giving a high rank to a brochure to improve medication adherence. There was significant positive correlation between the ranking of phone call refill reminder and medication review (0.6940) for patients in CHCs. Conclusion For both patients and pharmacists, consultation, brochure, and group discussion were the highest-ranked services. Education, age, experience with pharmacist services, and medical facility features need to be considered when evaluating which pharmacist services to implement in Indonesia.

General practitioners’ views of pharmacist services in general practice: a qualitative evidence synthesis

Background Pharmacist services in general practice are expanding worldwide, with evidence to show pharmacists’ presence in general practice has financial, workload, and clinical benefits. Yet, little is known globally about general practitioners’ (GPs’) views on their presence in general practice. Objective To synthesize the qualitative research evidence on GPs’ views of pharmacist services in general practice. Methods Qualitative evidence synthesis; 8 electronic databases were searched from inception to April 2021 for qualitative studies that reported the views of GPs regarding pharmacist services in general practice. Data from included studies were analyzed using thematic synthesis. The Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach was used to assess the confidence in individual review findings. Results Nineteen studies were included, which captured the views of 159 GPs from 8 different countries. Four analytical themes describing the factors that should be considered in the development or optimization of pharmacist services in general practice, based on the views of GPs, were developed from the coded data and descriptive themes: (i) optimal environment for a pharmacist, (ii) the ideal pharmacist characteristics, (iii) complex stakeholder relationships, and (iv) benefits of an effective pharmacist. Conclusion Based on the synthesis of GPs’ views, we have created a conceptual model of factors that should be considered by policymakers, GPs, pharmacists, and other relevant stakeholders when developing or optimizing pharmacist services in general practice going forward.

The impact of clinical pharmacist services on patient health outcomes in Pakistan: a systematic review

Background The pharmacist’s role shifts from dispensing to bedside care, resulting in better patient health outcomes. Pharmacists in developed countries ensure rational drug use, improve clinical outcomes, and promote health status by working as part of a multidisciplinary team of healthcare professionals. However, clinical pharmacist services on healthcare utilization in low-and middle-income countries (LMICs) like Pakistan are unclear. As a result, we aim to systematically review pharmacists’ clinical roles in improving Pakistani patients’ therapeutic, safety, humanistic, and economic outcomes. Methods We searched PubMed, Scopus, EMBASE, CINAHL, and Cochrane Library for relevant articles published from inception to 28th February 2021. All authors were involved in the screening and selection of studies. Original studies investigating the therapeutic, humanistic, safety, and economic impact of clinical pharmacists in Pakistani patients (hospitalised or outpatients) were selected. Two reviewers independently assessed the risk of bias in studies, and discrepancies were resolved through mutual consensus. All of the included studies were descriptively synthesised, and PRISMA reporting guidelines were followed. Results The literature search found 751 articles from which nine studies were included; seven were randomized controlled trials (RCTs), and two were observational studies. Three RCTs included were having a low risk of bias (ROB), two RCTs were having an unclear ROB, while two RCTs were having a high ROB. The nature of clinical pharmacist interventions included one or more components such as disease-related education, lifestyle changes, medication adherence counselling, medication therapy management, and discussions with physicians about prescription modification if necessary. Clinical pharmacist interventions reduce medication-related errors, improve therapeutic outcomes such as blood pressure, glycemic control, lipid control, CD4 T lymphocytes, and renal functions, and improve humanistic outcomes such as patient knowledge, adherence, and health-related quality of life. However, no study reported the economic outcomes of interventions. Conclusions The findings of the studies included in this systematic review suggest that clinical pharmacists play important roles in improving patients’ health outcomes in Pakistan; however, it should be noted that the majority of the studies have a high risk of bias, and more research with appropriate study designs is needed.

The remuneration of the community pharmacist in the developing world: the case in Indonesia

Introduction: The remuneration of pharmacist is critical to ensure sustainability of pharmacist services. There has been limited study about pharmacist remuneration in Indonesia. Aim: This study aims to investigate pharmacist remuneration system in Indonesia. Methods: A nationwide community pharmacy survey was conducted involving 7,000 pharmacies. Questions around remuneration models and amounts, types of incentives and other financial benefits structured the questionnaire. Descriptive analysis was used to evaluate the findings. Results: Of 2,087 pharmacists participated in the survey, only 1,952 respondents were recorded. More than half of respondents did not receive any particular fees designated to compensate provision of cognitive services. Fixed monthly salary predominantly formed the structure of remuneration system with less than half of the respondents received additional incentives to top up this monthly salary. Conclusion: The current remuneration system which mainly relies on monthly salary basis may not be sustainable to support provision of pharmacist-led cognitive services.

The Effect of Pharmacist Services on Patient Health Outcomes in a Low Middle-income Country: a Systematic Review

Background: The pharmacist's role is shifting from dispensing to bedside care, resulting in better patient health outcomes. However, pharmacist services on healthcare utilization in low- and middle-income countries such as Pakistan are unclear. As a result, we intend to conduct a systematic review of pharmacists' roles in improving Pakistani patients' health outcomes.Methods: We searched PubMed, Scopus, EMBASE, CINAHIL, and Cochrane Library for relevant articles published from inception to February 2021. Original studies investigating the therapeutic, humanistic, safety, and economic impact of pharmacists in Pakistani patients (hospitalized or outpatients) were selected. Two reviewers independently assessed the bias in studies, and mutual consensus resolved discrepancies. Results: The literature search found 751 articles from which ten studies were included; seven were randomized controlled trials (RCTs), and three were observational studies. Three RCTs included were having a low risk of bias (ROB), two RCTs were having an unclear ROB, while two RCTs were having high ROB. Pharmacist interventions comprised one or more components like provision of education about the disease, medication adherence counselling, medication therapy management, and consultation with a physician regarding change of prescription. In most studies, pharmacists provided therapeutic care, followed by humanistic and safety outcomes with significant improvements. Intervention effect on cost-effectiveness and long-term outcomes were unclear.Conclusions: Positive but not always statistically significant pharmacist effects on therapeutic, humanistic, and safety outcomes have been reported. Therefore, the results favour adding on the benefit of pharmacist services but lack evidence of economic feasibility and long-term impact of pharmacist interventions.