Expanded Pharmacy Practice Implementation: Lessons from Remote Practice

Aim: The aim of this study is to explore pharmacist perspectives of the implementation of a community pharmacy-based ear health service in rural communities. Method: A community pharmacy-based health service model was designed and developed to provide an accessible ear care service (LISTEN UP—Locally Integrated Screening and Testing Ear aNd aUral Program) and pharmacist’s perspectives of the implementation of LISTEN UP were explored. Thematic analysis was conducted and data coded according to the Consolidated Framework for Implementation Research. Results: A total of 20 interviews were conducted with 10 pharmacists, averaging 30 min. Visualistion of the ear canal was reported as the greatest advantage of the service, whilst the time required for documentation reported as a complexity. The number of pharmacists working at one time and the availability of a private consultation room were identified as the two limiting factors for execution. On reflection, the need for government funding for service viability and sustainability was highlighted. Discussion/Conclusion: Expanded pharmacy practice is emerging for the Australian pharmacy profession. Rural community pharmacists are recognised as integral members of healthcare teams, providing accessible medication supply and health advice to seven million people in Australia who call rural and remote regions home. However, there are no structured models supporting them to provide expanded services to improve health outcomes in their communities. This study provides lessons learnt to guide future design and development of expanded models of pharmacy practice.

Provision of community pharmacy services during the first wave of COVID-19 pandemic in Estonia – experiences and future implications

The spread of COVID-19 outbreak in 2020 had significant impact on the functioning of the existing healthcare system and required fast adaption to new circumstances for continuing with daily practices. Community pharmacists shared responsibility of ensuring supply of medicines and medical devices, educating people on health related issues, providing pharmaceutical care etc. The aim of this study was to understand how the provision of community pharmacy services changed during the first wave of COVID-19 pandemic in spring of 2020 in Estonia. Qualitative in-depth semi-structured interviews were conducted. Recorded interviews with community pharmacists (n = 21) and experts (n =10) were transcribed verbatim and a systematic text condensation method for textual content analysis was performed. The findings indicated that a number of changes took place in provision of community pharmacy services to assure continuity in providing high-quality pharmacy services in crisis, including addressing difficulties in the supply of medicines; at the same time, to acquire new knowledge for counselling health related topics and personal protective equipment, and to provide psychological support to people in stress. Pandemic had an impact on the content and structure of traditional community pharmacy services in Estonia. The need for expanded professional role of pharmacists was clearly expressed in an emergency situation.

The Influence of Cognitive Styles as Promoters of Entrepreneurial Orientation and Intrapreneurship as Drivers of Innovation: The Case of Pharmacy Professionals in Portugal

Innovation in the community pharmacy field has extreme importance in building customer loyalty and competitiveness and, during the COVID-19 pandemic, its value was even more noted. Thus, in this study, we aimed to assess the influence of cognitive styles (rational and intuitive) on individual entrepreneurial orientation and intrapreneurship and how they impact innovation. A questionnaire was applied to 209 community pharmacy professionals in Portugal during the COVID-19 pandemic, and PLS-SEM was used to statistically analyze the data obtained. For the results, we perceived those cognitive styles’ (rational and intuitive) impact on individual entrepreneurial orientation and partially on intrapreneurship, and this innovation is explained by individual entrepreneurial orientation and intrapreneurship. For the theoretical implications, we have contributed to the advancement of knowledge by establishing and understanding the relationship between the different dimensions suggested and, at the practical level for management, we have perceived where to act at the individual level, to improve innovation and provide suggestions in the directions suggested here. This study is original and innovative because there are no general studies in the literature that have related all the dimensions addressed here, and there is little current research in the community pharmacy field.

Co-designing a Community Pharmacy Pharmacogenomics Testing Service In The UK

Introduction: Pharmacogenomics (PGx) testing services have been delivered through community pharmacies across the globe, though not yet in the UK. This paper is reporting a focus group study, the first stage of a participatory co-design process to increase the chance of a successful implementation of a PGx service through community pharmacy in the UK.Aim: To identify the barriers and enablers to implementing a community pharmacy based PGx service in the UK.Method: Three focus groups were conducted with community pharmacists (n= 10), prescribers (n= 8) and patients (n=8) in England. The focus groups were recorded, transcribed and thematically analysed using the Braun and Clarke six step reflexive thematic analysis approach.Results: The analysis identified five themes about PGx testing in community pharmacies: (1) In- principle receptiveness, (2) Appreciation of the benefits, (3) Lack of implementation resources (4) Ambiguity about implications for implementation and (5) Interprofessional relationship challenges.Conclusion: The identified enablers for implementation of a PGx service were at a macro health system strategic level; the concerns were more at a granular operational procedural level. Overall receptiveness was noted by all three participant groups, and both prescriber and pharmacist groups appreciated the potential benefits for patients and the healthcare system. Prior to implementation in the UK, there is a need to disambiguate health professional’s concerns of the guidance, resources, and knowledge required to set up and deliver the service and to resolve patient concerns about the nature of genomics.

Impact of pharmacist-led interventions on diabetes management at a community pharmacy in Pakistan: a quasi-experimental study

Published in August 2021

A study to investigate the implementation process and fidelity of a hospital to community pharmacy transfer of care intervention

Background Hospital to community pharmacy transfer of care medicines-related interventions for inpatients discharged home aim to improve continuity of care and patient outcomes. One such intervention has been provided for seven years within a region in England. This study reports upon the implementation process and fidelity of this intervention. Methods The process evaluation guidance issued by the Medical Research Council has informed this study. A logic model to describe the intervention and causal assumptions was developed from preliminary semi-structured interviews with project team members. Further semi-structured interviews were undertaken with intervention providers from hospital and community pharmacy, and with patient and public representatives. These aimed to investigate intervention implementation process and fidelity. The Consolidated Framework for Implementation Research and the Consolidated Framework for Intervention Fidelity informed interview topic guides and underpinned the thematic framework analysis using a combined inductive and deductive approach. Results Themes provided information about intervention fidelity and implementation that were mapped across the sub processes of implementation: planning, execution, reflection and evaluation, and engagement. Interviewees described factors such as lack of training, awareness, clarity on the service specification, governance and monitoring and information and feedback which caused significant issues with the process of intervention implementation and suboptimal intervention fidelity. Conclusions This provides in-depth insight into the implementation process and fidelity of a ToC intervention, and the extant barriers and facilitators. The findings offer learning to inform the design and implementation of similar interventions, contribute to the evidence base about barriers and facilitators to such interventions and provides in-depth description of the implementation and mechanisms of impact which have the potential to influence clinical and economic outcome evaluation.

Clinical and Organizational Impacts of Medical Ordering Settings on Patient Pathway and Community Pharmacy Dispensing Process: The Prospective ORDHOSPIVILLE Study

During the dispensing process of medical orders (MOs), community pharmacists (CPs) can manage drug-related problems (DRPs) by performing pharmacist interventions (PIs). There is little evidence that the PI rate is higher with MOs from hospitals (MOHs) than ambulatory (MOAs) settings, and their impact on the patient and community pharmacy is unknown. The primary objective of this study was to compare the MOH and MOA PI rates. The secondary objective was to describe PIs and their clinical and organizational impacts on patient and community pharmacy workflow. A total of 120 CPs participated in a prospective study. Each CP included 10 MOH and 10 MOA between January and June 2020. DRP and PI description and clinical and organizational impacts between MOH and MOA were assessed and compared. We analyzed 2325 MOs. PIs were significantly more frequent in MOH than in MOA (9.7% versus 4.7%; p < 0.001). The most reported PI was the difficulty of contacting hospital prescribers (n = 45; 52.2%). MOHs were associated with a longer dispensing process time and a greater impact on patient pathway and community pharmacy workflow than MOAs. Lack of communication between hospital and primary care settings partly explains the results. Implementation of clinical pharmacy activities at patient discharge could alleviate these impacts.

Assessment of Knowledge, Attitude, and Practice of Adverse Drug Reaction Reporting Among Community Pharmacy in Gondar Town, Ethiopia, 2021

Background: Drugs can treat diseases, reduce symptoms, and enhance patients’ health and quality of life. However, taking a drug is not always as easy as just swallowing a pill. This is because drugs have some unwanted effects. Adverse Drug Reactions (ADRs) are one of the leading causes of morbidity and mortality and contribute to excessive health care costs. Objectives: To assess knowledge, attitude, and practice of health care providers on adverse drug reporting among community pharmacists, Gondar, Ethiopia Methods: Community-based cross-sectional study designs were used from July - August 2021. The sampling method was a survey from community pharmacists. Self-administered questioner was used, and the collected data was entered into Epi-info Version 7.0 and exported to SPSS version 20 software for analysis. Result: The study included 215 community pharmacy professionals to assess the knowledge, attitudes, and practices of adverse drug reaction reporting. From a total of 215 community pharmacy professionals, 34 (15.8%) of the respondents were able to differentiate ADR from side effects and only 56(26%) respondents felt that they are adequately trained in ADR reporting. Out of 215 respondents, 78(36.3%) and 146(67.9%) knew the availability of the national reporting system and ADR reporting form in Ethiopia respectively. The study revealed that 21.4% [95% CI: 18.6-35.9] and 42.3% [95% CI: 38.2-65.9] of community pharmacists have poor knowledge and negative attitude towards ADR reporting respectively. Conclusion: Underreporting of ADR by community pharmacists was identified in this study. Training sessions to clarify the role of various community pharmacists in ADR reporting will hopefully fill the observed gap in knowledge and practices. The community pharmacy should formulate strategies to enhance the detection and reporting of ADRs.