Analysis of the information and support needs generated by a community pharmacy‐based methadone treatment programme

Background — Methadone treatment has been provided in Ireland since 1998 under the methadone protocol scheme. Two liaison pharmacists were employed by the Eastern Health Board to interface between pharmacists dispensing methadone in primary and tertiary care. Objective — To analyse and review the inquiries received and addressed by one liaison pharmacist in the first year of operation of a community pharmacy‐based methadone treatment scheme. Method — Inquiries received were recorded by the pharmacist using a standard data collection form. Using content analysis, key themes were identified and each inquiry was classified. Data were analysed using standard computer software. Key findings — Two primary categories of liaison inquiry were addressed: “patient‐related” inquiries, requiring the organisation of community pharmacy‐based methadone dispensing services for patients, and “pharmacy‐related” inquiries, which were requests from community pharmacists for information or support. Two thirds of the inquiries were “patient‐related.” The primary users of the liaison service were prescribers employed by the addiction services and community pharmacists. Conclusion — The liaison pharmacy service handled diverse inquiries, with an emphasis on the facilitation of the provision of pharmaceutical care for patients requiring community pharmacy‐based methadone dispensing services. The liaison service had a significant secondary role in the provision of support and information for community pharmacists. The study findings are of relevance to those involved in developing and introducing primary care‐based services for drug misusers.     

Consumer attitudes towards community pharmacy services in Saudi Arabia

Objective The purpose of this study was to determine consumer attitudes towards community pharmacy and their preferences for the introduction of new services. Methods A self‐completion questionnaire was developed and 1,144 consumers in 55 community pharmacies were invited to complete it. The questionnaire covered consumers' choice of pharmacy; their perceptions of, and actual interactions with, community pharmacists; advice from pharmacists about general health and prescribed medicines; and privacy in the pharmacy. Respondents were asked for their views about five possible new services. Setting The study was based in community pharmacies in Riyadh City, Saudi Arabia. Key findings The response rate was 79.6%. Fifty‐nine per cent of respondents often or sometimes visited a particular pharmacy. One‐quarter of respondents perceived community pharmacists as having a good balance between health and business matters, while 56.1% thought pharmacists were more concerned with the business. The majority of respondents (69.7%) said they felt comfortable asking the pharmacist for advice. Just under half (44.8%) felt that pharmacists allowed them enough time to discuss their problem fully and listened well. In addition, 58.5% of respondents indicated that their pharmacists showed sensitivity to privacy by speaking more quietly across the counter. In 14.4% of situations pharmacists were reported to use a private area within the pharmacy when discussing personal or private matters. Most respondents (65.2%) indicated that their pharmacist was willing to discuss their health problems and tried to understand their feelings. Consumers' priorities for new services were: monitoring blood pressure; measuring weight, height and temperature; monitoring blood sugar; and monitoring cholesterol. Conclusion This study showed that most pharmacy customers feel comfortable seeking advice from their pharmacist. Although many pharmacists were reported to show sensitivity to a possible lack of privacy in the pharmacy, few respondents reported that their pharmacy had a private area for discussion. Customers' views on possible new services were generally positive, with the exception of patient medication records.     

The development and evaluation of an extended adherence support programme by community pharmacists for elderly patients at home

Objective —To devise, implement and evaluate a medication adherence support service by community pharmacists for elderly patients living at home and at risk of non‐adherence. Method — Six community pharmacists identified patients who were 65 years of age and older, prescribed four or more regular medicines and living alone. A random sample of patients was visited at home and assessed for adherence‐related problems using a structured interview. The pharmacist then drew up an action plan in conjunction with the patient and general practitioner (GP), and returned for a second home visit, where the revised regime was delivered and explained. A self‐reported adherence questionnaire was also administered. After two months an independent researcher visited the patients at home to assess progress. Setting — Six community pharmacies in the city of Leeds, UK, and patients' homes. Key findings — A total of 143 patients were recruited and 441 medicine‐related problems were identified. Of these, 241 (55 per cent) required the provision of information and advice, 106 (24 per cent) required consultation with the GP and 86 (20 per cent) required changes in the presentation of the medicines. The median number of regular prescribed medicines fell from six to five (P<0.001). Overall, there was a reduction in the number of patients with one or more problems from 94 per cent to 58 per cent (P<0.001). The proportion of patients who reported non‐adherence fell from 38 per cent to 14 per cent (P<0.001). Conclusion — This study shows that community pharmacists can target patients at risk of medication non‐adherence and, using a structured approach, identify problems and implement solutions. The pharmacy patient medication record is an underutilised tool for identifying patients with adherence problems. The software needs enhancing to enable pharmacists to maximise their use of these records in adherence support. An adherence support programme needs to take more account of intentional non‐adherence and should be closely linked with the rest of the primary health care team.     

Pharmacists solving problems in asthma management — experiences from a one‐year intervention programme in Finland

Objective — To study the effect of an intervention provided by community pharmacists on detection and resolution of problems in asthma patients' self‐management and to study patients' opinions about the perceived usefulness of the pharmacists' input. Method — A one‐year intervention study was conducted with scheduled visits and follow‐ups at baseline, four, eight and 12 months. Study patients (n=28) acted as their own controls. Setting — Four communities and community pharmacies in different parts of Finland. Key findings — At study baseline, all patients had at least one documented problem, the most commonly reported being problems with medication, side effects, problems with inhalation devices and not using asthma medicines according to the physician's instructions. On average, patients had five “intervention” consultations with the pharmacist during the one‐year study. After the intervention, half of the patients reported that their problems had been resolved. The most useful areas of advice were considered by the patients to be instructions about changing asthma medication according to asthma symptoms and management of asthma symptoms. Twenty‐five of the 28 patients reported that they were satisfied with the education and counselling provided by pharmacists, a higher number than for physicians or nurses. Conclusion — The findings from this small longitudinal study indicate that community pharmacists can improve asthma patients' treatment by consultations during which they identify and address problems in self‐management of asthma.     

Measurement of patient satisfaction with community pharmacy services: a review

Aim of the review The aim of this review is to conduct an in-depth analysis of the available literature in order to identify and evaluate studies measuring patient satisfaction with pharmacy services delivered by pharmacists in a community setting. Method An extensive literature search was conducted in five databases (Medline, Scopus, Embase, Psychinfo, International Pharmaceutical Abstracts) using the search terms “patient/client/consumer satisfaction” AND “community pharmacy/pharmacies” AND “pharmacy service/pharmaceutical services/pharmacy program/intervention/intervention studies”. Only those articles where the main focus was measuring patient satisfaction with services delivered in community pharmacies were included in the review. Patient satisfaction was explored with three different levels of pharmacy services—general services, intervention services and cognitive services. Results Twenty-four articles measuring patient satisfaction with community pharmacy services were retrieved. Of these, eleven measured patient satisfaction with general services, six measured satisfaction with intervention services and seven measured satisfaction with cognitive services. The majority of studies reviewed had adopted and measured satisfaction as a multidimensional construct. None of the studies reviewed tested any theoretical models of satisfaction. Further a lack of consistent instruments measuring patient satisfaction was observed, with most of the reviewed studies using self developed, non-validated or ad hoc instruments with items from various previously published papers. The review also observed high levels of patient satisfaction with pharmacy services be they general, intervention or cognitive services. Conclusion This review found that patient satisfaction has been measured within the community pharmacy context to a certain degree. Further research is needed to develop and test instruments based on theoretical frameworks, to test satisfaction pre and post hoc and in well designed randomized controlled trials and to measure changes in satisfaction over time. Novel approaches involving an understanding of expectations and preferences of patients and matching these to the services provided also need to be explored.     

Pharmaceutical care research and education project: patient outcomes

OBJECTIVE: To compare patients' adherence to therapy, expectations, satisfaction with pharmacy services, and health-related quality of life (HRQOL) after the provision of pharmaceutical care with those of patients who received traditional pharmacy care. DESIGN: Randomized controlled cluster design. SETTING: Sixteen community pharmacies in Alberta, Canada. PATIENTS AND OTHER PARTICIPANTS: Ambulatory elderly (> or = 65 years of age) patients covered under Alberta Health & Wellness's senior drug benefit plan and who were concurrently using three or more medications according to pharmacy profiles. INTERVENTION: Pharmacies were randomly assigned to either treatment (intervention) or control (traditional pharmacy care) groups. Patients at treatment pharmacies were recruited into the study, and pharmacists provided comprehensive pharmaceutical care services. Pharmacists at control pharmacies continued to provide traditional pharmacy care. MAIN OUTCOME MEASURES: Study participants' opinions, adherence to therapy, and scores on the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). RESULTS: Compared with those of patients receiving traditional care, treatment patients' expectations that their pharmacist would perform activities congruent with pharmaceutical care changed over the study period. Treatment patients' satisfaction with the constructs "trust," "evaluation and goal setting," and "communicates with doctor" were also positively affected. HRQOL and patient adherence were not significantly affected by pharmaceutical care interventions. CONCLUSION: Successful implementation of a pharmaceutical care practice model has the potential to increase patients' satisfaction with their pharmacists' activities and may increase patients' expectations that pharmacists will work on their behalf to assist them with their health care needs. If pharmaceutical care affects patients' HRQOL, instruments more specific than the SF-36 may be needed to detect the differences.     

Pharmaceutical consultations in community pharmacies: utility of the Roter Interaction Analysis System to study pharmacist–patient communication

Communication is a key issue in the delivery of healthcare services. In the pharmacy context, pharmacist–patient communication may vary from brief counselling episodes to extensive pharmaceutical care consultations. Many community pharmacies have developed practices to facilitate the effective delivery of pharmacy care, in particular to chronic patients, although the nature and extent of the services differ widely from country to country. Diabetes‐focused pharmaceutical care is an example highlighting both the opportunities and challenges associated with an expansion of pharmacy services from product dispensing to pharmaceutical consultations. An area of particular challenge of such an expansion of pharmaceutical services is the development of expertise in the delivery of patient‐centred pharmaceutical consultations. Although well known to medicine and nursing, patient‐centredness has not been routinely incorporated into the training of pharmacists, evaluation of pharmacy practice or conduct of pharmacy‐related research. There are few studies of the communication process based on analysis of an objective record such as an audio or video recording and the common perspective is largely a one‐way information flow from pharmacist to patient. This has hampered the field's ability to link pharmacy communication to outcomes, including patient adherence and satisfaction with services. An extensive body of communication research on physician–patient interaction, employing the Roter Interaction Analysis System (RIAS), exists and the system presents a potentially useful tool in the pharmacy context. The purpose of this essay is to explore the utility of the RIAS for analysis of pharmacist–patient interaction and its implication for improving patient care and optimizing pharmacy‐specific outcomes.     

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.     

Community pharmacy services for antidepressant users

Objective — To evaluate the communication and barriers to communication between community‐based pharmacists and antidepressant users. Method — A survey package designed to evaluate the communication between pharmacists and antidepressant users was distributed to 50 community pharmacies. Each package included one pharmacist survey and 10 sealed antidepressant user surveys to be distributed by the pharmacy staff. The survey addressed the components of communication, level of satisfaction and barriers to effective communication. Setting — Urban and rural community pharmacies in the Canadian Maritime provinces of Nova Scotia and New Brunswick. Key findings — Overall, pharmacists rated the value of their communication more highly than did antidepressant users, although the difference was not statistically significant. When beginning treatment, between one‐half and two‐thirds of antidepressant users recalled pharmacists inquiring about past use of the antidepressant and discussing information provided by the physician, time to onset of benefits and potential side effects. The purpose of the antidepressant, target symptoms, usual duration of therapy and risk of relapse with premature discontinuation were addressed less often according to antidepressant users, and monitoring of compliance was not a common activity. Antidepressant users estimated that initial communication with the pharmacist generally lasted less than five minutes, and often less than two minutes. However, pharmacists appeared to resolve misconceptions and concerns about antidepressant use efficiently. According to pharmacists, the major barrier to effective communication was a lack of privacy. Conclusion — Although compliance with antidepressants is low and treatment outcomes are sub‐optimal, pharmacists are not using their opportunities to minimise this problem through effective communication and follow‐up. Pharmacists, pharmacy administrators and regulators need to re‐assess their contribution to this problem and how they can lead to its resolution in the patient's best interest.     

Intervention research to enhance community pharmacists' cognitive services: A systematic review

BackgroundPositive impact of community pharmacists' cognitive pharmaceutical services (CPS) is well documented. However, community pharmacists have been slow to expand CPS roles. This systematic review explores how community pharmacy intervention research can help inform efforts to expand cognitive pharmaceutical service delivery.ObjectivesTo: 1) identify community pharmacy CPS intervention studies that report data on pharmacist behaviors, either as a final study outcome itself or as a fidelity measure in patient outcome studies, and 2) describe the state of this research to help frame future research agendas.MethodsEmpirical articles examining improvement or expansion of community pharmacist cognitive services published through December 2010 were searched using various search engines, bibliography searches and authors' libraries. Studies were included if they: 1) reported findings on pharmacist behaviors during cognitive service delivery, 2) employed a minimum of pre-post design or two study arms for pharmacists/pharmacies, and 3) were in community-based pharmacies.ResultsA total of 50 studies evaluated impact of community pharmacy based CPS delivery; however, only 21 included a pharmacist behavior outcome measure as a final outcome or as a fidelity measure. The majority (14 out of 21) of studies used a randomized controlled trial design. Nearly half (10 of 21) addressed asthma or tobacco cessation. Limited details were provided about interventions to prepare pharmacists for CPS delivery. The most frequent measures of pharmacist behavior were patient surveys and observation of pharmacists' behavior by secret shoppers; electronic data sets were rarely used.ConclusionsThere is a need for well-designed intervention research that evaluates how interventions impact on pharmacist cognitive service behavior. Positive findings from this review reinforce that planned interventions have the potential to improve and expand pharmacist cognitive service delivery; however, more detail is needed in study publications for this potential to be fully realized.     

The General Level Framework: use in primary care and community pharmacy to support professional development

Objectives To compare practice pharmacists and community pharmacists based on the use of the General Level Framework (GLF) as a tool to support continuing professional development (CPD). Setting Primary care and community pharmacy in London and the East of England. Method The study pharmacists were self‐selected after distribution of recruitment packs in the study area through local pharmaceutical committees, primary care trusts and two large multiples. Sixty‐nine pharmacists used the framework to support their CPD (42 community pharmacists and 27 with a role in primary care pharmacy). Pharmacists made an initial self‐assessment against the GLF and then used the framework over a 12‐month period to identify learning needs for CPD. Pharmacists identified their desired performance levels for the behaviours in the framework, based on guidance from the project team, and then identified their learning needs by comparing the desired performance level with their self‐assessment. Pharmacists were visited at 4 and 8months by a trained facilitator to support their self‐assessment and progress with CPD. Final self‐assessments were collected at 12months. Assessment ratings for the delivery of patient‐care competencies were compared. Key findings There was no difference in the probability of either group achieving their desired performance level (log rank = 0.023, 1 df, P = 0.878): pharmacists achieved their desired performance level irrespective of their sector of work, demonstrating the applicability of the GLF to the different sectors of practice. Practice pharmacists had a higher aggregated score for the desired performance levels than the community pharmacists (Mann‐Whitney U = 10.500, P < 0.001; median = 133.0 and 119.5 respectively). Conclusion Both groups of pharmacists were able to apply the framework to their practice and use it to support their CPD, resulting in increasing self‐assessed competency scores over time. The higher desired performance level for practice pharmacists compared with community pharmacists conveys a difference, perceived or actual, between the two roles. Irrespective of the difference in desired performance levels, both groups of pharmacists have improved, to meet their level of expectation, over the 12‐month period.     

Satisfaction with community pharmacies services in Jordan: A cross-sectional study

BackgroundPharmacists are responsible for giving patients basic information about their medications, as well as informing them about drug administration, safety, efficacy, medication storage, and promoting patient adherence to their medications. Patient satisfaction will undoubtedly improve if patient-centered care is used and the patient is encouraged to participate in the decision-making process. The aim of this study is to explore patients' satisfaction with the pharmacy, its location, medication handling, dispensing and counselling procedures, or other non-paid services.MethodThis was a cross-sectional study that was conducted in Jordan using online questionnaire tool. Data was collected for the period between November 2021 and January 2022. A previously developed and validated questionnaire tool was used in this study. Binary logistic regression analysis was used to determine factors affecting satisfaction with community pharmacy services.ResultsA total of 1,611 patients participated in this study. More than half of the patients (55.5%) were males. Around 50.0% of the patients were aged 30 years and below. Patients were moderately satisfied with community pharmacy services (the mean satisfaction score was 148.6 (SD: 19.4) out of 205 (maximum obtainable score), which is equal to 72.5%). Patients' satisfaction was relatively consistent across the four sub-scales, ranging from 68.0% (satisfaction with additional non-paid services) to 74.7% (for satisfaction with the store, location, and staff). Patients' satisfaction with the store, location, and staff, as well as satisfaction with dispensing and counselling methods, differed significantly by age, marital status, work status, and the existence of chronic disease history. Patients' satisfaction with drug handling varies significantly depending on the patients' age, marital status, education level, employment position, and the presence of a history of chronic conditions. Patients' satisfaction with additional non-paid services differed significantly depending on the patients' educational level alone. Patients aged between 24 and 30 years old, as well as university students, were more likely to be satisfied with community pharmacy services.ConclusionIn Jordan, patients were satisfied with community pharmacy services to a moderate degree. Future research should look on patient satisfaction with pharmaceutical services in hospitals. Furthermore, strategies to promote satisfaction with pharmaceutical services should be investigated.     

Care providers' satisfaction with restructured clinical pharmacy services in a tertiary care teaching hospital

Background:

At the time this study was undertaken, clinical pharmacy services at the authors’ institution, a tertiary care teaching hospital, were largely reactive in nature, with patients and units receiving inconsistent coverage.

Objective:

To develop an evidence-based model of proactive practice and to evaluate the satisfaction of pharmacists and other stakeholders after restructuring of clinical pharmacy services.

Methods:

The literature was reviewed to determine a core set of pharmacist services associated with the greatest beneficial impact on patients’ health. On the basis of established staffing levels, the work schedule was modified, and pharmacists were assigned to a limited number of patient care teams to proactively and consistently provide these core services. Other patient care teams continued to receive reactive troubleshooting-based services, as directed by staff in the pharmacy dispensary. A satisfaction survey was distributed to all pharmacists, nurses, and physicians 18 months after the restructuring.

Results:

Of the 26 pharmacists who responded to the survey, all agreed or strongly agreed that the restructuring of services had improved job satisfaction and patient safety and that other health care professionals valued their contribution to patient care. Nurses and physicians from units where pharmacists had been assigned to provide proactive services perceived pharmacist services more favourably than those from units where pharmacist services were reactive. Pharmacists, nurses, and physicians all felt that proactive pharmacist services should be more widely available. Challenges reported by pharmacists included increased expectations for documentation and guilt about “cutting back” services where they had previously been provided.

Conclusions:

Restructuring clinical pharmacy services in an evidence-based manner improved pharmacists’ satisfaction and created demand from other stakeholders to provide this level of service for all patients.     

Public perceptions of community pharmacists in Benin City,Nigeria

Objective — To determine public perceptions of community pharmacists and pharmacies in Benin City, Nigeria. Method — A self‐completion questionnaire was distributed to a stratified random sample of 1,500 households. Data were collected using a 22‐item, Likert‐type scale which was shown to have 0.77 reliability. The neutral point was assumed to be 66 on the scale of 22 to 110. Scores above 66 were interpreted as positive perception. Results — The response rate was 68.3 per cent (1,025/1500). Almost two‐thirds (64 per cent) of respondents perceived the community pharmacist as a health care provider, and 70 per cent agreed that community pharmacists are needed, especially in the area of medicinal product selection (76 per cent). However, 52 per cent believed pharmacists are profit motivated and only 43 per cent said they would be willing to pay for pharmacist consultation. Respondents reported difficulty in differentiating between pharmacists and pharmacy attendants, with only 58 per cent reporting that they could tell the difference. The pharmacists scored 76.37 ± 27.63, with 60 per cent of respondents scoring them above 66. Conclusion — This study found that community pharmacists received a moderately positive rating from the public. There is a need for community pharmacists to carve out a more distinct professional identity for themselves.     

Outcomes of pharmaceutical care intervention to hypertensive patients in a Nigerian community pharmacy

Objective To describe pharmaceutical care interventions provided to hypertensive patients in a Nigerian community pharmacy setting, and to assess the impact of the practice on selected patient outcomes. Method A non‐randomised, single‐site study was conducted using community‐dwelling patients with hypertension. A pharmaceutical care intervention, which consisted mainly of verbal counselling, provision of an information leaflet, and subsequent monitoring with reinforcement, was provided. Parameters assessed at baseline and end of investigation included blood pressure control, body mass index determination, level of medication adherence, patient knowledge of the disease, and patient satisfaction. Key findings Forty‐two (42) patients were recruited and 36 completed the study, 26 (73%) were males, and 33 (92%) were married. Twenty (20, 58%) had post‐secondary education. About three‐quarters (27, 81%) were either overweight or obese (BMI >25). There was a significant difference between mean systolic blood pressure at baseline (187.67 ± 29.46 mmHg) and at the end of the study (137.22 ± 21.65 mmHg), P< 0.0001. Changes in mean diastolic blood pressure at baseline (117.56 ± 21.65) and end of study (89 ± 17.23), were also significant (P< 0.0001). Some 27 (75%) reached systolic blood pressure goals while 25 (69%) attained diastolic blood pressure goals. Prior to the pharmaceutical care intervention, 27 (75%) were not aware that salt intake was a risk factor in hypertension, and a similar proportion thought that hypertension was curable. The pharmaceutical care intervention produced a significantly higher patient‐reported satisfaction rating than baseline: 3.48 ± 0.83 (49%) versus 3.92 ± 0.62 (74%); t = 2.548; P=0.013 and 3.30 ± 0.72 (41%) versus 4.27 ± 0.56 (87%); t= 6.381, P< 0.0001 on the subscales respectively. Conclusion Pharmaceutical care provided to hypertensive patients in a Nigerian community pharmacy setting improved blood pressure control and overall patient satisfaction with pharmaceutical services.