Considerations of Australian community pharmacists in the provision and implementation of cognitive pharmacy services: a qualitative study

Abstract

Background Australian federally-funded cognitive pharmacy services (CPS) (e.g. medication management and reconciliation services) have not been translated into practice consistently. These health services are purportedly accessible across all Australian community pharmacies, yet are not delivered as often as pharmacists would like. There are international indicators that pharmacists lack the complete behavioural control required to prioritise CPS, despite their desire to deliver them. This requires local investigation. Objective To explore Australian pharmacists’ perspectives [1] as CPS providers on the micro level, and [2] on associated meso and macro level CPS implementation issues. Methods Registered Australian community pharmacists were recruited via professional organisations and snowball sampling. Data were collected via an online demographic survey and semi-structured interviews until data saturation was reached. Interview transcripts were de-identified then verified by participants. Content analysis was performed to identify provider perspectives on the micro level. Framework analysis using RE-AIM was used to explore meso and macro implementation issues. Results Twenty-three participants across Australia gave perspectives on CPS provision. At the micro level, pharmacists did not agree on a single definition of CPS. However, they reported complexity in interactional work and patient considerations, and individual pharmacist factors that affected them when deciding whether to provide CPS. There was an overall deficiency in pharmacy workplace resources reported to be available for implementation and innovation. Use of an implementation evaluation framework suggested CPS implementation is lacking sufficient structural support, whilst reach into target population, service consistency and maintenance for CPS were not specifically considered by pharmacists. Conclusions This analysis of pharmacist CPS perspectives suggests slow uptake may be due to a lack of evidence-based, focused, multi-level implementation strategies that take ongoing pharmacist role transition into account. Sustained change may require external change management and implementation support, engagement of frontline clinicians in research, and the development of appropriate pharmacist practice models to support community pharmacists in their CPS roles. Trial registration This study was not a clinical intervention trial. It was approved by the University of Technology Sydney Human Research Ethics Committee (UTS HREC 19–3417) on the 26th of April 2019.

Qualitative exploration of the experiences of community pharmacists delivering the Diabetes MedsCheck service

“…This is the first study to explore the experiences of Australian community pharmacists in delivering DMC since its roll out in 2012. The findings confirmed traditional barriers (e.g., time shortage, pharmacist shortage, and lack of knowledge and confidence) and facilitators (pharmacist and ancillary staff training) 11,21 . Of these facilitators, pharmacists stated training and experience in diabetes management are key enablers in delivering optimal DMCs.…”

“…Unfortunately, however, only a small proportion of patients with diabetes have accessed the DMC service, which may be due to various factors, such as service delivery and community pharmacy staffing and other resource limitations 11 . A 2012 initial mixed methods evaluation of DMC which involved surveying and interviewing pharmacists, patients and other stakeholders found that patients benefited from the service and that it improved the relationship between pharmacists with patients and other healthcare professionals 12 .…”

Pharmacist’s time spent: Space for Pharmacy-based Interventions and Consultation TimE (SPICE)—an observational time and motion study

“…Time constraints are a commonly cited barrier to PS delivery. 4 16 37 Other literature infers that non-metropolitan pharmacies provide more patient-orientated services due to having lighter workloads and, hence, more time; or such areas being underserved and, hence, placing greater emphasis on these pharmacists to extend their roles. 37 38 Yet, a narrative review by Howarth et al challenges the validity of these results suggesting limitations in study design and inadequate control of potential confounding variables.…”

“…2 3 The resultant services aim to complement general practitioner (GP) and allied health service offerings and help reduce public demand for services in overloaded emergency departments and medical clinics. 4 There are many definitions for these health services within the pharmacy sector and they are differentiated from dispensing and related professional activities by terms including 'cognitive', 'extended', 'enhanced', 'newer', 'patient-centred', 'professional' and 'clinical' pharmacy services. [3][4][5] In this paper, such non-dispensing-related activities and non-over-the-counter medicine sales services, and those identified by the Australian Seventh Community Pharmacy Agreement (7CPA) as patient-centred services will be referred to as 'professional services'.…”

“…4 There are many definitions for these health services within the pharmacy sector and they are differentiated from dispensing and related professional activities by terms including 'cognitive', 'extended', 'enhanced', 'newer', 'patient-centred', 'professional' and 'clinical' pharmacy services. [3][4][5] In this paper, such non-dispensing-related activities and non-over-the-counter medicine sales services, and those identified by the Australian Seventh Community Pharmacy Agreement (7CPA) as patient-centred services will be referred to as 'professional services'. 5 In Australian community pharmacies, PS such as vaccinations, Diabetes MedsCheck, Quality Use of Medicines Maximised for Aboriginal & Torres Strait Islander people and health check programmes are already offered.…”