Pharmacists' Perspectives on Providing Chronic Disease Management Services in the Community — Part II: Development and Implementation of Services

Abstract

Background: The need for alternative methods of providing primary care and chronic disease management (CDM) is becoming more urgent. To understand pharmacists' role in this changing health care system, we must better understand their desire and capacity to provide these services. Methods: Key stakeholders from all facets of pharmacy practice were recruited to participate in focus groups held in Alberta and British Columbia. Qualitative methodologies involving a phenomenological approach with content analysis were used to gather and analyze information. Results: In total, 36 pharmacists participated in 8 focus groups to identify enablers and challenges to the provision of CDM (reported in Part I). The topic of how such services could be implemented in the community developed naturally from these discussions. Participants expressed a need for changes to both the physical layout of pharmacies (to incorporate private counselling spaces) and the documentation and information systems used (to improve communication and continuity of care). Furthermore, the intentions of both pharmacists and employers must be communicated effectively to all parties, including patients. Participants also identified an alternative remuneration model as being essential, to allow adequate time for provision of CDM services and to ensure that current high-quality dispensing practices can be continued. Conclusion: Pharmacists have a tremendous opportunity to change practice and to contribute more to patient care. To guide and implement such change will require that pharmacists restructure their physical and information environments, strengthen their relationships with key stakeholders and develop a sustainable model of practice that includes the needs of the business, the client (patient) and the pharmacist.

An explanatory model of community pharmacists' support in the secondary prevention of cardiovascular disease

“…client health outcomes, job satisfaction, and pharmacy investment). 57 Although the study 57 produced results which corroborate the findings of previous research exploring factors influencing community pharmacists' delivery of clinical services in general, [5][6][7][8][9][10][11][12][13][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][35][36][37] little is known about the extent to which these factors affect community pharmacists' activities in CVD secondary prevention. Therefore, the objectives of the current study were to determine how: (1) pharmacists' attitudes to delivering CVD support and (2) environmental factors, influence the provision of CVD care in the community pharmacy setting.…”

“…[5][6][7][8][9][10][11][12][13][14][15][16] In the context of community pharmacy, good relationships with general practitioners (GPs) and other health care professionals, high patient expectation, the availability of remuneration, appropriate pharmacy infrastructure, adequate staff, as well as external support and assistance from other pharmacists, professional organizations and the government have been identified as essential to the practice change implementation. [5][6][7][8][9][10][11][12][13]15,16 Because pharmacists' attitudes toward community pharmacy practice change have also been reported as key influences, [17][18][19][20][21][22][23][24][25][26][27] behavioral theories such as the Theory of Reasoned Action, the Theory of Planned Behavior (TPB), the Theory of Trying and the Theory of Goal-Directed Behavior have been applied as frameworks in pharmacy practice research. [28][29][30][31][32][33][34][35][36][37]…”

“…6,12,16,17,19,22,[40][41][42][43] These findings have highlighted the need for appropriate and relevant training and continuing pharmacy education for community pharmacists. 6,12,16,17,21,24,[40][41][42][43] The TPB "subjective norm" construct may be defined as pharmacists' perceptions of others' beliefs about their behaviors. 28,29,[31][32][33][34][35][36][37] This could include beliefs of patients, GPs, pharmacy managers, colleagues, professional organizations, and the government of pharmacists performing clinical services.…”

The influence of pharmacy and pharmacist characteristics on the secondary prevention of cardiovascular disease

“…It should be noted, however, that three of four types of EPS listed on the survey were government funded programs, so the pharmacist is reimbursed for these services. Support from the government in the form of structured programs and remuneration might be essential to motivate community pharmacists to implement EPS [30][31][32][33], which in turn [18]. Negative attitudes among pharmacists' towards a role in EPS provision may be a greater barrier to provision than lack of remuneration [7,[33][34][35][36][37][38][39].…”

“…The literature has shown that components of successful advanced healthcare support within pharmaceutical care practices include philosophy of practice, patient care process, management systems, and clinical knowledge [31,33]. Looking at predictors of EPS provision described above, they could be regarded as elements of ''management systems'' and ''clinical knowledge'' [33].…”