Pharmacists' Perspectives on Providing Chronic Disease Management Services in the Community — Part I: Current Practice Environment

Abstract

Background: Several practice models have been developed to support pharmacists in providing chronic disease management. However, most of these models have not been readily accepted by pharmacists, which has led to low uptake and short-term change. Methods: Pharmacists 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. Analysis of their discussions revealed 4 main themes: the current practice environment and the need for education about, remuneration for and a plan for the implementation of chronic disease management services. Participants cited several challenges to the provision of this type of care, as experienced in the current practice environment: time constraints; relationships with physicians, patients and employers; limited access to clinical information; and absence of a model for chronic disease management in pharmacy practice. However, these perceptions were not universal, and pharmacists with experience in this area described some of these commonly cited “challenges” (e.g., relationships with physicians) as enablers in their own practices. In addition, staff pharmacists, regional managers and owners often had differing opinions about the key challenges and the role of remuneration. Conclusion: Some of the perceived challenges to providing chronic disease management described by staff pharmacists were not consistently supported by employers or those with experience in this practice area. This observation suggests that the greatest challenge to developing a successful model of chronic disease management for pharmacists lies in pharmacists' own perceptions about their relationships with other health care providers and their own role as health care professionals. These issues must be addressed if the practice of pharmacy is to move forward.

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.…”

“…This indicates that pharmacists themselves may be less supportive of their role in advanced health care services such as CVD secondary prevention, which is consistent with the findings of previous studies. [18][19][20][21][23][24][25][26] Thus, beliefs and expectations of pharmacists themselves as well as GPs and clients should become a focus in the development of advanced pharmacy services.…”

“…[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

“…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]. Prescriptions volume, and number of pharmacists and dispensary assistants working were used in the current study to assess pharmacy workload.…”