Mapping the terrain: A conceptual schema for a mental health medication support service in community pharmacy

Objective: Mental health–related problems pose a serious issue for primary care, and community pharmacy could make a significant contribution, but there is a dearth of information. Methods: This article reports synthesis of the literature on mental health interventions across a range of pharmacy models, and pharmacy services in contexts beyond mental health. To best inform the design of a community pharmacy medication support intervention for mental health consumers, the literature was reported as a conceptual schema and subsequent recommendations for development, implementation and evaluation of the service. A broad conceptualisation was taken in this review. In addition to mental health and community pharmacy literature, policy/initiatives, organisational culture and change management principles, and evaluative processes were reviewed. Key words were selected and literature reviews undertaken using EMBASE, PubMed, CINAHL and Web of Science. Results: Recommendations were made around: medication support intervention design, consumer recruitment, implementation in community pharmacy and evaluation. Surprisingly, there is a scarce literature relating to mental health interventions in community pharmacy. Even so, findings from other pharmacy models and broader medicines management for chronic illness can inform development of a medication support service for mental health consumers. Key learnings include the need to expand medicines management beyond adherence with respect to both intervention design and evaluation. Conclusion: The conceptual framework is grounded in the need for programmes to be embedded within pharmacies that are part of the health system as a whole

Issues with medication supply and management in a rural community in Queensland

Objective: To identify the key issues reported by rural health-care providers in their provision of medication supply and related cognitive services, and in order to advise health workforce and role development and thus improve the quality use of medicines in rural communities. Design: Exploratory semistructured interview research. Setting: A rural community comprising four towns in a rural health service district in Queensland, Australia. Participants: Forty-nine health-care providers (medical practitioners, pharmacists, nurses and others) with medication-related roles who serviced the study community, identified through databases and local contacts. Main outcome measures: Medication-related roles undertaken by the health-care providers, focusing on medication supply and cognitive services; challenges in undertaking these roles. Results: Medical and nursing providers reported challenges in ensuring continuity in supply of medications due to their existing medical workload demands. Local pharmacists were largely involved in medication supply, with limited capacity for extended cognitive roles. Participants identified a lack of support for their medication roles and the potential value of clinically focused pharmacists in medication management services. Conclusions: Medication supply may become more efficient with extended roles for certain health-care providers. The need for cognitive medication management services suggests potential for clinical pharmacists' role development in rural areas. © 2012 The Authors. Australian Journal of Rural Healt

Future-proofing the pharmacy profession in a hypercompetitive market

This paper highlights the hypercompetitive nature of the current pharmacy landscape in Australia and to suggest either a superior level of differentiation strategy or a focused differentiation strategy targeting a niche market as two viable, alternative business models to cost leadership for small, independent community pharmacies. A description of the Australian health care system is provided as well as background information on the current community pharmacy environment in Australia. The authors propose a differentiation or focused differentiation strategy based on cognitive professional services (CPS) which must be executed well and of a superior quality to competitors' services. Market research to determine the services valued by target customers and that they are willing to pay for is vital. To achieve the superior level of quality that will engender high patient satisfaction levels and loyalty, pharmacy owners and managers need to develop, maintain and clearly communicate service quality specifications to the staff delivering these services. Otherwise, there will be a proliferation of pharmacies offering the same professional services with no evident service differential. However, to sustain competitive advantage over the long-term, these smaller, independent community pharmacies will need to exploit a broad core competency base in order to be able to continuously introduce new sources of competitive advantage. With the right expertise, the authors argue that smaller, independent community pharmacies can successfully deliver CPS and sustain profitability in a hypercompetitive market. (C) 2014 Elsevier Inc. All rights reserved

A review of the medication pathway in rural Queensland, Australia

Objectives: It is well established that rural areas have compromised access to health services, including medication services. This paper reviews the practice developments for rural health professionals in relation to medication processes, with a focus on regulatory provisions in Queensland, Australia, and a view to identifying opportunities for enhanced pharmacy involvement. Methods: Literature referring to ‘medication/medicine’, ‘rural/remote’, ‘Australia’ and ‘pharmacy/pharmacist/pharmaceutical’ was identified via EBSCOhost, Ovid, Informit, Pubmed, Embase and The Cochrane Library. Australian Government reports and conference proceedings were sourced from relevant websites. Legislative and policy documents reviewed include drugs and poisons legislation, the National Medicines Policy and the Australian Pharmaceutical Advisory Council guidelines. Key findings: The following developments enhance access to medication services in rural Queensland: (1) endorsement of various non-medical prescribers, (2) authorisation of registered nurses, midwives, paramedics and Indigenous health workers to supply medications in sites without pharmacists, (3) skill-mixing of nursing staff in rural areas to ease medication administration tasks, (4) establishment of pharmacist-mediated medication review services, (5) electronic transfer of medical orders or prescriptions and (6) enhanced transfer of medication information between metropolitan and rural, and public and private facilities.Conclusions: This review identified a divide between medication access and medication management services. Initiatives aiming to improve supply of (access to) medications focus on scopes of practice and endorsements for non-pharmacist rural healthcare providers. Medication management remains the domain of pharmacists, and is less well addressed by current initiatives. Pharmacists' involvement in rural communities could be enhanced through tele-pharmacy, outreach support and sessional support