A model for the financial assessment of professional services in community pharmacy: A systematic review

© 2019 American Pharmacists Association® Objectives: Limited studies have assessed the financial benefit of professional pharmacy services (PPSs) to the community pharmacy as a business. These studies are crucial in developing an insight into the long-term sustainability and broader implementation of services. We reviewed the literature to identify measures and indicators used to assess the financial performance of professional services in community pharmacy. Data sources: The literature search was undertaken in Pubmed and Scopus, and a gray literature search was performed in Google.com. References of the included papers were reviewed for other relevant studies. Study selection: Articles were reviewed against the following exclusion criteria: 1) literature reviews, 2) studies not reporting quantitative financial data from community pharmacy, 3) studies not assessing a PPS, 4) studies lacking a methodology for the measurement and assessment of financial outcomes, and 5) cost-effectiveness analysis, cost-utility analysis, or cost-benefit analysis studies. Data extraction: A piloted data extraction form was used. A selection of key data collected is as follows: 1) method of data collection and calculation, 2) currency, limitations for cost and revenue and method of data collection and method of calculation, 3) standardized currency value for the results reported, 4) professional services: number assessed, type of service, name of services, nature of services, implementation stage reported, financial result, the frequency of service, costs, sources of revenue, net total cost, net total revenue, break-even point, break-even price, net profit and loss. Results: The 21 studies included used different methodologies and indicators to financially assess PPSs. This has led to the development of a model for assessing PPSs composed of the key financial elements identified in this systematic review. Conclusion: From this review, we propose a model that provides a structured approach for pharmacists to manage the financial performance of services

Data-driven approach for tailoring facilitation strategies to overcome implementation barriers in community pharmacy

Background: Implementation research has delved into barriers to implementing change and interventions for the implementation of innovation in practice. There remains a gap, however, that fails to connect implementation barriers to the most effective implementation strategies and provide a more tailored approach during implementation. This study aimed to explore barriers for the implementation of professional services in community pharmacies and to predict the effectiveness of facilitation strategies to overcome implementation barriers using machine learning techniques. Methods: Six change facilitators facilitated a 2-year change programme aimed at implementing professional services across community pharmacies in Australia. A mixed methods approach was used where barriers were identified by change facilitators during the implementation study. Change facilitators trialled and recorded tailored facilitation strategies delivered to overcome identified barriers. Barriers were coded according to implementation factors derived from the Consolidated Framework for Implementation Research and the Theoretical Domains Framework. Tailored facilitation strategies were coded into 16 facilitation categories. To predict the effectiveness of these strategies, data mining with random forest was used to provide the highest level of accuracy. A predictive resolution percentage was established for each implementation strategy in relation to the barriers that were resolved by that particular strategy. Results: During the 2-year programme, 1131 barriers and facilitation strategies were recorded by change facilitators. The most frequently identified barriers were a ‘lack of ability to plan for change’, ‘lack of internal supporters for the change’, ‘lack of knowledge and experience’, ‘lack of monitoring and feedback’, ‘lack of individual alignment with the change’, ‘undefined change objectives’, ‘lack of objective feedback’ and ‘lack of time’. The random forest algorithm used was able to provide 96.9% prediction accuracy. The strategy category with the highest predicted resolution rate across the most number of implementation barriers was ‘to empower stakeholders to develop objectives and solve problems’. Conclusions: Results from this study have provided a better understanding of implementation barriers in community pharmacy and how data-driven approaches can be used to predict the effectiveness of facilitation strategies to overcome implementation barriers. Tailored facilitation strategies such as these can increase the rate of real-time implementation of innovations in healthcare, leading to an industry that can confidently and efficiently adapt to continuous change

Cost utility of a pharmacist‑led minor ailment service compared with usual pharmacist care

Background: A cluster randomised controlled trial (cRCT) performed from July 2018 to March 2019 demonstrated the clinical impact of a community pharmacist delivered minor ailment service (MAS) compared with usual phar‑ macist care (UC). MAS consisted of a technology-based face-to-face consultation delivered by trained community pharmacists. The consultation was guided by clinical pathways for assessment and management, and communica‑ tion systems, collaboratively agreed with general practitioners. MAS pharmacists were trained and provided monthly practice support by a practice change facilitator. The objective of this study was to assess the cost utility of MAS, compared to UC. Methods: Participants recruited were adult patients with symptoms suggestive of a minor ailment condition, from community pharmacies located in Western Sydney. Patients received MAS (intervention) or UC (control) and were followed-up by telephone 14-days following consultation with the pharmacist. A cost utility analysis was conducted alongside the cRCT. Transition probabilities and costs were directly derived from cRCT study data. Utility values were not available from the cRCT, hence we relied on utility values reported in the published literature which were used to calculate quality adjusted life years (QALYs), using the area under the curve method. A decision tree model was used to capture the decision problem, considering a societal perspective and a 14-day time horizon. Deterministic and probabilistic sensitivity analyses assessed robustness and uncertainty of results, respectively. Results: Patients (n=894) were recruited from 30 pharmacies and 82% (n=732) responded to follow-up. On aver‑ age, MAS was more costly but also more efective (in terms of symptom resolution and QALY gains) compared to UC. MAS patients (n=524) gained an additional 0.003 QALYs at an incremental cost of $7.14 (Australian dollars), com‑ pared to UC (n=370) which resulted in an ICER of$2277 (95% CI $681.49–3811.22) per QALY. Conclusion: Economic fndings suggest that implementation of MAS within the Australian context is cost efective. Trial registration Registered with Australian New Zealand Clinical Trials Registry (ANZCTR) and allocated the ACTRN: ACTRN12618000286246. Registered on 23 February 2018.Consumer Healthcare Products AustraliaAustralian Governmen

A holistic and integrated approach to implementing cognitive pharmaceutical services

La Farmacia Comunitaria forma parte del sistema de salud. Este sistema actualmente se encuentrasometido a presiones económicas y debe afrontar cambios en la demanda tanto de los consumidorescomo de los gobiernos. La respuesta de la profesión farmacéutica está dirigida a orientar su prácticahacia el paciente y a implantar servicios cognitivos farmacéuticos (CPS). En distintos países estosservicios tiene objetivos similares aunque presentan diferencias en el énfasis de los servicios, en susdefiniciones, denominaciones y en la utilización de diferentes herramientas. Sin embargo, todos ellospueden clasificarse utilizando un amplio modelo jerárquico que se basa en la toma de decisionesclínicas y en la amplitud del cambio requerido. (Box 1). Los retos que debe afrontar la profesión estánrelacionados con el desarrollo de un nuevo modelo de farmacia orientado al paciente que afecta a laspolíticas de salud, a la formación e investigación, a la evolución de los mercados, a los abordajes delcambio tanto a nivel individual como organizacional, y a la implantación de CPS. Estos temas y lainvestigación en práctica farmacéutica que se ha venido realizando con anterioridad han sidosintetizados para proporcionar una plataforma para el cambio que pueda guiar un planteamientoholístico e integrado de implantación de CPS. Conceptualmente la implantación de CPS puedeenmarcarse en seis niveles: clínico, provisión de servicios, farmacia comunitaria, organizaciónprofesional, gobierno y agentes implicados (Figura 1). La experiencia reciente relacionada con laimplantación de servicios ha mostrado la aplicación de programas de implantación que han incluidouno o dos de estos niveles en lugar de haber utilizado un abordaje holístico. Por ello se ha desarrolladoun modelo concéntrico para ilustrar la implantación de CPS dentro del planteamiento integrado yholístico necesario para apoyar el cambio En España se ha desarrollado un programa (conSIGUE) quepretende integrar los seis niveles con el objetivo de apoyar la implantación y evaluación de un CPS, elservicio de seguimiento farmacoterapéutico.Community pharmacy is part of the health care system which is currently under economic pressureand facing changes in demands from consumers and government. In response, the pharmacy profession is becoming more patient orientated and implementing cognitive pharmaceutical services(CPS). CPS in various countries has similar objectives with different emphasis, definitions, labels andusing different tools. However, they can be classified using a broad hierarchical model based onclinical decision making and the extent of change required (Box 1). The challenges faced by theprofession are related the development of a new patient orientated model of pharmacy which affectshealth care policy, education and research, the evolution of the market, the individual andorganisational approaches to change and the implementation of CPS. These issues and previousresearch conducted in pharmacy practice have been synthesised to provide a platform for change thatcan guide a holistic and integrated approach to CPS implementation. Implementation can beconceptually framed in six levels: clinical, service provision, community pharmacy, professionalorganisation, government and stakeholder (Figure 1). Past experience with service implementation hasseen the application of programs that include one or two of these levels in practice rather than aholistic approach. A concentric model was developed to illustrate the implementation of CPS and theholistic and integrated approach required to support change. A program (conSIGUE) being conductedin Spain has attempted to integrate all six levels to support the implementation and evaluation of amedication management service (Seguimiento Farmacoterapéutico

Community pharmacists' opinions of their role in administering non-prescription medicines in an emergency

Objective: To obtain community pharmacists’ opinions of their role in administering Pharmacy (S2) and Pharmacist Only (S3) Medicines in a medical emergency. These medicines can only be sold in a pharmacy and are not available for self-selection by patients. Whilst qualified pharmacy assistants can supply S2 medicines, pharmacists must be directly involved in the supply of S3 medicines. Setting: Community pharmacies in South East Queensland, Australia. Method: A survey of 151 Gold Coast and Toowoomba community pharmacists was conducted during October 2009. Main outcome measures: Pharmacists were asked their opinions as to whether the administration of S2 and S3 medicines should fall within their scope of practice, whether they had administered S2 and S3 medicines in a medical emergency in the past and if clarification of this role was required. Results: The study achieved a 30% (n = 45) response rate and demonstrated similar results regarding whether pharmacists should administer salbutamol (22/44), adrenaline (23/42), glyceryl trinitrate (22/43) and aspirin (18/36) in a medical emergency. The majority (36/43) believed that role clarification was required. Pharmacists were more likely to administer an S3 medicine in a medical emergency when they considered potential outcomes first, had no easy access to a doctor and the patient could not administer the medicine they carried with them themselves (40/45).Conclusion: Community pharmacists have direct access to S2 and S3 medicines that could be required in the management of a variety of medical emergencies. This study demonstrates that some pharmacists have administered S2 and S3 medicines in an emergency situation. However, there are currently no clear guidelines for pharmacists when faced with a medical emergency other than to act within their professional competence. To promote patient safety through the appropriate use of S2 and S3 medicines in the event of a medical emergency, additional training of pharmacists on the administration of these readily accessible medicines is needed. Clarification of the role of pharmacists in an emergency situation is required

From "retailers" to health care providers: Transforming the role of community pharmacists in chronic disease management

© 2015. Community pharmacists are the third largest healthcare professional group in the world after physicians and nurses. Despite their considerable training, community pharmacists are the only health professionals who are not primarily rewarded for delivering health care and hence are under-utilized as public health professionals. An emerging consensus among academics, professional organizations, and policymakers is that community pharmacists, who work outside of hospital settings, should adopt an expanded role in order to contribute to the safe, effective, and efficient use of drugs-particularly when caring for people with multiple chronic conditions. Community pharmacists could help to improve health by reducing drug-related adverse events and promoting better medication adherence, which in turn may help in reducing unnecessary provider visits, hospitalizations, and readmissions while strengthening integrated primary care delivery across the health system. This paper reviews recent strategies to expand the role of community pharmacists in Australia, Canada, England, the Netherlands, Scotland, and the United States. The developments achieved or under way in these countries carry lessons for policymakers world-wide, where progress thus far in expanding the role of community pharmacists has been more limited. Future policies should focus on effectively integrating community pharmacists into primary care; developing a shared vision for different levels of pharmacist services; and devising new incentive mechanisms for improving quality and outcomes

Progress in patient couselling practices in Finnish community pharmacies

Access restricted by publisherObjective The aim of this study was to assess progress in patient counselling practices in Finnish community pharmacies during a national four-year program (TIPPA) from 2000–2003 promoting enhanced pharmacist–customer communication about medicines. Method A pseudo customer method was applied. Four visits with four different scenarios were conducted in a convenience sample of 60 Finnish community pharmacies of different size and geographic location. In total there were 240 visits during each time point measured (baseline in 2000 and three annual follow-ups, n = 960). The pseudo customers presented three scenarios related to self-medication and one related to a prescription medicine with a new prescription (baseline and the second follow-up) or a repeat prescription of the same medication (the first and the third follow-up). A structured data form customised to each scenario was used to record the interaction. Key findings Baseline scores were generally low. In two of the four scenarios (one self-medication and one prescription) a statistically significant improvement (P < 0.05) was found in total scores between the baseline and the third follow-up. Aggregation of the scores of the three self-medication scenarios did not show any change in counselling practices between the baseline and the third follow-up, measured as mean total scores (P = 0.439). Conclusions Some improvements were found in pharmacists' counselling performance in relation to customers' requests for advice about nasal products and also when prescription scenarios were presented. However, pharmacists' counselling rates were low in relation to a repeat prescription or when a request was made to buy a specific medicine. Further attention needs to be paid to the latter two types of consultation

Systematic Review and Meta-Analysis of Medication Reviews Conducted by Pharmacists on Cardiovascular Diseases Risk Factors in Ambulatory Care

Background Pharmacists-led medication reviews (MRs) are claimed to be effective for the control of cardiovascular diseases; however, the evidence in the literature is conflicting. The main objective of this meta-analysis was to analyze the impact of pharmacist-led MRs on cardiovascular disease risk factors overall and in different ambulatory settings while exploring the effects of different components of MRs. Methods and Results Searches were conducted in PubMed, Web of Science, Embase, the Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library Central Register of Controlled Trials database. Randomized and cluster randomized controlled trials of pharmacist-led MRs compared with usual care were included. Settings were community pharmacies and ambulatory clinics. The classification used for MRs was the Pharmaceutical Care Network Europe as basic (type 1), intermediate (type 2), and advanced (type 3). Meta-analyses in therapeutic goals used odds ratios to standardize the effect of each study, and for continuous data (eg, systolic blood pressure) raw differences were calculated using baseline and final values, with 95% CIs. Prediction intervals were calculated to account for heterogeneity. Sensitivity analyses were conducted to test the robustness of results. Meta-analyses included 69 studies with a total of 11 644 patients. Sample demographic characteristics were similar between studies. MRs increased control of hypertension (odds ratio, 2.73; 95% prediction interval, 1.05-7.08), type 2 diabetes mellitus (odds ratio, 3.11; 95% prediction interval, 1.17-5.88), and high cholesterol (odds ratio, 1.91; 95% prediction interval, 1.05-3.46). In ambulatory clinics, MRs produced significant effects in control of diabetes mellitus and cholesterol. For community pharmacies, systolic blood pressure and low-density lipoprotein values decreased significantly. Advanced MRs had larger effects than intermediate MRs in diabetes mellitus and dyslipidemia outcomes. Most intervention components had no significant effect on clinical outcomes and were often poorly described. CIs were significant in all analyses but prediction intervals were not in continuous clinical outcomes, with high heterogeneity present. Conclusions Intermediate and advanced MRs provided by pharmacists may improve control of blood pressure, cholesterol, and type 2 diabetes mellitus, as statistically significant prediction intervals were found. However, most continuous clinical outcomes failed to achieve statistical significance, with high heterogeneity present, although positive trends and effect sizes were found. Studies should use a standardized method for MRs to diminish sources of these heterogeneities

Evaluation of a collaborative protocolized approach by community pharmacies and general medical practitioners for an Australian minor ailments scheme: study protocol for a cluster-randomized controlled trial (Preprint)

BACKGROUND Internationally, governments have been investing in supporting pharmacists to take on an expanded role to support self-care for health system efficiency. There is consistent evidence that minor ailment schemes (MAS) promote efficiencies within the healthcare system. The cost savings and health outcomes demonstrated in the UK and Canada opens up new opportunities for pharmacists to effect sustainable changes through MAS delivery in Australia. OBJECTIVE This trial is evaluating the clinical, economic and humanistic impact of an Australian minor ailments service (AMAS), compared with usual pharmacy care in a cluster-randomized controlled trial in Western Sydney, Australia. METHODS The cluster-randomized controlled trial design has an intervention and a control group, comparing individuals receiving a structured intervention with those receiving usual care for specific common ailments. Participants will be community pharmacies, general practices and patients located in Western Sydney Primary Health Network region. 30 community pharmacies will be randomly assigned to either intervention or control group. Each will recruit 24 patients seeking, aged 18 years or older, presenting to the pharmacy in person with a symptom-based or product-based request for one of the following ailments (reflux, cough, common cold, headache (tension or migraine), primary dysmenorrhoea and low back pain). Intervention pharmacists will deliver protocolized care to patients using clinical treatment pathways with agreed referral points and collaborative systems boosting clinician-pharmacist communication. Patients recruited in control pharmacies will receive usual care. The co-primary outcomes are rates of appropriate use of nonprescription medicines and rates of appropriate medical referral. Secondary outcomes include self-reported symptom resolution, time to resolution of symptoms, health services resource utilization and EQ VAS. Differences in the primary outcomes between groups will be analyzed at the individual patient level accounting for correlation within clusters with generalized estimating equations. The economic impact of the model will be evaluated by cost analysis compared with usual care. RESULTS The study began in July 2018. At the time of submission, 30 community pharmacies have been recruited. Pharmacists from the 15 intervention pharmacies have been trained. 27 general practices have consented. Pharmacy patient recruitment began in August 2018 and is ongoing and monthly targets are being met. Recruitment will be completed March 31st, 2019. CONCLUSIONS This study may demonstrate the utilization and efficacy of a protocolized intervention to manage minor ailments in the community, and will assess the clinical, economic and humanistic impact of this intervention in Australian pharmacy practice. Pharmacists supporting patient self-care and self-medication may contribute greater efficiency of healthcare resources and integration of self-care in the health system. The proposed model and developed educational content may form the basis of a MAS national service, with protocolized care for common ailments using a robust framework for management and referral. CLINICALTRIAL Registered with Australian New Zealand Clinical Trials Registry (ANZCTR) and allocated the ACTRN: ACTRN12618000286246. Registered on 23 February 2018. </sec

Serviços Farmacêuticos em Doentes com Insuficiência Renal Crónica

O papel dos farmacêuticos na assistência a doentes com insuficiência renal crónica tem sido documentado na literatura internacional e este estudo teve como objetivo compilar os serviços farmacêuticos prestados para que possam vir a ser considerados para eventual adaptação à realidade Portuguesa.Conduziu-se uma busca nas fontes secundárias Medline, International Pharmaceutical Abstracts, Pharmacy Abstracts e The Cochrane Library para recolher estudos descrevendo intervenções farmacêuticas em doentes com insuficiência renal crónica. No final, e após aplicação dos critérios de inclusão e exclusão, foram incluídos e analisados 37 estudos (correspondendo a 38 artigos). As intervenções farmacêuticas reportadas nos estudos foram: revisão do perfil farmacoterapêutico para identificação de problemas relacionados com a medicação, ajuste e otimização da terapêutica, identificação e correção de discrepâncias nos processos clínicos, avaliação da adequação da terapêutica durante a admissão e alta hospitalares, monitorização de parâmetros laboratoriais, implementação de protocolos de atuação na anemia, hiperparatiroidismo secundário, e hiperlipidemia, educação dos doentes, promoção da adesão à terapêutica, participação nas visitas médicas e reuniões multidisciplinares, comunicação e interação com outros profissionais de saúde, e fornecimento de informação sobre a escolha de fármacos e regimes terapêuticos.Em conclusão, a análise da literatura internacional revelou uma multiplicidade de potenciais intervenções farmacêuticas em doentes com insuficiência renal crónica que evidenciam o potencial de atuação do farmacêutico no processo de uso de medicamentos destes doentes e na melhoria dos resultados clínicos.The role of pharmacists caring for patients with chronic kidney disease has been documented in the international literature. This study aims at compiling all pharmaceutical services provided to these patients in order to adapt them to the Portuguese reality. Medline, International Pharmaceutical Abstracts, Pharmacy Abstracts and The Cochrane Library were searched for studies describing pharmacist interventions in patients with chronic kidney disease. Ultimately, and after applying the inclusion and exclusion criteria, 37 studies (corresponding to 38 articles) were included and analysed. Pharmacist interventions reported were: performing medication reviews to identify drug-related problems, adjusting and optimising drug therapy, identifying and correcting drug records discrepancies, evaluating admission and discharge medication appropriateness, performing laboratory monitoring of specific parameters, implementing anaemia-managing, phosphate-managing and lipid-managing protocols, performing patient education, improving compliance, participating in medical rounds and multidisciplinary patient care meetings, communicating and interacting with other health care professionals, and providing information about drug selection and therapeutic regimes. In conclusion, a multitude of potential pharmacist interventions in patients with chronic kidney disease was reported in the literature, where pharmacists played a key role in contributing to improve the process of use of medicines and clinical outcomes in these patients.