A national study into the rural and remote pharmacist workforce

As for many health professionals, distance presents an enormous challenge to pharmacists working in rural and remote Australia. Previous studies have identified issues relating to the size of the rural and remote pharmacist workforce, and a number of national initiatives have been implemented to promote the recruitment and retention of pharmacists in rural and remote locations. The aim of this study was to explore and describe the current rural and remote pharmacy workforce, and to identify barriers and drivers influencing rural and remote pharmacy practice. A mixed-methods approach was used, which comprised a qualitative national consultation and a quantitative rural and remote pharmacist workforce survey. Semi-structured interviews (n=83) and focus groups (n=15, 143 participants) were conducted throughout Australia in 2009 with stakeholders with an interest in rural and remote pharmacy, practising rural/remote pharmacists and pharmacy educators, and as well as with peak pharmacy organizations, to explore the issues associated with rural/remote practice. Based on the findings of the qualitative work a 45-item survey was developed to further explore the relevance of the issues identified in the qualitative consultation. All registered Australian pharmacists practising in non-urban locations (RRMA 3-7, n=3,300) were identified and invited to participate in the study, with a response rate of 23.4%. The main themes identified from the qualitative consultation were the impact of national increases in the pharmacist workforce on rural/remote practice; the role of the regional pharmacy schools in contributing to the rural/remote workforce; and the perceptions of differences in pharmacist roles in rural/remote practice. The survey indicated that pharmacists practising in rural and remote locations were older than the national average (55.8 years versus 40 years). Differences in their professional role were seen in different pharmacy sectors, with hospital pharmacists spending significantly more time on the delivery of professional services and education and teaching, but less time on medication supply than community pharmacists. Rural/remote pharmacists were generally found to be satisfied with their current role. The main 'satisfiers' reported were task variety, customer appreciation, use of advanced skills, appropriate remuneration, happiness in their work location, sound relationships with other pharmacists, a happy team and relationships with other health professionals. This study described the distribution, roles and factors affecting rural and remote pharmacy practice. While the results presented provide an extensive overview of the rural/remote workforce, a comparable national study comparing rural/remote and urban pharmacists would further contribute to this discussion. Knowledge on why pharmacists chose to work in a particular geographical location, or why pharmacists chose to leave a location would further enrich our knowledge on what drives and sustains the rural/remote pharmacist workforce

Pharmacists in general practice: a qualitative interview case study of stakeholders’ experiences in a West London GP Federation

Background Increased patient demand for healthcare services coupled with a shortage of general practitioners necessitates changes in professional roles and service delivery. In 2016, NHS England began a three year pilot study of pharmacists in general practice, however, this is not an entirely new initiative. There is limited, current, evidence-based, UK research to inform the pilot so studies of pre-existing services must suffice until findings from a formal national evaluation are available. Methods The aim of this exploratory, descriptive interview study was to explore the experiences of stakeholders in eight general practices in the Ealing GP Federation, West London, where pharmacy services have been provided for several years. Forty-seven participants, including pharmacy team members (pre-registration and clinical pharmacists, independent prescribers and pharmacy technicians), general practitioners, patients, practice managers, practice nurses and receptionists took part in semi-structured, audio-recorded qualitative interviews which were transcribed verbatim, coded and analysed thematically to extract the issues raised by participants and the practicalities of providing pharmacy services in general practice. Results Findings are reported under the themes of Complementarity (incorporating roles, skills, education and workloads); Integration (incorporating relationships, trust and communication) and Practicalities (incorporating location and space, access, and costs). Participants reported the need for time to develop and understand the various roles, develop communication processes and build inter-professional trust. Once these were established, however, experiences were positive and included decreased workloads, increased patient safety, improved job satisfaction, improved patient relationships, and enhanced cost savings. Areas for improvement included patients’ awareness of services; pharmacists’ training; and regular, onsite access for practice staff to the pharmacy team. Conclusions Recommendations are made for the development of clear role definitions, identification of training needs, dedication of time for team building, production of educational materials for practice staff members and patients, and provision of on-site, full-time pharmacy services. Future work should focus on evaluation of various models of employing pharmacy teams in general practice; integration of pharmacists and pharmacy technicians into multidisciplinary general practice teams; relationships between local community pharmacy and general practice personnel and patients’ service and information needs. A formal national evaluation of the pilot scheme is overdue

Scholarly publishing depends on peer reviewers

The peer-review crisis is posing a risk to the scholarly peer-reviewed journal system. Journals have to ask many potential peer reviewers to obtain a minimum acceptable number of peers accepting reviewing a manuscript. Several solutions have been suggested to overcome this shortage. From reimbursing for the job, to eliminating pre- publication reviews, one cannot predict which is more dangerous for the future of scholarly publishing. And, why not acknowledging their contribution to the final version of the article published? PubMed created two categories of contributors: authors [AU] and collaborators [IR]. Why not a third category for the peer-reviewer

Scholarly publishing depends on peer reviewers

The peer-review crisis is posing a risk to the scholarly peer-reviewed journal system. Journals have to ask many potential peer reviewers to obtain a minimum acceptable number of peers accepting reviewing a manuscript. Several solutions have been suggested to overcome this shortage. From reimbursing for the job, to eliminating pre-publication reviews, one cannot predict which is more dangerous for the future of scholarly publishing. And, why not acknowledging their contribution to the final version of the article published? PubMed created two categories of contributors: authors [AU] and collaborators [IR]. Why not a third category for the peer-reviewer?Scopu

An introduction to how realist research can inform pharmacy practice and policy

Theory-driven implementation and evaluation of pharmacy services can enhance their contribution to overall healthcare. Most pharmacy practice programs and services will be adopted and modified during their implementation into various healthcare contexts and systems. Realist approaches to theory-driven evaluation consider these variations in programs, interventions and the contexts of their implementation and establish theories on how they work best, for whom and why. This chapter illustrates the practical application of the realist philosophy of science to pharmacy practice and health services research. Two case studies, a realist synthesis of existing literature on medication reviews and a realist review and evaluation related to medicines management, illustrate the practical application of the realist logic of analysis. Causative explanations generated by this approach enable policy makers in their decision-making and pharmacy practice researchers and practitioners to optimize service design