Macmillan Rural Palliative Care Pharmacist Practitioner Project : Baseline Report 2013

The University of Strathclyde is funded to provide academic input into the NHS Highland project for 2 years (starting February 2013). The project is to be a demonstration project to inform national policy and will have direct relevance to the new proposal on the delivery of pharmacy services within NHS Scotland, ‘Prescription for Excellence’ (8). This opportunity gives NHS Highland access to the expertise developed through the previous Glasgow program and allows the University team to develop the evidence base for clinical practice within this area, and focus on developing rural pharmaceutical care capacity through the use of a community pharmacy - based practitioner

Development and psychometric testing of an instrument to measure safety climate perceptions in community pharmacy

A positive and strong safety culture underpins effective learning from patient safety incidents in health care, including the community pharmacy (CP) setting. To build this culture, perceptions of safety climate must be measured with context-specific and reliable instruments. No pre-existing instruments were specifically designed or suitable for CP within Scotland. We therefore aimed to develop a psychometrically sound instrument to measure perceptions of safety climate within Scottish CPs.  The first stage, development of a preliminary instrument, comprised three steps: (i) a literature review; (ii) focus group feedback; and (iii) content validation. The second stage, psychometric testing, consisted of three further steps: (iv) a pilot survey; (v) a survey of all CP staff within a single health board in NHS Scotland; and (vi) application of statistical methods, including principal components analysis and calculation of Cronbach's reliability coefficients, to derive the final instrument.  The preliminary questionnaire was developed through a process of literature review and feedback. This questionnaire was completed by staff in 50 CPs from the 131 (38%) sampled. 250 completed questionnaires were suitable for analysis. Psychometric evaluation resulted in a 30-item instrument with five positively correlated safety climate factors: leadership, teamwork, safety systems, communication and working conditions. Reliability coefficients were satisfactory for the safety climate factors (α > 0.7) and overall (α = 0.93).  The robust nature of the technical design and testing process has resulted in the development of an instrument with sufficient psychometric properties, which can be implemented in the community pharmacy setting in NHS Scotland

Identifying the important outcomes to measure for pharmacy-led, clinical services within primary care : a nominal group technique approach

Background The introduction of clinical pharmacy services is part of a multi-disciplinary approach to reduce pressure on primary care. Ascertaining the impact of clinical pharmacists in general practice is vital to ensure intended benefits are achieved. However, this is complicated by poor quality evidence, multiple interventions, and a lack of agreement regarding outcome measures. Objectives To develop an outcomes framework for clinical pharmacy services delivered in Scottish general practice using a consensus methodology. Methods A modified nominal group technique (NGT) was conducted using Microsoft Teams and Qualtrics. This involved a pre-NGT questionnaire, silent generation of ideas, round robin, discussions, ranking, and a final consensus exercise. A selective sampling strategy recruited experienced pharmacists from Scottish health regions. NGT ranking results were used to signify relative importance of the outcome areas. NGT discussions underwent inductive thematic analysis to explore key areas considered. Result Overall, 13 (median: 24 years of experience) pharmacists participated, representing 11 of 14 Scottish regions. In total, 21 outcome areas, derived from the literature and a pre-NGT questionnaire, were considered during the NGT ranking exercise. Consensus identified five important outcome areas: Patient Experience, Medication Related Adverse Events, Cost-Effectiveness, Medication Optimisation, and Health Related Quality of Life. Thematic analysis highlighted the importance of the outcome framework's target audience, factors influencing the interpretation of outcomes, and the feasibility of the associated outcome measures. Conclusions The five key outcome areas will facilitate evidence-based decisions regarding service delivery. Future work should develop a measurement plan, involving routinely collected sources of outcomes data. The feasibility of collecting outcomes in the real-world context should be considered, identifying measures which are easy to collect within existing data infrastructures. This paper describes a replicable method to gain consensus for a national approach to data collection from a strong theoretical basis using an online methodology

A mixed-method study of community pharmacy staff's use, perceptions and acceptance of barcode scanning technology : pharmacy's experience of scanning technology

Introduction Increasing technology is a strategic goal within pharmacy to facilitate medicines' dispensing. Barcode scanning technology (BST) is considered low cost and reliable with potential safety benefits. A barrier to BST implementation within hospital pharmacy includes staff resistance; however, few studies explore BST within community pharmacy. To address this, pharmacy staff's use, perceptions and acceptance of BST within Scottish community pharmacies were examined. Methods Community pharmacies within Scotland using BST to scan medicines were identified using Twitter, eNewsletters and snowball sampling; 57 pharmacies were identified. Between May-Aug 2019, managers/owners participated in semi-structured interviews to explore BST use, and staff operating BST completed an online questionnaire to examine perceptions and acceptance. Interview data underwent content analysis and questionnaire data presented as medians (IQR). Results BST was used for various purposes, most commonly for dispensed item verification (n = 43 pharmacies) and to identify falsified medicines (n = 10 pharmacies). Twenty pharmacy managers/owners were interviewed which revealed multiple scanners and BST functionalities. Thirty-five participants from 16 pharmacies participated in the questionnaire. Staff considered BST as easy to use. There were positive perceptions and acceptance of BST for dispensed item verification, and negative perceptions and less acceptance of BST for identifying falsified medicines. Discussion BST implementation was identified in a minority of Scotland's 1,254 community pharmacies, and greater effort may be needed to increase technology utilisation. The variation of BST use may affect safety due to increased complexity. BST's purpose may underpin staff perceptions and acceptance. Future studies should explore barriers and observe BST use in practice. Public interest summary Barcode scanning technology (BST) may help pharmacy staff to dispense medicines safely. Hospital pharmacy staff have reported disliking using BST to scan medicines; however, no similar research has been carried out within community pharmacy. This study examined Scottish community pharmacies’ use of BST to scan medicines, and the pharmacy staff's views. Fifty-seven pharmacies were identified. BST was most commonly used to verify that the correct medicine was selected during dispensing (n = 43 pharmacies) and to identify 'falsified medicines' which were not safe to dispense (n = 10 pharmacies). Staff considered BST as easy to use, but were more positive and accepting of BST for verifying the correct medicine than for identifying falsified medicines. This suggests BST's purpose may underpin pharmacy staff perceptions and acceptance. A small number of pharmacies in Scotland used BST for this purpose, therefore more efforts may be needed to promote technology use

Factors influencing national implementation of innovations within community pharmacy : a systematic review applying the consolidated framework for implementation research

Background: To meet emergent healthcare needs, innovations need to be implemented into routine clinical practice. Community pharmacy is increasingly considered a setting through which innovations can be implemented to achieve positive service and clinical outcomes. Small-scale pilot programmes often need scaled up nation-wide to affect population level change. This systematic review aims to identify facilitators and barriers to the national implementation of community pharmacy innovations. Methods: A systematic review exploring pharmacy staff perspectives of the barriers and facilitators to implementing innovations at a national level was conducted. The databases Medline, EMBASE, PsycINFO, CINAHL, and Open Grey were searched and supplemented with additional search mechanisms such as Zetoc alerts. Eligible studies underwent quality assessment, and a directed content analysis approach to data extraction was conducted and aligned to the Consolidated Framework for Implementation Research (CFIR) to facilitate narrative synthesis. Results: Thirty-nine studies were included: 16 were qualitative, 21 applied a questionnaire design, and 2 were mixed methods. Overarching thematic areas spanning across the CFIR domains were pharmacy staff engagement (e.g. their positive and negative perceptions), operationalisation of innovations (e.g. insufficient resources and training), and external engagement (e.g. the perceptions of patients and other healthcare professionals, and their relationship with the community pharmacy). Study participants commonly suggested improvements in the training offered, in the engagement strategies adopted, and in the design and quality of innovations. Conclusions: This study's focus on national innovations resulted in high-level recommendations to facilitate the development of successful national implementation strategies. These include (1) more robust piloting of innovations, (2) improved engagement strategies to increase awareness and acceptance of innovations, (3) promoting whole-team involvement within pharmacies to overcome time constraints, and (4) sufficient pre-implementation evaluation to gauge acceptance and appropriateness of innovations within real-world settings. The findings highlight the international challenge of balancing the professional, clinical, and commercial obligations within community pharmacy practice. A preliminary theory of how salient factors influence national implementation in the community pharmacy setting has been developed, with further research necessary to understand how the influence of these factors may differ within varying contexts. Trial registration: A protocol for this systematic review was developed and uploaded onto the PROSPERO international prospective register of systematic reviews database (Registration number: CRD42016038876)

Pharmacist and patient perspectives on the use of video consultations in primary care pharmacy in Scotland

Although over 80% of patients and 94% of healthcare professionals feel video consultations should be offered for healthcare appointments, use in pharmacy has been limited both before and during the COVID-19 pandemic (1, 3). Human Factors is the study of the interactions between humans, the tools and technologies they use and the complex environments in which they work (4). Applying human factors can assist in understanding the influence that each component of a system has on the use of video consultations. The aim of this study was to understand the factors influencing patients' and community and general practice pharmacists' use of video consultations (VCs), using a human factors approach

Implementation of pharmacist-led services in primary care : a mixed-methods exploration of pharmacists' perceptions of a national educational resource package

Background: To help alleviate the global pressure on primary care, there has been an increase in the number of clinical pharmacists within primary care. Educational resources are necessary to support this workforce and their development within this role. An educational resource package was developed in Scotland to support the General Practice Clinical Pharmacists (GPCPs), containing a hard copy Competency and Capability Framework (CCF), an online platform (TURAS) and both clinical and educational supervisors in 2016. Objective: To examine the implementation of a competency-based educational resource package through the exploration of pharmacists’ perceptions of its adoption, acceptability, appropriateness, and feasibility. Methods: Participants were GPCPs who had been part of a national training event between 2016 and 2018. The participants were given the opportunity to complete an online questionnaire or a semi-structured telephone interview. Both data collection tools were based on Proctor’s model of implementation outcomes: adoption, acceptability, appropriateness and feasibility. Areas covered included GPCPs’ perceptions and level of adoption of the educational resource package developed to support them in their role. Results: Of a potential 164 participants, 52 (31.7%) completed the questionnaire and 12 (7.3%) completed the interview. GPCPs indicated widespread adoption and were accepting of the resources; however, it was suggested that its value was undermined, as it was not associated with a qualification. The appropriateness and feasibility of the resources depended on GPCPs’ individual situation (including current role, previous job experience, time available, support received from peers and supervisors, and perceptions of resources available). Conclusions: The suitability of the CCF was evidenced by participants’ adoption and acceptance of the resource, indicating the necessity of a competence-based framework to support the GPCPs’ role. However, its suitability was hindered in terms of varied perceptions of appropriateness and feasibility. Despite the limited sample size, the results indicate that the value of these resources should be promoted across primary care; nevertheless further facilitation is required to allow GPCPs to fully engage with the resources

Competencies required for general practice clinical pharmacists providing the Scottish pharmacotherapy service : a modified eDelphi study

Due to work load pressures in primary care, increasing efforts are being made internationally to implement pharmacists working alongside general practitioners. While there is wide interest in the contributions pharmacists can make within primary care, there is limited research which explores the competencies pharmacists need to safely and effectively provide care in this arena. Therefore, a modified eDelphi study was conducted between July 2019 and January 2020 among pharmacists working in General Practice in Scotland in order to a) generate a list of competencies required to undertake pharmacotherapy tasks within General Practice using content analysis; and b) establish consensus regarding the importance of these competencies using a rating scale ranging from 1 (“not important”) to 10 (“very important”). A framework of competencies was developed, containing eight competency categories with a total of 31 individual competency items. Overall, study participants considered all eight competency categories as being important, with a mode of 10 and a median > 8; agreement among participants was high, with the majority of individual competency items rated 8 or above by more than 75% of participants. There was, however, variation in responses with regards to specific tasks such as medicines reconciliation and medication compliance reviews. Findings indicate that the GP setting requires a broad set of competencies – covering areas including the use of IT systems; clinical knowledge; and communicating with patients and other health care professionals. This implies that further emphasis on clinical and consultation skills should be added to training programmes aimed at GP pharmacists; furthermore, ongoing support is also needed with regards to generic skills such as the use of IT systems, documentation, and general procedures and processes within primary care, some of which might need to be tailored to the specific practice context

Pharmacist and patient perspectives on the use of video consultations in primary care pharmacy in Scotland

Although over 80% of patients and 94% of healthcare professionals feel video consultations should be offered for healthcare appointments, use in pharmacy has been limited both before and during the COVID-19 pandemic (1, 3). Human Factors is the study of the interactions between humans, the tools and technologies they use and the complex environments in which they work (4). Applying human factors can assist in understanding the influence that each component of a system has on the use of video consultations. The aim of this study was to understand the factors influencing patients' and community and general practice pharmacists' use of video consultations (VCs), using a human factors approach

Pharmacist and patient perspectives on the use of video consultations in primary care pharmacy in Scotland

Although over 80% of patients and 94% of healthcare professionals feel video consultations should be offered for healthcare appointments, use in pharmacy has been limited both before and during the COVID-19 pandemic (1, 3). Human Factors is the study of the interactions between humans, the tools and technologies they use and the complex environments in which they work (4). Applying human factors can assist in understanding the influence that each component of a system has on the use of video consultations. The aim of this study was to understand the factors influencing patients' and community and general practice pharmacists' use of video consultations (VCs), using a human factors approach