An exploration of Scottish community pharmacists' adoption of innovative services and products relating to minor ailment management.

This research utilised mixed methodology to gain insight into community pharmacists adoption of medicines and services related to two key innovative policy interventions aimed at enhanced minor ailment management; namely the ongoing legal status reclassification of medicines; and the introduction of the Scottish Minor Ailment Service. Prompted by the lack of qualitative and large scale quantitative evaluation from the pharmacists perspective, the aim was to investigate pharmacists adoption of these innovations. Data were generated to evaluate the process related aspects of innovation adoption from community pharmacists perspectives; and to identify and quantify key factors associated with the adoption of these innovations, thereby considering the wider relevance to new community pharmacy services. A range of methods was used including: formal systematic review of peer reviewed published literature on factors associated with innovation adoption following methods recommended by the Centre for Reviews and Dissemination at the University of York; extensive review of policy documents of all the devolved UK Governments; qualitative focus groups and interviews with 20 community pharmacists from four Scottish Health Boards; and lastly a cross sectional survey of the pharmacists responsible for nonprescription medicines from all Scottish community pharmacies (N=1138). The theoretical framework of diffusion of innovations was adopted to design the quantitative research instrument and interpret the data. Rigour was enhanced by consideration of aspects of validity and reliability at all stages. The highest standards of research governance and ethics were applied throughout the study. Qualitative interviews provided insight into the process related aspects of innovation adoption. Where current changes were embraced reluctantly by many who deemed the pace as fast and furious, others were keen to contribute to developments taking place within pharmacy and were eager to play a more proactive role in leading and introducing change to the public. Regardless of practice setting and ownership model, the merits of each innovation appeared to be considered at the individual practitioner level. Hence an organisational level decision to implement an innovation did not necessarily translate to adoption at the individual practitioner level. Using descriptive, bivariate and multivariate quantitative models informed by the results of the qualitative interviews and systematic review of the literature, the quantitative study showed pharmacists perceived attributes of innovations (such as benefits to their professional role development and patients); and patient demand and use of services had the highest association with whether or how far innovations were adopted. Issues such as differences in availability of resources were less able to explain differing level of innovation adoption by the pharmacist respondents. These findings suggest that as innovations around minor ailment management have not yet required reorientation of existing services, the issue of how pharmacists perceive the characteristics of the innovations such as: potential for financial benefits to pharmacy, professional role development and patients; is key to predicting whether future innovations of a similar nature will be successfully adopted by pharmacists

Perspectives of Healthy Living Pharmacy support staff on integration of public health activities into traditional pharmacy roles: A qualitative study

Introduction: Community pharmacy has been acknowledged as a valuable and trusted public health resource1, however in order for public health activity to be sustainable, it needs to be seen as integral to the role of a pharmacy. The aim of this study was to explore the views and attitudes of pharmacy support staff on the Health Living Pharmacy (HLP) initiative. Methods: Face to face semi-structured interviews were conducted with 21 participants from 12 HLPs in Northumberland. HLP Champions (n=16) who had received Royal Society for Public Health training on understanding health improvement alongside non-champion staff (n=5) were included in the sample. Participants also covered a range of pharmacy roles including medicines counter assistants (MCAs) (n=9), dispensing assistants (n=6) and pharmacy technicians (n=6). National multiple (n=8), small chain (n=2) and independently owned (n=2) pharmacies were represented. Participants were recruited by contacting pharmacists in HLPs who nominated support staff for potential participation. Informed consent was obtained prior to conducting interviews. A topic guide was developed and underwent face validity testing and piloting with one participant. Interviews were audio recorded, transcribed verbatim and analysed using Framework approach. The study was approved by Robert Gordon University ethics committee. NHS ethics approval was not required. Results: One of the themes identified from the data was integration of public health activity into traditional pharmacy roles. Participants discussing integration of public health activities with other pharmacy duties included examples of advice when conducting product sales and responding to symptoms. An example participants often referred to was sales of nicotine replacement therapy: "...say if it's somebody [who came in to buy] nicotine replacement therapy, we would say that there are services available, had they thought about giving up. And it's just basically like a couple of lines like that." HLP Champion, MCA Availability of in-pharmacy clinics was frequently described by participants as aiding integration. Participants also described examples of linking pharmacy sales with healthy eating advice, and advising patients about codeine dependence with requests for codeine-containing medicines. Many participants also expressed a perception that they were integrating public health activity subconsciously: "...you don't realise that you are doing it. Because it's all part and parcel of the job." HLP Champion, MCA There was little in the data describing integration of public health activity with dispensing, though one participant did describe a diabetic foot care campaign where people with diabetes were identified from prescriptions they presented. Another form of integration from dispensing that a couple of respondents described was clients browsing health promotion materials within the pharmacy when waiting for their prescriptions. Health promotion materials were widely described as a facilitator for interventions including alcohol awareness, sexual health, cancer screening and cardiovascular health. Discussion: Whilst participants in this study described integration of public health advice for some pharmacy roles seamlessly, participants were less able to describe integration into dispensing activity despite opportunity in areas such as diabetes and cardiovascular health. Contextualisation of public health activity within community pharmacies for support staff could enable further integration of public health into the role of community pharmacy. Facilitators from achieving this integration for medicines counter activities should be explored to inform better integration of public health into dispensary based activities. References: 1. Department of Health 2010 White Paper Healthy Lives Healthy People. Available at: https://www.gov.uk/government/publications/healthy-lives-healthy-people-our-strategy-for-public-health-in-england (Accessed 13/04/14

Reviewing the literature, how systematic is systematic?

Introduction Professor Archibald Cochrane, after whom the Cochrane Collaboration is named, was influential in promoting evidence-based clinical practice. He called for 'relevant, valid research' to underpin all aspects of healthcare. Systematic reviews of the literature are regarded as a high quality source of cumulative evidence but it is unclear how truly systematic they, or other review articles, are or ‘how systematic is systematic?’ Today’s evidence-based review industry is a burgeoning mix of specialist terminology, collaborations and foundations, databases, portals, handbooks, tools, criteria and training courses. Aim of the review This study aims to identify uses and types of reviews, key issues in planning, conducting, reporting and critiquing reviews, and factors which limit claims to be systematic. Method A rapid review of review articles published in IJCP. Results This rapid review identified 17 review articles published in IJCP between 2010 and 2015 inclusive. It explored the use of different types of review article, the variation and widely available range of guidelines, checklists and criteria which, through systematic application, aim to promote best practice. It also identified common pitfalls in endeavouring to conduct reviews of the literature systematically. Discussion Although a limited set of IJCP reviews were identified, there is clear evidence of the variation in adoption and application of systematic methods. The burgeoning evidence industry offers the tools and guidelines required to conduct systematic reviews, and other types of review, systematically. This rapid review was limited to the database of one journal over a period of 6years. Although this review was conducted systematically, it is not presented as a systematic review. Conclusion As a research community we have yet to fully engage with readily available guidelines and tools which would help to avoid the common pitfalls. Therefore the question remains, of not just IJCP but potentially all published reviews, ‘how systematic is systematic?