It is the future. Clinical pharmaceutical care simply has to be a matter of course: community pharmacy clinical service providers' and service developers' views on complex implementation factors.

Background: While there is a lot of documented evidence about the clinical and cost effectiveness of pharmacists' role extensions there is an inherent gap between service development and implementation. Objective(s): This study aims to better understand the complex factors that influence the implementation of clinical pharmacy services from both the perspective of the community pharmacy service providers and service developers. Methods: A prospective qualitative interview study using purposive sampling of twelve service developers and twelve community pharmacy service providers from across all nine Federal States of Austria. The validated and piloted interview guide contained questions and prompts on role perceptions, attitudes, experience, implementation barriers, training needs and measures identified to strengthen clinical pharmacy provision in community pharmacy. Verbatim quotes were independently mapped to the Framework for the Implementation of Services in Pharmacy (FISpH) by two researchers. Results: 24 Interviews were carried out. Data saturation was achieved. There is a great deal of enthusiasm to develop the remit of clinical pharmacy services. It is seen as important to ensure the future survival of the profession. Service developers are more positive and confident in the implementation success and pharmacists' skills than providers. Clear mandates for politics, academia and individual pharmacists have been discussed to affect change. Conclusions: Austrian pharmacists are facing the same well documented challenges as many other healthcare systems only with more urgency. The development of a clinical pharmacy service framework; education accreditation standard and a well-supported continuous professional development system are considered key to bring about the necessary culture shift

Interprofessional student-run primary health clinics: implications for pharmacy education in Scotland.

Introduction Interprofessional student run primary health care clinics have been a flagship model of health professional education in Canada for many years. The purpose of this study was to determine if there is support for implementing this educational model in the United Kingdom and to highlight the implications for pharmacy education in Scotland. Method A cross-sectional postal survey of 3000 randomly selected citizens of Aberdeen city and shire, Scotland, aged 18 years and over. Results Out of the 824 questionnaires that were returned (response rate 27.5%) over half of respondents (62.4%; n=514) would consider accessing healthcare from a student led, walk in service. The range of services they expect to see include general health checks (60%; n=494); help for sexually transmitted diseases (57.5%; n=474); weight management (56.8%; n=468); smoking cessation (54.4%; n=448) and drug misuse services (47.2%; n=387). Concerns raised pertained to student ability; suitability for children and accessibility. Many comments pertained to the improvement of the current system by offering after-hours care. Discussion The positive response from the general public towards an interprofessional student run primary health care clinic in Aberdeen, suggest that this Canadian model of interdisciplinary health professional education would likely be a successful addition to the pharmacy curriculum in Scotland

Patients' lived experiences with antineoplastic medicines for the management of malignant solid tumours: a systematic review.

Background: Antineoplastic medicines affect the patients’ physical and psychosocial well-being posing challenges for patients, caregivers and healthcare professionals. However, little is known about the patients’ lived experience with medicines (PLEM) for antineoplastic treatment. It is the lived experience that gives meaning to each individual’s perception of a particular phenomenon which is influenced by internal and external factors relevant to the individual. Objectives: To critically appraise, synthesise and present the available evidence of patients’ lived experience with antineoplastic medicines prescribed for the management of malignant solid tumours. Method: A systematic literature search was conducted in six electronic databases for articles published in English with no date restrictions. The search terms were related to beliefs, practice and burden in relation to patient, antineoplastic medicines, tumours and lived experience. Study selection, quality assessment and data extraction were performed independently by 2 reviewers. Research findings were analysed using narrative and meta-synthesis approaches. Results: The search retrieved 31,004 articles with only 10 studies satisfying the inclusion and exclusion criteria. These studies were published between 2005 and 2016 in Europe (n=6), America (n=3) and Asia (n=1). Nine themes were identified to contribute to the patients’ lived experience with antineoplastic medicines. These were (a) influence from family members, healthcare professionals, media and culture, (b) general attitude towards medicine, (c) accepting medicine, (d) modifying or altering medicine regimen or dose, (e) medicine characteristics, (f) medicine routine, (g) medicine adverse events, (h) medicine and social burden and (i) healthcare associated medicine burden. Patients tend to undergo a continuous process of reinterpretations of their experience with medicines throughout their treatment journey. Conclusion: The use of antineoplastic medicines has a profound effect on the patients’ lives. Further longitudinal in-depth studies are required to provide deeper insight into PLEM and support patients in their treatment journey

Just a 'romantic idea'? A theory-based interview study on medication review implementation with pharmacy owners.

Recent legal changes in Germany entitle patients on multiple medications to receive a medication review (MR). However, the provision of MRs is not mandatory and pharmacy owners decide whether to implement this service in their pharmacies. The aim of this study was to determine pharmacy owners' attitudes towards MRs, explore their experiences with MR implementation and examine their perceptions of barriers and facilitators towards implementation of MRs in community pharmacies. Pharmacy owners were invited to participate in semi-structured interviews. Purposive sampling was used with selection criteria being MR-implementation stage, and geographical location of the pharmacy. The topic guide was based on a systematic review and the Framework for Implementation of Services in Pharmacy (FISpH). Interviews were recorded, transcribed verbatim and coded directly against the FISpH. Twenty-one pharmacy owners were interviewed. Despite participants' consistent positive attitude towards MRs, most believed that providing MRs on an economically viable basis would be challenging. Several practical suggestions emerged which would enable community pharmacies a smoother implementation of MRs. Suggestions included employing ‘change facilitators', who visit and support implementing pharmacies; national awareness campaigns targeting patients and health professionals; reducing bureaucracy; continuing professional development; involving technicians in some MR-tasks; and offering an additional incentive to lower the initial implementation threshold. This research identified numerous factors that are likely to increase owners' and managers' support to the idea of MRs. This may be of interest to any country planning implementation of MRs

Implementation of medication reviews in community pharmacy: reaching consensus on stakeholders' recommendations for mechanisms of change using the nominal group technique.

Since 2022, patients with five or more medicines are eligible for a medication review (MR) in a community pharmacy remunerated by the German health system. However, implementation has been slow, with few pharmacies providing MRs. Stakeholders' input is necessary to detail how implementation strategies can be executed effectively on a national level. Prior research identified "external facilitation" and "altering incentives" as crucial strategies to achieve implementation outcomes. To gather stakeholders’ recommendations for, and obtain consensus on, mechanisms of change that allow implementation strategies to work in practice. The consensus method used was the nominal group technique (NGT) with NGT-discussions held separately with pharmacy owners and pharmacy chambers employees. Votes were summed and the relative importance (rI) calculated, defined as (score achieved for a mechanism)/(maximum possible score) × 100. Content analysis provided context for the highest ranked mechanisms and allowed linking to implementation outcomes. Four NGT-discussions were held in 2023 (n = 2 owners; n = 2 chamber employees) with a total of 17 participants. The overall highest ranked mechanisms were fit-for-purpose software (rI = 154.7) detailed process support (rI = 104.9) and an expert support line (rI = 77.7). These together with financial viability (rI = 40.0) were prioritised by both participant groups. Three mechanisms were favoured for both implementation strategies, namely software, process support and materials (rI = 34.3). This study identified stakeholders' priorities for mechanisms of change to implement MRs in community pharmacies. Focusing efforts on the prioritised mechanisms is likely to significantly advance a national implementation plan for countries which are at an early implementation stage

Facilitating implementation of medication reviews in the community pharmacy setting: an application of the implementation research logic model.

Previous research has identified both determinants and potential strategies to facilitate implementation of medication reviews (MR). A conceptual model which links determinants, strategies to support implementation and mechanisms of change to execute implementation, with projected outcomes is helpful to plan the approach and facilitate MR-implementation. The aim of this research was to apply the Implementation Research Logic Model (ILRM) for the implementation of medication reviews in the German community pharmacy setting, and thus illustrate the links between determinants, strategies, and implementation outcomes. The resulting map is meant to inform and facilitate MR-implementation. The IRLM was populated with determinants (barriers and facilitators structured using the Framework for Implementation of Services in Pharmacy, FISpH), proposed strategies (according to the Expert Recommendations for Implementing Change, ERIC) and mechanisms of change which were identified in an interview study with 21 German pharmacy owners. The research team linked these with 8 implementation outcomes derived from Proctor: acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, sustainability. Twenty strategies from the interview study were mapped against 32 determinants. All strategies were hypothesised to impact on one or several of the 8 implementation outcomes. Depending on pharmacies' implementation stage (exploration, preparation, implementation, and sustainment) the importance of strategies was expected to vary. Strategies such as educational meetings and learning collaboratives can increase perceived appropriateness and boost adoption of MRs which is particularly important for pharmacies in the early exploration stage. Strategies such as receiving support from external implementation advisors as well as recruiting and training internal implementation leaders were deemed particularly important for pharmacies at the preparation stage to strengthen feasibility and fidelity. In later stages (implementation and sustainment) pharmacies were thought to benefit from provision of clinical feedback, obtaining and using patient feedback and re-examining implementation to achieve high fidelity, penetration, and sustainability of MR-provision. Some strategies such as fixed payment and stable delivery contracts were deemed pre-requisites for implementation irrespective of the stage the pharmacy was at. The application of the Implementation Research Logic Model illustrated the relations between determinants, strategies, mechanisms, and implementation outcomes. Future research is needed to ascertain that strategies work as planned and achieve the projected implementation outcomes

Austrian pharmacy students' views, experiences and attitudes on an elective clinical pharmacy teaching event delivered in the English language.

Introduction: The World Health Organisation (WHO) and the International Pharmaceutical Federation (FIP) recommend emphasising clinical education within a balanced pharmacy curriculum. During the summer of 2016 the University of Graz (KFU), sponsored an elective English language teaching event on clinical pharmacy for undergraduate pharmacy students. This project aimed to evaluate the views, experiences and attitudes of Austrian students taking part in this clinical pharmacy teaching event. Methods: A mixed method study using a quantitative questionnaire survey followed by qualitative semi-structured, one-to-one telephone interviews. Results: The response rate to the questionnaire and telephone interview study was 67% (n=20) and 30% (n=6) respectively. Students were satisfied with the teaching event (very good: 90% (n=18); good: (10% (n=2). They felt inspired to learn more about clinical pharmacy in the future (100% (n=20)). Main themes included opportunity, relevance and the desire to shape their own future profession

The standards of practice for delivery of polypharmacy and chronic disease medication reviews by general practice clinical pharmacists: a consensus study.

Background: General practice in the UK is experiencing a crisis. Greater multidisciplinary working is a potential solution. The new general practice contract in Scotland encourages this and includes a new pharmacotherapy service to be delivered by General Practice Clinical Pharmacists (GPCPs). Consensus is lacking for the standards of practice for delivery of pharmacotherapy medication reviews (which are polypharmacy and chronic medication reviews) as part of this service. Aim: To identify and validate standards of practice for polypharmacy and chronic disease medication (pharmacotherapy level 3) reviews conducted by GPCPs. Method: A two-phased mixed-methods consensus methodology was used. Phase 1: An expert group of GPCPs (n = 4) and clinical pharmacist managers (n = 2) responsible for delivering the pharmacotherapy service used a Modified Nominal Group Technique to generate potential standards. Phase 2: Two-round Delphi survey involving GPCPs with ≥ 1 year of experience of working in general practice (n = 159). Results: The expert group identified 44 potential standards of practice for polypharmacy and chronic disease reviews. Practicing GPCPs indicated during the Delphi phase that the 44 standards were applicable to practice. The standards of practice covered seven main categories: skills, environment, qualifications, qualities and behaviours, knowledge, process and experience. Conclusion: Practicing GPCPs indicated that the standards identified by the expert group are acceptable and valid for current practice and the delivery of polypharmacy and chronic medication reviews. The application of these standards to practice may help GPCPs and general practices to ensure equitable delivery of patient care

Patients’ experiences of medicines on initiation of antineoplastic agents for the treatment of colorectal cancer : a qualitative study

Objective To explore the patients’ experiences on initiation of treatment with antineoplastic medicines for colorectal cancer. Design A qualitative study using semistructured, face-to-face interviews based on the adapted patients’ lived experience with medicines conceptual model was conducted. Ethics approval was granted. Interviews took place while eligible patients were receiving their first cycle of antineoplastic medicines, audiorecorded and transcribed verbatim. Interpretative phenomenological analysis was used. Setting National oncology hospital in Malta. Participants Adult patients over 18 years, newly diagnosed with colorectal cancer and initiating treatment with 5-fluorouracil/folinic acid and oxaliplatin (FOLFOX) or capecitabine plus oxaliplatin (XELOX) between October 2018 and September 2019 were recruited. Patients were included if fully aware of their diagnosis and the treatment being received. A purposive sample of 16 patients participated in the study. Results Five themes emerged from our analysis: (1) beliefs and knowledge on cancer and treatment; (2) healthcare system in relation to treatment; (3) medicine-taking practice; (4) medicine-related impact and (5) personal support structure. In addition, 16 subthemes were identified to describe the interplay of all aspects of the patients’ experiences on initiation of treatment with antineoplastic medicines. Conclusion This qualitative study illustrated that the patients find themselves in a complex situation on initiation of treatment with antineoplastic medicines. The patients’ knowledge on their specific treatment and active participation in making an informed decision need to be addressed. The healthcare system should develop tailored patient-centred services that specifically address the lack of patient empowerment and patient’s concern about treatment specific information

How to write a successful grant application: guidance provided by the European Society of Clinical Pharmacy.

Considering a rejection rate of 80–90%, the preparation of a research grant is often considered a daunting task since it is resource intensive and there is no guarantee of success, even for seasoned researchers. This commentary provides a summary of the key points a researcher needs to consider when writing a research grant proposal, outlining: (1) how to conceptualise the research idea; (2) how to find the right funding call; (3) the importance of planning; (4) how to write; (5) what to write, and (6) key questions for reflection during preparation. It attempts to explain the difficulties associated with finding calls in clinical pharmacy and advanced pharmacy practice, and how to overcome them. The commentary aims to assist all pharmacy practice and health services research colleagues new to the grant application process, as well as experienced researchers striving to improve their grant review scores. The guidance in this paper is part of ESCP’s commitment to stimulate "innovative and high-quality research in all areas of clinical pharmacy"