Academic literature on the topic 'Community-pharmacy'

The change in community pharmacists’ practice from compounding and effectively unregulated medicines supply through to the highly regulated and largely automated high-volume dispensing process of today has been challenging. The economic and social standing of community pharmacy was transformed creating a need for further adaptation. This thesis explores ‘how business and professional practice models for community pharmacy in England in ten to twenty years are likely to be structured?’. It has six sections, plus an overarching discussion. A work sampling study of ten community pharmacies found that pharmacists continue to spend two-thirds of their time on dispensing related activities, compared to one tenth on counselling. The accompanying analysis links this to an increase in prescription volumes and payments that have incentivised pharmacy contractors to focus on medicines supply. A significant decrease in the average prescription duration for eight chronic disease medications over the past decade is revealed, and its desirability questioned. Using the Kingdon model of the policy process as an evaluative framework, 16 interviews with ‘policy leaders’ provided insight into how seven factors (identified from a structured thematic review of the implementation of Medicines Use Reviews) have influenced the implementation of the New Medicines Service. In addition, role theory-based thematic analysis involving 17 stakeholders in pharmacy policy highlighted the tensions between community pharmacists’ roles as shopkeepers, clinicians and businessmen, and the effects that new technologies will have on them. The analysis identifies a need for pharmacy to embrace a new strategic direction that enhances pharmacy’s contributions to health outcomes. In conclusion, community pharmacy in England should offer timelier and economically efficient ways of solving contemporary health problems. The evidence presented here suggests that without stronger internal leadership and robust external stakeholder support medicines supply will split from the provision of clinical pharmacy in the community setting, leaving community pharmacies as ‘commodity cost’, low return medicines suppliers.

In South Africa the pharmacy profession has experienced a number of changes around the turn of the century such as the introduction of the National Drug Policy (NDP), pharmacy ownership and price regulation. With this the role and earnings of the pharmacy profession, as well as to what extent the pharmacist adds value to the profession and society, are being questioned. Community pharmacists are thus faced with the challenge to prove that the value that they add to society is meaningful. Therefore, the aim of the study was to document community pharmacy availability and activities in South Africa and based on this to quantify the perceived value that the community pharmacist adds to society through the delivery of pharmaceutical services and pharmaceutical care. In order to determine the pharmacist’s true value added two surveys were conducted in 2006; an original pharmacist survey and a general public survey. The results obtained were verified by a follow–up pharmacist survey in 2009 to confirm or reject the results obtained in the original survey. The study was representative of both the community pharmacies and the general public in South Africa and was primarily quantitative in design and analysis. More than half of the responding pharmacies (63.16%) were open seven days a week. The average hours of service per day ranged from 10 hours (Monday to Friday) through to 6.45 hours on Saturdays and 3 hours on Sundays. Pharmacists continuously upgraded their professional knowledge. More than three quarters of pharmacies had the necessary equipment available to perform the services investigated in the study. The general public was not aware of all the services provided by pharmacists and as a result, depending on the service, many people did not make use of these services. The general public that made use of services delivered by community pharmacies mainly perceived the services delivered to be of good quality. The main barrier to practicing pharmaceutical care was indicated by pharmacists as not receiving payment for the advice given followed by pharmaceutical care being time consuming, and that there was not enough time to talk to patients. The general public indicated that they found it difficult to ask questions in pharmacies because other patients could hear what was discussed, or other patients had to wait longer if they asked something, and pharmacy staff being too busy. The results of the original pharmacist and the general public survey were confirmed by the results of the follow-up survey with the exception of dispensing prescription medicine (8 minutes 28 seconds), OTC medicine (7 minutes 23 seconds), counselling of prescription medicine (8 minutes 51 seconds) and OTC medicine (8 minutes) which on average took longer to conduct than in the previous analysis. The study highlighted the value added to the wellness and quality of life of the community of South Africa through the delivery of pharmaceutical care and pharmaceutical services by community pharmacy staff, and proved that pharmacists are committed to the provision of pharmaceutical care and pharmaceutical services.

Thesis (MBA)--University of Stellenbosch, 2011.<br>On 16 January 2004, the Parliament of the Republic of South Africa published the Draft Regulations to the Medicines and Related Substances Act No. 101 of 1965 (Republic of South Africa, 2010a) for comments due by 16 April 2004. These regulations would change the retail pharmacy landscape that generations of pharmacists had become dependent on in supporting themselves and the communities that they served. These regulations proposed a single exit price (SEP) that manufacturers might charge pharmaceutical wholesalers, which included the distribution cost. The wholesaler in turn would sell the pharmaceutical to the pharmaceutical retailer at the listed SEP, thus prohibiting discounts and in the process creating transparency in the pharmaceutical industry. This transparency would ensure that all people would pay the same price for their medication with the aim of making it affordable and available to those in need. Preceding these draft regulations was the amendment to the Pharmacy Act No. 53 of 1974 (Republic of South Africa, 2010c) concerning pharmacy ownership, which allowed non-pharmacist and legal entities to own pharmacies as of 2003. This amendment posed the first external threat to the autonomy of pharmacists regarding independent pharmacy ownership. Pharmacists now had to compete not only amongst themselves but also with large corporate food and health shops with in-house pharmacies. The resources and capabilities inherent to independent community pharmacies given the events of the past few years proved inadequate in competing with the corporate retailers. These two amendments to acts that influenced the existing pharmacy landscape posed a real threat to the sustainability of independent pharmacy business models. This paper investigates the issues that independent community pharmacies in South Africa are facing and their strategic options in the pharmaceutical and services value chain.

Computers have, over the past 10 to 15 years, become an integral part of many activities carried out by British community pharmacists. This thesis employs quantitative and qualitative research methods to explore the use of computers and other forms of information technology (IT) in a number of these activities. Mail questionnaires were used to estimate the level of IT use among British community pharmacists in 1989 and 1990. Comparison of the results suggests that the percentage of community pharmacists using computers and other forms of IT is increasing, and that the range of applications to which pharmacy computers are put is expanding. The use of an electronic, on-line information service, PINS, by community pharmacists was investigated using mail questionnaires. The majority of community pharmacists who subscribed to the service, and who responded to the questionnaire, claimed to use PINS less than they had expected to. In addition, most did not find it user-friendly. A computer program to aid pharmacists when responding to their patients' symptoms was investigated using interviews and direct observation. The aid was not found to help pharmacists in responding to patients' symptoms because of impracticalities involved in its operation. Use of the same computer program by members of the public without the involvement of a pharmacist was also studied. In this setting, the program was favourably accepted by the majority of those who used it. Provision of computer generated information leaflets from pharmacies was investigated using mail questionnaires and interviews. The leaflets were found to be popular with the majority of recipients interviewed. Since starting to give out the leaflets, 27 out of 55 pharmacists who responded to the questionnaire had experienced an increase in the numbers of prescriptions they dispensed. 46 had experienced an increase in the number of patient enquiries they received.

Community pharmacy practice is changing, putting a greater emphasis on patient involvement and empowerment than on physical drug products. Developing practice philosophies, such as pharmaceutical care, are operationalised through an ever-evolving service proliferation. There is, however, a paucity of studies addressing the patients’ subjective perceptions of pharmacy services. The few studies that measure the impact of pharmacy services on humanistic outcomes show little or no effect. This might be due to the services, or the assessment instruments used. The aim of this thesis was to enhance the understanding of how patients perceive community pharmacy services, their preferences for community pharmacy services, and how these services could be evaluated from the patient perspective. This was done by: 1.exploring patients’ perceptions of an existing pharmaceutical care service using in-depth interviews; 2. exploring patient preferences for the ideal pharmacy visit using Q methodology, and characterising those patient groups that have different preferences and; 3. testing the validity of the Swedish version of the Pharmaceutical Therapy-Related Quality of Life (PTRQoL)-instrument, using think aloud methodology. Patients had vague, and sometimes erroneous, understandings about a pharmaceutical care service that they were currently receiving. They reported that the service had increased their feeling of safety, enhanced their knowledge, provided drug treatment control, and empowered them. Seven different viewpoints of the ideal pharmacy service were identified, which could be broadly divided into two groups, those emphasising the physical drug products as central to the encounter and those seeking a relationship with the pharmacist. Some differences between the group characteristics were identified, but not specific enough to guide individualised care practice. Several problems with the validity of the PTRQoL-instrument were detected. Overall, the thesis has highlighted various aspects of patient perspectives on community pharmacy services that could be used for the development andassessment of such services.

Background and Aims: One method for understanding the quality of care provided by community pharmacies is to assess it using objective measures such as indicators. These, however, should be based on a common frame of reference for describing quality. As no such definition exists specifically for community pharmacy, this research aimed to gain an understanding of community pharmacy quality and its assessment. Methodology: In order to conceptualise community pharmacy quality, ten focus groups were conducted across the northwest of England with 47 purposively sampled participants who had experiences with community pharmacy healthcare services. Constant comparative analysis was used to analyse the verbatim transcripts. To develop the quality indicators, a scoping review was conducted to identify descriptive statements which mirrored the quality attributes and quality dimensions analysed from the focus groups. Then, once customised into clearly defined statements with a measurable element, 458 potential quality indicators were arranged into four questionnaires to be rated on their face-validity. Finally, consensus was gathered on each indicator's face-validity by using a two-round modified Delphi technique. Panellists were recruited from across England and were community pharmacists or PCT employees who were involved with community pharmacies (second round: n₁=20, n₂=19, n₃=19, n₄=19). Findings: It emerged that community pharmacy quality can be conceptualised as dynamic and complex with interdependent dimensions of 'opportunity', 'effectiveness' and 'positive perceptions of the experience'. Each dimension contains structures, processes and associated outcomes. These were illustrated by a dynamic model of quality dimensions and by its related static framework of structures processes and outcomes. In the Delphi questionnaires, a total of 51 potential indicators were added by panellists, and after the second rounds, 452 indicators achieved consensus for having face-validity as community pharmacy quality indicators. These assessed one or more of the three quality dimensions and related to: the pharmacy environment, equipment and facilities; patient access to medicines, advice and services; effectiveness; and management and leadership in the pharmacy. Ten indicators achieved consensus for lacking face-validity, and 47 indicators did not achieve consensus. Discussion: This research provides a foundation for future work in community pharmacy quality, and could enable those who design, develop and provide pharmacy services to better target their efforts in delivering high quality care. The quality indicators may help with assessing pharmacies and with making changes based on objective data. Before the 452 quality indicators are implemented, future study should include testing them in pharmacies to determine their reliability, feasibility and acceptability. Other recommendations for research, policy and practice are outlined in the text.