Services for Community Healthcare

Introduction (2000-3000)

Essential services

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Community pharmacies provide various services to their customers every day. These services include essential services such as dispensing medicines, dispensing appliances, repeat dispensing, clinical governance, signposting, promotion of healthy lifestyle, disposal of unwanted medicines and support for self-care. These services are delivered by all pharmacies as part of the NHS pharmacy contract.[1]

Advanced services

There are four advanced services that can be delivered by the community pharmacies if they meet the criteria set up in the contract. These services include Medicines Use Reviews (MUR), New Medicines Service (NMS), Appliance Use Reviews (AUR) and Stoma Appliance Customisation (SAC).[2]

Most customers visit pharmacies in order to receive essential services. Customer’s perspectives on community pharmacies can be based around other factors as well as the quality of service they received from their pharmacist. Therefore customer’s perception of community pharmacies is of extreme importance as they deliver various services to patients on daily basis. Each pharmacist has a duty of care to their patients.

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Pharmacists are easily accessible and highly trusted in the communities. Their responsibilities include dispensing medicines as well as providing pharmaceutical care. They can increase patient’s participation in their own care by educating them about their disease, explaining the importance of adherence and increasing awareness of the most common side effects.[3] They can counsel patients about drugs such as appropriate drug usage, administration, dosage, side effects, storage and drug–drug and drug–food interactions.[4]

Pharmaceutical Care

Pharmaceutical care is described as the responsible provision of drug therapy for the purpose of achieving definitive outcomes that improve a patient’s quality of life.[5]

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Later a new definition emerged in which pharmaceutical care was described as “A practice in which the practitioner takes responsibility for the patients’ drug related needs and is held accountable for this commitment”[6]

Many people are prescribed multiple and long term medication. Pharmaceutical care includes collecting information, assessing information, setting appropriate objectives, selecting appropriate therapy and monitoring the effectiveness of therapy and educating patients on medicine use. All steps need the involvement of patient from collecting information to the selection of therapy and implementing that therapy for the benefit of the patient.

Today’s pharmacist needs to make patients the centre of their attention. Pharmacists can maximise the therapeutic benefit to the patient by using a multidisciplinary approach such as consultation with other healthcare professionals and the patients themselves. Pharmacists can play a fundamental role in the overall patient experience as they are a critical source of drug knowledge in community, hospitals and industry.

Different roles are played by the pharmacists throughout the world such as some prepare and supply medicines whilst others share their expertise and knowledge with healthcare professionals and patients and work in medicines information teams.[7]

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Social change through health promotion campaigns, media and internet has led to increased risk awareness amongst the public and therefore there is an increase in demand for their questions to be answered and their issues to be taken up by healthcare professionals. Pharmacists are at the forefront of this interaction and they must lead as a model to others and develop confidence amongst their patients by appropriately dealing with their concerns.

They can do this by keeping themselves up to date with the latest developments in the pharmaceutical industry. The media plays a key role in influencing public opinion regarding the quality of treatment and the variety of different drugs used to treat disease. Pharmacists should ensure that they are fully aware of such topics and can thoroughly answer any issues raised in their pharmacy. A good example of this is the advice that the pharmacists can offer to their patients in regards to their smoking habits. They can play a proactive role in identifying the fact that they smoke and then tailoring them to the appropriate smoking cessation schemes. This will improve the quality of pharmaceutical services, instilling confidence in the patient with the fact that pharmacist is an effective point of call.

In recent years, provision of pharmacy services has shifted more towards pharmaceutical care along with medicine supply.[8] Although some personal and social barriers exist in pharmacist-patient communication[9] but the involvement of patients in their own care is helping to eliminate these barriers.[10] The quality of pharmaceutical care depends on the ability of the pharmacist. An outcome of the therapy can be improved if regular interactions are maintained between the pharmacist and the patient.[11]

Many studies have shown that patients feel they benefit more if they maintain a regular contact with the pharmacist and they consider pharmacist to be an important source of information for medicines and minor ailments.[12][13][14]

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The World Health Organisation (WHO) has made a valuable contribution to the recognition of the importance of a pharmacist’s role worldwide, especially in quality assurance and the safe and effective administration of drugs.[15] WHO along with International Pharmaceutical Federation proposed a seven star pharmacist concept, which requires future pharmacists to possess specific knowledge, attitude, skills and behaviour.[16]

In addition WHO recommends 1 pharmacist per 2000 population to ensure optimum benefit to the society from efficient provision of pharmaceutical services. Each pharmacist should be held accountable for the cost, quality and results of pharmaceutical care provided to the patients. Also they should be involved in decisions about health policies.[17]

Adverse Drug Reactions (ADRs)

Pharmacists can play a vital role in healthcare by preventing adverse drug reactions (ADRs) caused by overdosing, medication errors and non-adherence. ADRs include any undesirable outcome that can be attributed to the action of a drug.

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ADRs can cause various problems such as: the driving of further complications in existing disease, delaying the cure of a disease, mimicking other disease states. As a consequence this result in ineffective treatment as the drug induced problem goes unrecognised. Thus, causing patients to lose confidence in their pharmacist and the overall quality of their treatment.

This demonstrates that ADRs are a driving force behind additional problems e.g 6.5% of hospital admissions are due to drug therapy problems.[18] 10% of patients admitted to acute hospitals experienced an adverse drug reaction. Half of these were considered preventable.[19] 14.7% of hospital in-patients are as a consequence of ADRs. ADRs are also a significant cause of morbidity thus increasing the length of stay of patients by an average of 0.25 days/patient per admission episode.

The drugs most frequently associated with ADRs are diuretics, opioid analgesics, anticoagulants and NSAID’s.[20] These four drug groups account for 50% of all drug related admissions. As an example ADRs caused by NSAID’s account for 12,000 bleeding ulcers/year leading to 2,000 deaths/year.[21]

Pharmacist’s Significance

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One of the very important aspects of this profession involves every professional working to their full potential to provide the best possible care and service to their customers. However, if a pharmacist does not provide the optimum attention and care to their patients then it can bring down the reputation and the effectiveness of the profession.

Pharmacists are of utmost importance in ensuring that their attitude towards this side of the practice is as critical as ensuring the clinical and legal correctness of a prescription. This can not only correct the mistakes made while dispensing but ensure a significant benefit to the patient’s health from the therapy utilised to benefit the patient. A lack of consideration towards this aspect of the practice is harmful to the patient and the NHS as it will prolong the time required to manage and cure the conditions under treatment.

Quality of services delivered by community pharmacies is mostly assessed by patient’s opinion and customer satisfaction surveys which are carried out as an integral component of the essential services through clinical governance.[22]

The responsibility of ensuring the safe and effective use of medicines lies with the pharmacists whether it is community or hospital pharmacy. Pharmacists can fulfil this responsibility by counselling patients about their conditions and medications.[23]

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Precise role of the community pharmacist is defined by General Pharmaceutical Counsel (GPHC) and other professional pharmaceutical associations.[24]

Public Perception of Community Pharmacist

Public view of pharmacists is not that of healthcare advisors thus limiting pharmacist’s role and restricting them in providing beneficial services to the public. There is a need to educate public about the role a pharmacist could play in providing advice and guidance in minor ailments and pharmacists being the first line of approach when faced with a health related issue. Consumers who approach pharmacists are those who have previous experience of receiving help from pharmacists to treat minor ailments. Even then they don’t use pharmacists as first point of contact they normally tend to research and self-diagnose before seeking help from a healthcare professional such as a pharmacist. Thus this limits the role a pharmacist could play in giving advice and helping customers.[25]

Patient-pharmacist interaction is an essential tool to discovering better strategies and methods that could be employed in everyday practice to make the service better and more useful. This can be done by asking for opinions from the patients about the services that they have received while attending a pharmacy. These can be used to evaluate the need for a new intervention and improve the quality of current services.[26] Also these observations can form a guideline when implementing improved strategies and referred to when measuring an improvement in the quality of service.[27]

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Customer Satisfaction

Satisfaction has been defined as “the health care recipient’s reaction to salient aspects of his or her service experience” by Cleary and McNeil.[28] A study has defined customer satisfaction as an emotional response which relates to expectations and develops after consumption experience.[29]

Throughout the world many studies have been conducted in to the role of the pharmacist and patient satisfaction from the community pharmacies. [30] [31] [32] [33] [34] [35] [36] [37] [38] [39] [40]

A study in Qatar reported that public does not understand the role of community pharmacists as healthcare provider. [41] However, people in Maltese and Portuguese understand community pharmacist’s roles as a healthcare provider. [42] Public in Saudi Arabia appreciated pharmacists role and did approach them for advice. [43] Most Australians feel that pharmacist do not explain medication use properly. [44] Japanese customers would like direct communication with pharmacist and convenient opening hours. [45] A study in Canada reported high levels of customer satisfaction from the services provided by community pharmacies.[46] Hargie et al conducted a study in UK in 1992 to measure consumer perceptions and attitudes to community pharmacy services. They found that 32% of people considered pharmacists as business orientated, 26% considered pharmacists as health orientated and 42% considered them as both health and business. [47] Community pharmacies were highly rated in US by the public in a survey in 1997. [48]

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A study by Larson et al. (2002) into patient satisfaction found that customers were more satisfied with the friendly approach by the staff than the pharmaceutical care by the pharmacists. [49] Another study by Cerulli (2002) reported that customers had a positive impression of community pharmacists and a foundation of customer-pharmacist relationship had been established. [50] The US national pharmacy consumer survey in 2002 reported high satisfaction with pharmacy services. [51]

Most reports suggest that customers are satisfied with the pharmacist as drug experts and the services provided by community pharmacies. However some aspects can be improved such as the privacy, confidentiality and unequal treatment of customers.[52]

This study can provide important information about patient’s perception of community pharmacies and the changes required to improve quality of performance.

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[1] http://psnc.org.uk/services-commissioning/essential-services/

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[2] http://psnc.org.uk/services-commissioning/essential-services/

[3] Bluml BM. Definition of medication therapy management: development of professionwide consensus. J Am Pharm Assoc. 2005;45:566–572

[4] Hämmerlein A., Griese N., Schulz M. Survey of drug-related problems identified by community pharmacies. Ann Pharmacother. 2007;41(11):1825–1832. [PubMed]

[5] Hepler C.D., Strand L.M.: Am. J. Hosp. Pharm.

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47, 533 (1990).

[6] Strand L.M.: J. Am. Pharm. Assoc. 37, 474, (1997)

[7]Gilbert L.: Curr. Sociol.49, 97 (2001).

[8]. Kotecki J.E.: J. Commun. Health, 27, 291 (2002). Worley M.M. Schommer J.C., Brown L.M., Hadsall R.S., Ranelli P.L., Stratton T.P., Uden D.L.: Res. Social Adm. Pharm. 3, 47 (2007).

[9]Paluck E.C., Green LW, Frankish CJ, Fielding DW, Haverkamp B: Eval. Health Prof. 26, 380 (2003).

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[10]Tio J., LaCaze A., Cottrell N.: Pharm. World Sci. 29, 73 (2007)

[11]Nau D.P., Ried L.D., Lipowski E.E., Kimberlin C., Pendergast J., Spivey-Miller S.: J. Am. Pharm. Assoc. 40, 36 (2000).

[12]Tio J., LaCaze A., Cottrell N.: Pharm. World Sci. 29, 73 (2007).

[13]

[14]. Nau D.P., Ried L.D., Lipowski E.E., Kimberlin C., Pendergast J., Spivey-Miller S.: J. Am. Pharm. Assoc. 40, 36 (2000).

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[15] Dunlop J.A., Shaw J.P.: Pharm. World Sci. 24, 224 (2002).

[16]Zammit D.: Pharm. J. 271, 468 (2003).

[17]Khan, R.A., Pharmacy education and healthcare.Dawn, Pakistan, June 29 (2007).

[18]Pirmohamed et al, British Medical Journal2004; 329: 15-19

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[19]Vincent C et al, British Medical Journal2001; 322: 517-519

(http://bmj.bmjjournals.com)

[20](Davies EC et al PLoS ONE 2009; 4(2): e4439)

[21](Davies EC et al PLoS ONE 2009; 4(2): e4439)

[22] Ried LD, Wang F, Young H, Awiphan R. Patients’ satisfaction and their perception of the pharmacist. J Am Pharm Assoc (Wash) 1999;39(6):835–842. [PubMed]

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[23] Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47:533–543. [PubMed]

[24] FIP – International Pharmaceutical Federation. URL: http://www.fip.org/community_pharmacy . [15 April 2014].

[25] Advice provided in British community pharmacies: what people want and what they get.

Hassell K¹, Noyce P, Rogers A, Harris J, Wilkinson J.

[26] Kucukarslan S.N., Nadkarni A. Evaluating medication-related services in a hospital setting using the disconfirmation of expectations model of satisfaction. Res Social Dam Pharm. 2008;4(1):12–22. [PubMed]

[27] Iqbal Z, Jalees AF, Khar Roop Krishen KR, Sushama T. Pharmacist as an Indispensable Part of Health Care System: A Survey, Outcome and Reflections. Indian J. Pharm. Educ. Res. 42(1), Jan- Mar, 2008:78–83.

[28] Cleary PD, McNeil BJ. Patient satisfaction as an indicator of quality care. Inquiry. 1988;25(1):25-36. [PubMed]

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[29] Oparah A.C., Kikanme L.C. Consumer satisfaction with community pharmacies in Warri. Nigeria. Res Social Adm Pharm. 2006;2(4):499–511. [PubMed]

[30] Wirth F., Tabone F., Azzopardi L.M., Gauci M., Zarb-Adami M., Serracino-Inglott A. Consumer perception of the community pharmacist and community pharmacy services in Malta. Journal of Pharmaceutical Health Services Research. 2010;1:189–194.

[31] Cavaco A.M., Dias J.P., Bates I.P. Consumers’ perceptions of community pharmacy in Portugal: a qualitative exploratory study. Pharm World Sci. 2005;27(1):54–60. [PubMed]

[32] Bawazir S.A. Consumer attitudes towards community pharmacy services in Saudi Arabia. Int J Pharm Pract. 2004;12:83–89.

[33] Oritz M, Liden D, Thomas R, Morgan G, Morland R. The impact of professional services on pharmacy patronage: findings of a pharmacy practice foundation survey (Part 6) Aust J Pharm 1987; 68: 207–14.

[34] Farris K.B., Stenton S.B., Samnani M., Samycia D. How satisfied are your patients? Can Pharm J. 2000;10:32–36.

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[35] Kamei M., Teshima K., Fukushima N., Nakamura T. Investigation of patients’ demand for community pharmacies: Relationship between pharmacy services and patient satisfaction. Yakugaku Zasshi. 2001;121(3):215–220. [PubMed]

[36] Hargie O., Morrow N., Woodman C. Consumer perceptions of and attitudes to community pharmacy services. Pharm J. 1992;249:988–991.

[37] Briesacher B., Corey R. Patient satisfaction with pharmaceutical services at independent and chain pharmacies. Am J Health-Syst Pharm. 1997;54:531–536. [PubMed]

[38] Larson L.N., Rovers J.P., MacKeigan L.D. Patient satisfaction with pharmaceutical care: Update of a validated instrument. J Am Pharm Assoc. 2002;42:44–50. [PubMed]

[39] Cerulli J. Patients’ perceptions of independent community pharmacists. J Am Pharm Assoc. 2002;42:279–282. [PubMed]

[40] Stergachis A., Maine L.L., Brown L. The 2001 national pharmacy consumer survey. J Am Pharm Assoc. 2002;42:568–576. [PubMed]

[41] El Hajj M.S., Salem S., Mansoor H. Public’s attitudes towards community pharmacy in Qatar: a pilot study. Patient Prefer Adherence. 2011;5:405–422. [PMC free article] [PubMed]

[42] Wirth F., Tabone F., Azzopardi L.M., Gauci M., Zarb-Adami M., Serracino-Inglott A. Consumer perception of the community pharmacist and community pharmacy services in Malta. Journal of Pharmaceutical Health Services Research. 2010;1:189–194.

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[43] Bawazir S.A. Consumer attitudes towards community pharmacy services in Saudi Arabia. Int J Pharm Pract. 2004;12:83–89.

[44] Oritz M, Liden D, Thomas R, Morgan G, Morland R. The impact of professional services on pharmacy patronage: findings of a pharmacy practice foundation survey (Part 6) Aust J Pharm 1987; 68: 207–14.

[45] Farris K.B., Stenton S.B., Samnani M., Samycia D. How satisfied are your patients? Can Pharm J. 2000;10:32–36.

[46] Kamei M., Teshima K., Fukushima N., Nakamura T. Investigation of patients’ demand for community pharmacies: Relationship between pharmacy services and patient satisfaction. Yakugaku Zasshi. 2001;121(3):215–220. [PubMed]

[47] Hargie O., Morrow N., Woodman C. Consumer perceptions of and attitudes to community pharmacy services. Pharm J. 1992;249:988–991.

[48] Briesacher B., Corey R. Patient satisfaction with pharmaceutical services at independent and chain pharmacies. Am J Health-Syst Pharm. 1997;54:531–536. [PubMed]

[49] Larson L.N., Rovers J.P., MacKeigan L.D. Patient satisfaction with pharmaceutical care: Update of a validated instrument. J Am Pharm Assoc. 2002;42:44–50. [PubMed]

[50] Cerulli J. Patients’ perceptions of independent community pharmacists. J Am Pharm Assoc. 2002;42:279–282. [PubMed]

[51] Stergachis A., Maine L.L., Brown L. The 2001 national pharmacy consumer survey. J Am Pharm Assoc. 2002;42:568–576. [PubMed]

[52] The Contribution of Community Pharmacy to Improving the Public’s Health (Anderson, Blenkinsopp & Armstrong, Pharmacy Health Link, 2009) <http://www.pharmacyhealthlink.org.uk/?q=evidence_base_reports>; [accessed 18.04.14].

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