Return to PJ Online Home Page
The Pharmaceutical Journal Vol 265 No 7114 September 16, 2000
Pharmacy Practice Research
Papers presented at the British Pharmaceutical Conference, Birmingham, September 10 to 13, 2000 pR33

Developing pharmaceutical care in community pharmacies

By J. Krska, G. B. A. Veitch and G. Calder

Introduction Differing health care systems, linguistic difficulties and the use of a number of terms interchangeably have all contributed to difficulties in describing pharmaceutical care in different countries.1 A range of activities has been described as contributing to pharmaceutical care, but again there is a lack of consistency. In Scotland, a Clinical Resource and Audit Group document, "Clinical pharmacy practice in primary care",2 which defines pharmaceutical care as "the pharmaceutical contribution to patient care", has as its principle objective "to improve pharmaceutical care through the development of a structured, systematic approach to clinical pharmacy practice".
This document outlines a methodology for providing pharmaceutical care to individual patients which is analogous to the three stages described elsewhere,3 namely, assessing patients for pharmaceutical care issues; formulating a pharmaceutical care plan; and implementing and monitoring the pharmaceutical care plan.
This systematic approach has been shown to be feasible for pharmacists working within medical practices and visiting patients at home.4 However community pharmacists may already have the long-term relationships with patients required for pharmaceutical care. A range of barriers to community pharmacists delivering pharmaceutical care has been identified.5 Therefore it is important to identify any changes and resources which may facilitate the development of pharmaceutical care services.

Method Potential factors of importance identified from the literature were incorporated into an interview checklist. Semi-structured, face-to-face interviews were held with 16 individuals who represented pharmaceutical organisations within Scotland or provided pharmaceutical care. Interviews were held with the following: national specialists in clinical pharmacy and in pharmaceutical care; one primary care NHS trust chief pharmacist; one employee community pharmacist; one contractor pharmacist; one full-time practice pharmacist; and representatives from each of: Scottish Centre for Post Qualification Pharmaceutical Education, Scottish Specialists in Pharmaceutical Public Health, Scottish Pharmaceutical Prescribing Advisers Group, National Pharmaceutical Association, Scottish Executive of the Royal Pharmaceutical Society (two), Strathclyde University school of pharmacy, Scottish Pharmaceutical General Council, Boots, Lloyds.
All were asked for their views on the approach provided in the guidelines, who should be providing pharmaceutical care and where. They were also asked to identify factors they considered relevant to its development, then questioned concerning the remainder of the checklist and asked to nominate the three most important factors. Interviews were tape-recorded and transcribed and their content analysed manually.

Focal points

  • The community pharmacy is a key locus for delivering pharmaceutical care
  • Remuneration for pharmaceutical care practice needs to be addressed as a priority if pharmaceutical care is to develop
  • Workforce issues to enable pharmacists to free up time are also important, as are pharmacists' clinical knowledge and skills
  • Good relationships with patients' GPs are needed to enable access to relevant clinical information

Results All 16 pharmacists interviewed agreed with the guideline approach to the pharmaceutical care of individual patients and, while the importance of a multi-disciplinary and all-embracing approach was stressed by many, almost all clearly identified the community pharmacy as a key locus for delivering pharmaceutical care. Many reasons for this were given, such as knowledge of the local patient population, accessibility, availability, informality and the size of the community pharmacy workforce. Workforce issues were also mentioned by ten as a barrier to implementing pharmaceutical care, because of the need to increase pharmacists' available time. Other factors frequently identified were the need for updating of clinical knowledge and the skills to implement these (10), space within the pharmacy (9), access to patient information (9) and the remuneration structure (9). Relationships with GPs, computer systems/IT, legislative issues, and the attitudes of pharmacists and patients were mentioned by less than half those interviewed.
Three factors were identified most frequently as of greater importance in enabling the development of pharmaceutical care in community pharmacies. These were the inappropriate nature of the current remuneration structure for pharmaceutical care practice, pharmacists' clinical knowledge/ skills and relationships with GPs enabling access to clinical information. Existing relationships with GPs were considered to be generally good. Several stated that there were no insurmountable barriers and that attitudes among community pharmacists, although not always supportive, could be changed if the remuneration increasingly rewarded pharmaceutical care activities.

Discussion This study found consensus among representatives of major pharmaceutical organisations that, although barriers5 still exist, community pharmacists should be involved in delivering pharmaceutical care using a systematic approach.2 To facilitate its development, pharmaceutical organisations must ensure pharmacists are adequately trained to provide pharmaceutical care services and consider changes to their remuneration to encourage changes in practice, which will capitalise on and extend existing good relationships with GPs.

College of Pharmacy Practice, University of Warwick Science Park, Coventry

References

1. van Mil JWF, McElnay J, de Jong-van den Berg W, Tromp TFJ. The challenges of defining pharmaceutical care on an international level. Int J Pharm Pract 1999;7:202-8.
2. Clinical Resource and Audit Group. Clinical pharmacy practice in primary care. Edinburgh: Scottish Office Department of Health; 1999.
3. Cipolle RJ, Strand LM, Morley PC. New York: Pharmaceutical care practice, McGraw-Hill; 1998.
4. Krska J, Cromarty J, Arris F, Jamieson D, Hansford D. Providing pharmaceutical care using a systematic approach. Pharm J. In press.
5. Bell HM, McElnay JC, Hughes CM, Woods A. Pharmacists' attitudes towards pharmaceutical care: a qualitative approach. Pharm J 1997;259:R29.