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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 pR40

Community pharmacy quality standards initiatives: the challenge of producing and demonstrating benefit

By M. B. Gregory, J. Wayne, R. Williams*, B. Taylor† and C. Cairns‡

Introduction Numerous local initiatives in the United Kingdom in the past few years have been aimed at promoting quality in community pharmacy.1-4 These can be regarded as precursors to clinical governance initiatives in pharmacy. However, quantitative evaluations of these pilots have not been published nor wider adoption reported. This paper describes such an initiative and its evaluation.

Method In 1996, a community pharmacy quality standards group was created in Lambeth Southwark and Lewisham health authority (HA). Professionally driven, it involved representatives of the local pharmaceutical committee (LPC), hospital trusts and the HA.
Quality standards based around the National Health Service core dispensing service were agreed in 1998. These incorporated the existence of a written dispensing protocol, a written locum pharmacists' guide, 99 per cent of drugs owing to be available next working day, written medication delivery procedures, and wearing of staff identification.
All the health authority's community pharmacies (180) were invited to participate. Supporting resources (eg, written protocol/guide templates, patient medication owing cards and delivery leaflets, staff name badges) and a fee to complete the documentation were offered. Thirty pharmacists attended a launch meeting; 26 signed up to participate and subsequently provided copies of the written information required and confirmed their implementation of the standards.
Initial assessment and feedback after a year, obtained by observation and informal discussions during HA pharmacy visits plus participants' questionnaires, was positive but raised questions over benefits. Therefore, to guide development, further evaluation was decided upon.
A questionnaire was designed to determine patients' perceptions of the elements the initiative had addressed. To minimise positive response bias, distribution of the questionnaires in pharmacies was avoided. Instead, they were distributed to patients in 16 GP practices. Half the surgeries were located near quality initiative participating pharmacies (QIPs) and half were relatively remote to any participating pharmacies (NQIPs). During a one-month survey period in 1999, completed questionnaires were returned by practices to the HA for analysis.

Focal points

  • The challenge of producing and demonstrating significant sustainable benefit in the quality of community pharmacy service provision should not be underestimated
  • No good evidence has been published that demonstrates the success and value of the numerous community pharmacy quality initiatives that have been implemented to date
  • Learning more from experiences and results of implementing pharmacy quality initiatives will facilitate the development of effective professional governance proposals
  • Quality and governance projects need to fully consider initially how they will: measure and demonstrate success; address barriers to change; prompt and sustain adoption beyond the initial core of motivated participants

Results Patient questionnaire responses are summarised in Table 1.
Table 1

Discussion Quantitative evaluation of this project was not initially planned and therefore associated baseline assessment was not carried out. Non-participating pharmacies were therefore used as comparators. The results show that, on most indicators, community pharmacies involved in the quality initiative obtained higher percentage patient satisfaction ratings than non-participants.
This suggests that this type of quality initiative may be of value in improving standards of service delivery in community pharmacy. However, because of study design limitations (eg, non-random selected pharmacy samples), definitive conclusions cannot be made on the extent to which the initiative actually produced these results.
As professional governance becomes increasingly important, the profession must confront the issues involved in effectively implementing the quality agenda. There is a need to demonstrate more clearly the value of quality initiatives in community pharmacy to promote their wider adoption, maintain sustainability and secure underpinning resources. Further work is necessary, from existing and future initiatives, to confirm whether current weak evidence is a true finding of benefit. If positive, such evidence would enable the development of more effective governance strategies in community pharmacy to support the challenging task of producing and maintaining benefit.

Lambeth Southwark & Lewisham health authority; *Lambeth Southwark & Lewisham local pharmaceutical committee; †Community Health South London trust; ‡Lewisham Hospital trust

References

1. Plans to improve pharmacy quality in East Sussex. Pharm J 1995;255:642.
2. Welsh quality project earns reward. Pharm J 1995;254:537.
3. Yorkshire pharmacy charter certificates. Pharm J 1996;256:49.
4. Derbyshire HA commitment to quality scheme. Pharm J 1997; 258:655.