Clinical pharmacy services in primary care

Abstract

The evolvement and implementation of clinical pharmacy services in primary care is a response by healthcare systems to meet healthcare needs. Comprehensive models that describe clinical pharmacy services support service development. This research aimed to develop and assess the feasibility of a framework to standardise clinical intervention by pharmacists in primary care. The study was divided into four phases. Phase 1: Review and critical analysis of the literature regarding clinical pharmacy services in primary care. Phase 2: Development and validation of a self-administered questionnaire to support framework elaboration. The questionnaire, available in English, Italian and Maltese, was disseminated to consumers (N=800) online and in community pharmacies. The mean rating scores of the participants' responses to the questionnaire were calculated. These mean scores range from 0 to 4, where 0 corresponds to 'strongly disagree' and 4 corresponds to 'strongly agree'. Phase 3: Focus group discussion with an interprofessional panel of six healthcare professionals and two laypersons to generate consensus on the services covered in the framework. Phase 4: Framework design and validation of the Standard Operating Procedures (SOPs) developed as part of the framework through a Delphi method consisting of two rounds. An expert panel of seven pharmacists and three physicians validated the SOPs for content, readability, and feasibility. The results from the four phases were: Phase 1 - Community pharmacist-led services identified from the literature review that demonstrated improvements in patient outcomes comprised management of chronic diseases, such as hypertension, dyslipidaemia, diabetes, and the provision of advice and treatment for smoking cessation and minor ailments. Phase 2 - Of the 800 respondents 74% (n=590) were female, 77% (n=621) were Maltese, and 43% (n=345) had tertiary level education. Consumers agreed that community pharmacists are knowledgeable about minor illnesses (mean=3.5 ±0.62) and chronic conditions (mean=3.2 ±0.85). The public agreed that they felt comfortable with the community pharmacist reviewing their medicines (mean=3.3 ±1.1) and performing diagnostic testing (mean=3.1 ±1.1). The pharmacist services for which the respondents showed the highest agreement were management of infections of the throat (n=674), skin (n=642), ears and eyes (n=635), and urinary system (n=565), provision of travel health advice (n=645), recommendations on routine immunisations (n=640), Medicine Use Review (n=487) and smoking cessation (n=322). Phase 3 - Consensus was reached among the focus group panel for the framework to include all the services obtaining the highest agreement in the questionnaire. Phase 4 - The developed framework defined the standards for service provision and included 22 SOPs covering the following aspects: General documents on conducting clinical services (n=5), patient review and point-of-care testing services (n=4), advice and treatment related to minor ailments, immunisation, and international travel health (n=8), and ancillary documents (n=5). This study put forward a validated framework to support clinical pharmacy expansion in primary care settings and highlights expectations of pharmacist's role in delivering clinical services from stakeholders, particularly patients. The clinical pharmacy services provided in primary care settings improve safe and timely access to care, increase patient choice to health services, and promote self-care.