Pharmacists' roles in assisted reproductive technology.

Background: The global issue of infertility has prompted an increased reliance on Assisted Reproductive Technology (ART) for conception. In Australia, patients have previously accessed ART medications through specialist clinics, however recently due to modifications in ART medication subsidisation, community pharmacists now dispense and counsel patients on ART medications. Patients residing in rural and remote locations face challenges in accessing fertility clinics, which are primarily located in metropolitan and large regional cities. Objective: To investigate the perceived role, experience, confidence, and training requirements that pharmacists have in relation to providing ART medications and counselling to patients. Methods: Purposive sampling related to location of practice, pharmacist experience with ART and self-classification as an ART specialist was used to recruit 19 Australian pharmacists from rural, remote, large regional, and metropolitan areas, who participated in semi-structured interviews based on the Consolidated Framework for Implementation Research (CFIR). Interview transcriptions were transcribed, imported into NVivo, analysed using thematic analysis and mapped to CFIR domains and constructs. Results: Of the nineteen pharmacists interviewed, six were from rural and remote areas and thirteen were from metropolitan or large regional areas. Eight participants perceived themselves as specialist pharmacists in ART, all of which were in metropolitan or large regional locations. Three CFIR domains were identified as relevant for this study, which were further developed, with data mapped to eleven constructs under those domains. Emergent themes were identified that contributed to the pharmacist role including patient needs, external policies, fertility clinics, pharmacist experience and training, procuring ART, and the personal attributes of participants. Some constructs and themes differed between participants dependent on self-reported specialisation status and geographical location (e.g., self-efficacy), whereas others were consistent (e.g., knowledge and belief about the intervention). Pharmacists considered their role not to be limited to the supply and counselling of medication, but to also involve a support role for patients undergoing an emotionally difficult and sensitive journey, without guaranteed success. Conclusion: This study reveals the diverse role of Australian pharmacists in ART, influenced by location, experience, and confidence. Pharmacists have an important role to play in reducing barriers to ART access by offering fertility education, addressing concerns, providing medications and counselling, and monitoring patient well-being, improving outcomes for this cohort of patients particularly in rural and remote areas.

Pharmacist-Led Interventions for Medication Adherence in Patients with Chronic Kidney Disease: A Scoping Review.

BACKGROUND: Patients with chronic kidney disease (CKD) are routinely prescribed complex medication regimes. Medication reconciliation, medicine reviews, patient counselling and disease state and medication education are all key pharmacist-led interventions, which can improve medication adherence in patients with CKD. AIM: To characterize peer reviewed literature on the role of pharmacists in supporting medication adherence of patients with chronic kidney disease and highlight the impact they might have in the health outcomes for patients. METHOD: This review was performed in accordance with the Scoping Review Framework outlined in the Joanna Briggs Institute Reviewer's Guide. Four electronic databases were searched (Medline (Ovid), Emcare, Scopus and Web of Science) for all relevant literature published up until November 2022. A total of 32 studies were reviewed against an exclusion and inclusion criteria, with findings from each study categorized into barriers, interventions, perceptions, financial implications and outcomes. RESULTS: Eight eligible studies were identified, where pharmacists' interventions including medication reconciliation, medicine reviews, patient counselling and disease state and medication education, were all reported to have a positive effect on medication adherence. Although pharmacy services in chronic kidney disease were acceptable to patients and pharmacists, these services were under-utilized and limited by logistical constraints, including staffing shortages and time limitations. Patient education supplemented with education tools describing disease states and medications was reported to increase patient adherence to medication regimes. CONCLUSIONS: Pharmacist-led interventions play an integral role in improving medication adherence in patients with chronic kidney disease, with their inclusion in renal care settings having the potential to improve outcomes for patients.

From Identity to Ambugity: Exploring Interprofessional Collaboration Opportunities for Pharmacists in Rural and Remote Australia.

Rural and remote populations are predisposed to poorer health outcomes, largely associated with limited access to health services and health professionals. This disparity provides an opportunity for health professionals to work collaboratively in interdisciplinary teams to deliver improved health outcomes for rural and remote communities. This study aims to explore exercise physiologist and podiatrist perceptions of interprofessional practice opportunities with pharmacists. Role theory provided a framework for this qualitative study. Interviews were conducted, recorded, transcribed, and thematically analysed according to the constructs of role theory (role identity, role sufficiency, role overload, role conflict, and role ambiguity). The perceptions of participants varied, largely due to the lack of understanding of the role and scope of the practice of a pharmacist. Participants acknowledged and adopted a flexible approach to the way in which they delivered health services to meet the needs of the community. They also described a more "generalist" approach to care, owing to the high prevalence of disease and disease complexity, along with a lack of staffing and resources. The potential for increased interprofessional collaboration was supported and identified as a strategy to manage significant workloads and provide improved patient healthcare. The application of role theory to this qualitative study provides insight into perceptions of interprofessional practice that may inform future development of remote practice models of care.

Inequity of Access: Scoping the Barriers to Assisted Reproductive Technologies.

Infertility impacts millions of people of reproductive age worldwide, with approximately 10-15% of couples affected. When infertility is present, there are many potential barriers to treatment, leading to inequity of access. Assisted reproductive technologies (ART) are the mainstay of medical treatment for infertility and include procedures such as in vitro fertilisation. This scoping review aims to explore the barriers to accessing assisted reproductive technologies to highlight a potential role for the pharmacist in addressing these barriers. Five databases, including CINAHL, Emcare, Medline, Scopus, and Web of Science, were searched using keywords that resulted in 19 studies that explored barriers to initially accessing or continuing ART. Studies identified more than one barrier to accessing ART, with the most mentioned barrier being the geographic location of the patient, with others themed as psychological, financial, minority groups, educational level, and the age of the patient. Recommendations were made to address barriers to accessing ART, which included changes to government regulations to increase health education and promotion of infertility. Pharmacists' accessibility, even in geographically remote locations, places them in an ideal position to address many of the challenges experienced by people accessing infertility treatment to improve outcomes for these people.

Feasibility, accessibility and acceptability a pharmacist-led ear health intervention at rural community pharmacies (LISTEN UP): a mixed-methods study in Queensland, Australia.

OBJECTIVE: Ear disease in rural and remote communities is occurring at high rates, with limited access to health services and health providers contributing to the problem. Community pharmacists are well-placed to provide expanded services to improve ear health in rural communities. We aimed to evaluate the feasibility, accessibility and acceptability of a pharmacist-led intervention for ear disease in consumers presenting to community pharmacy. DESIGN: Prospective preintervention and postintervention mixed-methods study. An ethnographic lens of rural culture was applied to the descriptive qualitative component of the study. SETTING: Two rural community pharmacies in Queensland, Australia. PARTICIPANTS: People aged 6 months or older, who present with an ear complaint to a participating community pharmacy. INTERVENTION: LISTEN UP (Locally Integrated Screening and Testing Ear aNd aUral Programme) is a community pharmacy-based intervention to improve the management of ear health. Trained pharmacists conducted ear examinations using otoscopy and tympanometry on consumers following a LISTEN UP protocol. They made recommendations including no treatment, pharmacy only products or general practitioner (GP) referral. Consumers were contacted 7 days later for follow-up. RESULTS: 55 rural consumers participated in the study. The most commonly reported complaints were 'blocked ear' and 'ear pain'. Pharmacists recommended over-the-counter products to two-thirds of the participants and referred one quarter to a GP. 90% (50/55) of the consumers were highly satisfied with the service and would recommend the service. All consumers described the service positively with particular reference to convenience, improved confidence and appreciation of the knowledge gained about their ear complaint. Pharmacists were motivated to upskill and manage workflow to incorporate the service and expected both consumers and GPs to be more accepting of future expanded services as a result of LISTEN UP. However, without funding to provide the service, during the study other remunerated pharmacy tasks took priority over providing LISTEN UP. CONCLUSION: Rural community pharmacists can provide an acceptable and accessible ear health service; however, it is not feasible without a clear funding structure to provide resources including additional pharmacists, equipment and training. TRIAL REGISTRATION NUMBER: ACTRN12620001297910.

Bridging Allied Health Professional Roles to Improve Patient Outcomes in Rural and Remote Australia: A Descriptive Qualitative Study.

Purpose: Australia's rural and remote populations experience inequality of access to healthcare, with demand exceeding capacity for delivery of health services, often due to a maldistribution of the health workforce. A strategy which may overcome barriers to accessing adequate healthcare includes implementation of interdisciplinary collaborative teams, identified as a successful method of healthcare delivery. This study thus aimed to explore interdisciplinary allied health collaborative practice in a rural community. Methods: Role theory, as a philosophical perspective, was used to explore role perceptions and the potential for interdisciplinary collaboration between pharmacists and allied health professionals including dieticians/public health nutritionists, speech pathologists, occupational therapists, and physiotherapists, by conducting 29 interviews in a rural community. All interviews were transcribed verbatim, coded, and categorised into emerging themes. Results: Five constructs of role theory were used to describe the data: role identity, role overload, role sufficiency, role conflict, and role ambiguity. Participants identified as rural generalists and health promoters, who work within innovative and adaptive healthcare settings. Role overload was reported as considerable due to high demand for services and a lack of resources in rural and remote regions, resulting in poor role sufficiency. Overall, there was a low level of role conflict, and participants were highly in favor of interprofessional collaboration; however, uncertainty of the pharmacist's role (role ambiguity) was a major barrier identified. Health professionals with more years in practice provided few examples of how they would utilise a pharmacist in their practice, although these gave valuable insight into the potential integration of a pharmacist into an interdisciplinary health team, with allied health professionals. Conclusion: This study has applied role theory providing a greater understanding of the enablers and barriers of pharmacists working within interdisciplinary allied health teams and highlighting opportunities to bridge interprofessional roles to improve patient outcomes, especially in rural and remote communities.

Expanded Pharmacy Practice Implementation: Lessons from Remote Practice.

AIM: The aim of this study is to explore pharmacist perspectives of the implementation of a community pharmacy-based ear health service in rural communities. METHOD: A community pharmacy-based health service model was designed and developed to provide an accessible ear care service (LISTEN UP-Locally Integrated Screening and Testing Ear aNd aUral Program) and pharmacist's perspectives of the implementation of LISTEN UP were explored. Thematic analysis was conducted and data coded according to the Consolidated Framework for Implementation Research. RESULTS: A total of 20 interviews were conducted with 10 pharmacists, averaging 30 min. Visualistion of the ear canal was reported as the greatest advantage of the service, whilst the time required for documentation reported as a complexity. The number of pharmacists working at one time and the availability of a private consultation room were identified as the two limiting factors for execution. On reflection, the need for government funding for service viability and sustainability was highlighted. DISCUSSION/CONCLUSION: Expanded pharmacy practice is emerging for the Australian pharmacy profession. Rural community pharmacists are recognised as integral members of healthcare teams, providing accessible medication supply and health advice to seven million people in Australia who call rural and remote regions home. However, there are no structured models supporting them to provide expanded services to improve health outcomes in their communities. This study provides lessons learnt to guide future design and development of expanded models of pharmacy practice.

Expanded practice for rural community pharmacy: what are we waiting for?

OBJECTIVE: To synthesise stakeholder (consumer, pharmacist and health professional) perspectives of expanded pharmacy practice in rural and remote community pharmacy. METHODS: Comparison of perspectives of stakeholder groups identified by four studies has highlighted the expected outcomes and anticipated barriers to expanded pharmacy practice. Aligning the studies has identified priority areas of health for which pharmacists may be able to provide expanded service delivery. KEY FINDINGS: Expanded pharmacy services are supported by consumers, pharmacists and health professionals and are expected to improve health outcomes for rural and remote populations. Barriers will need to be overcome for expanded services to be sustainable in the future. CONCLUSION: The pharmacy profession will need to undertake a paradigm shift to professional practice and work towards this should begin to reduce the health inequality for rural populations.

Community pharmacist interventions in ear health: a scoping review.

BACKGROUND: In Australia, around 3.6 million people suffer from hearing loss, more than 1.3 million with preventable hearing conditions. Ear diseases are prevalent in Indigenous populations, particularly children and are associated with poor educational outcomes and subsequent high rates of unemployment and incarceration. In Australia, rural and remote communities have rates of middle ear perforations five times the rate that the World Health Organisation regards to be a significant public health problem.Barriers to accessing ear health services have been identified including gaps in testing during the 'early years' and difficulty in accessing these services. Reducing the risk of hearing loss through improved ear health care can directly impact the ability to learn and develop. Collaboration between community, health providers and government is crucial to ensure necessary support for change. An opportunity presents for rural community pharmacists, who are both qualified and accessible to provide an ear health programme and thus improve health outcomes for both Indigenous and non-Indigenous Australians in their communities. AIM: The aim of this study was to identify published evidence of pharmacists' involvement in ear health care interventions to inform the development of ear health services able to be delivered in rural community pharmacy in Australia. DATA SOURCES: The search strategy was applied to the following electronic databases: MEDLINE, Scopus, CINAHL, Emcare, Cochrane, Google Scholar and Google.Study selection articles were included if they described an ear health intervention in a community pharmacy setting. The interventions reported in the articles were evaluated for their inclusion of effectiveness, whether the service was sustainable, and the inclusion of enablers and barriers to the provision of ear care. The articles were also thematically analysed using the Deadly Ears Deadly Kids Deadly Communities Framework. A total 8427 articles were identified and evaluated against inclusion and exclusion criteria, with eleven eligible articles suitable for inclusion in the review. The articles included were conducted in Australia (n = 4), England (n = 4), United States of America (n = 2) and Brazil (n = 1). The ear health interventions identified included hearing screening (n = 3), otoscopy pilot studies (n = 2), audiometry services (n = 1), specific education for undergraduate pharmacy students (n = 2) and a pharmacy-based clinic (n = 3). Effectiveness and sustainability were not formally reported in any of the included articles. Positive outcomes, funding availability, consumer access to community pharmacy, cost savings for consumers and improved connection to health providers were identified as enablers. Difficulty in attracting funding was the most commonly reported barrier. CONCLUSIONS: Improving ear health of both Indigenous and non-Indigenous peoples through services provided in community pharmacy presents as an important opportunity for rural pharmacists. Pharmacists are accessible and thus well placed to improve ear healthcare and resultant quality of life for these vulnerable populations. This review has identified factors required to effectively develop ear health models of care in community pharmacy including a pharmacist training program, continuous funding to ensure sustainability and support from pharmacy stakeholders and the community.

Developing an Ear Health Intervention for Rural Community Pharmacy: Application of the PRECEDE-PROCEED Model.

Unaddressed hearing loss affects an estimated 466 million people worldwide, costing over $750 billion globally, with rural communities being particularly disadvantaged, due to the greater inequity in access to healthcare services. This mixed-methods study aimed to use the PRECEDE-PROCEED model to develop and pilot a rural community pharmacy-based ear health service, LISTEN UP (Locally Integrated Screening and Testing Ear aNd aUral Program). The PRECEDE process involved an assessment of the predisposing, reinforcing and enabling constructs to support practice change through a scoping review, stakeholder surveys and interviews and consultation with governing bodies and regulatory authorities. The PROCEED segment structured the evaluation of the service pilot and informed planned implementation, process, impact and outcome evaluation. The pilot study conducted in February 2021 included 20 participants, with the most common ear complaints presented being pain, pressure or blockage. All these participants reported high levels of satisfaction with the service, would recommend the service to others and would attend the pharmacy first before seeing a GP for future ear complaints. The PRECEDE-PROCEED model provides a comprehensive model to guide the design of the LISTEN UP program, an innovative model, expanding services offered by rural community pharmacies, with preliminary results demonstrating high consumer satisfaction.

Expanded practice in rural community pharmacy: a macro-, meso and micro-level perspective.

INTRODUCTION: Expanding community pharmacists' scope of practice, in rural and remote locations has the potential to improve access to health care and health outcomes. Internationally, a lack of support from other health professionals (HPs) has presented a barrier to the uptake of expanded pharmacy models. Rural allied health workers, including pharmacists, however, already work across an extended scope using generalist and specialist skills to meet unique community needs with limited infrastructure for support. Limited data on expanded practice from Australia prompted this study to explore Australian rural and remote doctor, nurse and allied health perspectives of expanded pharmacy services in non-metropolitan settings. METHODS: An ethnographic lens of rural culture was applied to this descriptive qualitative study. Semi-structured, in-depth interviews were conducted with HPs working in rural and remote locations in Australia. Inductive and deductive thematic analysis was guided by a multi-level lens of macro- (policy level), meso- (HP level) and micro- (consumer and community level) perspectives. The World Health Organization (WHO) framework for integrated people-centred health services provided strategies to align to the theoretical framework for the analysis. RESULTS: Twenty-three rural and remote HPs (doctors (8), nurses (4), allied HPs (11)) participated. Key themes identified included supportive government and funding provisions (macro); collaboration with other health providers (meso); ensuring pharmacists have the required knowledge, skills, quality assurance and safety measures in place (meso); pharmacists' capacity, including time and space (meso); and opportunity to empower and engage consumers through rural community pharmacies (micro). CONCLUSION: As pharmacists internationally continue to develop their expanded scope of practice, these results provide the first evidence for Australian rural pharmacists to consider when planning for and developing expanded practice models. Recognition of challenges and motivators for pharmacists' expanded practice are highlighted. Engagement of both government and rural health providers is seen as crucial for expanded models of pharmacy practice to evolve to deliver improved health outcomes for rural and remote communities.

LISTEN UP (Locally Integrated Screening and Testing Ear aNd aUral Programme): a feasibility study protocol for a community pharmacy-based ear health intervention.

BACKGROUND: Ear disease is a major cause of preventable hearing loss and is very common in rural communities, estimated to affect 1.3 million Australians. Rural community pharmacists are well placed to provide improved ear health care to people who are unable to easily access a general practitioner (GP). The purpose of this study is to apply an ear health intervention to the rural community-pharmacy setting in Queensland, Australia, to improve the management of ear disease. The aims are the following: (1) to evaluate the feasibility, potential effectiveness and acceptability of a community pharmacy-based intervention for ear health, (2) to evaluate the use of otoscopy and tympanometry by pharmacists in managing ear complaints in community pharmacy and (3) to evaluate the extended role of rural pharmacists in managing ear complaints, with the potential to expand nationally to improve minor ailment management in rural communities. METHODS/DESIGN: This is a longitudinal pre- and post-test study of a community-pharmacy-based intervention with a single cohort of up to 200 patients from two rural community pharmacies. Usual care practices pertaining to the management of ear complaints will be recorded prior to the intervention for 8 weeks. The intervention will then be piloted for 6 weeks, followed by a 12 month impact study. Patients aged > 13 years presenting to the pharmacies with an ear complaint will be invited to participate. Trained pharmacists will conduct an examination including a brief history, hearing screening, otoscopy and tympanometry assessments. Patients will be referred to a general practitioner (GP) if required, according to the study protocol. Patients will complete a satisfaction survey and receive a follow-up phone call at 7 days to explore outcomes including prescribed medications and referrals. Pharmacists and GPs will complete pre- and post- intervention interviews. Patient, pharmacist and GP data will be analysed using descriptive statistics and thematic analysis for the qualitative data. DISCUSSION: This study will demonstrate the implementation of a screening and referring ear health intervention in rural community pharmacy. Feasibility, potential effectiveness and acceptability of the intervention will be assessed. TRIAL REGISTRATION: Australian and New Zealand Clinical Trial Registry Number: ACTRN12620001297910 .

Rural pharmacists and stakeholders perspectives of expanded pharmacy practice: A descriptive study.

OBJECTIVE: To explore pharmacist and stakeholder perspectives of pharmacists providing expanded services in rural community pharmacies. DESIGN: A descriptive qualitative study with an ethnographic lens of rural culture collected data via in-depth semi-structured interviews with stakeholder representatives and rural and remote pharmacists. SETTING: Regional, rural and remote practice settings as defined by the Modified Monash Model MM3-MM7. PARTICIPANTS: Twelve rural or remote pharmacists and eight stakeholder representatives from various government and professional organisations participated in the study. MAIN OUTCOME MEASURE: Macro-, meso- and micro-level perspectives of pharmacists providing expanded pharmacy services in rural community pharmacies. RESULT: At the macro-level, both pharmacists and stakeholders agreed that governance is needed to clarify the terms used to describe expanded practice as a first step to developing an expanded practice framework. The meso-level revealed that pharmacist participants expected expanded practice to improve rural pharmacist recruitment and retention through improved professional satisfaction. The importance of effective collaboration and coordination with other health care providers in a community was described by pharmacists and stakeholders to ensure success of expanded services. All participants agreed that sustainability of these services relied on appropriate remuneration. At the micro-level, expanded pharmacy services are expected to save consumers' time and money as patients are redirected into appropriate health care settings. CONCLUSION: Enablers and barriers across policy, health professional, consumer and community levels need to be addressed in order to design and develop sustainable expanded pharmacy services to improve health service provision in rural and remote communities.

Consumer perspectives of expanded practice in rural community pharmacy.

BACKGROUND: People living in rural and remote regions have mortality and morbidity rates worse than their counterparts in metropolitan cities. Distance to access healthcare and limited access to health professionals highlights the need for expanded pharmacy services to address the health disparity facing rural and remote Australia. OBJECTIVES: Examining consumers' perspective of expanded pharmacy services with a view to improving the health of their local community is a focus of the study. METHODS: A questionnaire was provided to 20 rural and remote community pharmacies across Australia, to be administered to pharmacy consumers during July-September 2019. The questionnaire involved consumers choosing expanded services that they would like to see provided by their local pharmacy. The data were manually entered, exported into IBM SPSS Statistic 25 and summarised using descriptive statistics. RESULTS: 406 consumers from rural and remote locations completed the questionnaire. Vaccinations, chronic disease management and mental health services represented eight out of the ten most frequently chosen services. Over 95% of respondents agreed or strongly agreed that they would support the expanded services and that pharmacists have the required skills and knowledge to deliver these services. Findings indicated that the remote and very remote participants chose all of the 26 services more frequently than those in large and medium towns. Age also significantly influenced the frequency of choosing particular services, including osteoporosis testing, vision and eye checks, counselling services, swallowing checks, diet checks and breastfeeding advice and support. CONCLUSION: This study demonstrates that consumers believe that the health of the people in their community will improve with the provision of expanded services. These preliminary findings provide useful baseline information suggesting the development of expanded pharmacy services in rural and remote communities is likely to be well accepted by consumers.

Pharmacists' "Full Scope of Practice": Knowledge, Attitudes and Practices of Rural and Remote Australian Pharmacists.

PURPOSE: Poor health outcomes for patients living in rural and remote areas of Australia are often attributed to the lack of a range of accessible health professionals delivering health services. Community pharmacists are already an integral part of these communities and as such are often the most frequently consulted health professionals. The aim of this study was to explore rural pharmacist knowledge and experiences of expanded pharmacy and to identify the barriers and enablers to remote pharmacists providing expanded pharmacy services (EPS), which can be described as services outside of usual medication management tasks. METHODS: Rural and remote pharmacists (Modified Monash Model (MMM) categories 2-7) participated in an online survey. Descriptive statistics and chi-squared tests were performed and data from open-ended questions were analyzed, categorized into themes and quantitized. RESULTS: Two-thirds (n=13, 68%) of rural pharmacists surveyed (n=19) had knowledge of EPS in rural pharmacies and the majority (n=17, 89%) agreed that these services would benefit rural communities. Mental health service referral was considered very/extremely important by the majority (n=16, 84%) of respondents; however, no pharmacists were currently providing mental health screening services while (n=15, 79%) were willing to provide these services. While staff shortages, costs, time and training were indicated to be the main barriers to the provision of EPS, enablers included accessibility of rural pharmacies and a perceived need. CONCLUSION: This study indicated that pharmacists are already providing some EPS and see value in their implementation; however, what constitutes an expanded service was unclear to some participants. Mental health services were highlighted as most important demonstrating a recognized burden of mental illness in rural and remote locations. Findings from this pilot study will provide further understanding for future development of the pharmacist's scope of practice and implementation of EPS.

Role Theory: A Framework to Explore Health Professional Perceptions of Expanding Rural Community Pharmacists' Role.

Pharmaceutical care is a concept which has moved the pharmacy profession from their primary focus on the product to optimising drug therapy for the individual patient. Expanded pharmacy practice beyond pharmaceutical care will further challenge the role perceptions that other health professionals have about pharmacists. Role theory as a philosophical perspective was used to explore rural and remote health professionals' beliefs on pharmacists expanding their clinical role by conducting twenty-three semi-structured interviews. Five role theory categories described the data, role ambiguity, role conflict, role overload, role identity and role insufficiency. The health professionals interviewed were found to be uncertain about the boundaries between the traditional roles of the pharmacist compared to that of the expanded roles. A perceived lack of accountability by pharmacists was seen as a major contributor to role conflict, which in turn was found to impact the ability of pharmacists and other health professionals to work collaboratively. Perspectives of other health professionals on pharmacists adopting expanded practice models has highlighted significant concerns with role conflict and role identity. Acknowledging and developing clear strategies to address these concerns is essential to ensure that expanded pharmacy practice can be effectively integrated to improve access to health services and thus health outcomes for rural Australians.

Health professional perspectives of expanded practice in rural community pharmacy in Australia.

OBJECTIVES: Expanded pharmacy service delivery for rural and remote Australia has potential to address the rural health disparity. Pharmacists practising to their full scope are recognised as being most beneficial in rural and regional communities, where access to health professionals (HPs) is not comparable to those in metropolitan areas. However, research on HP perspectives on expanded pharmacy practice is limited. This study aims to determine rural and remote HP (doctors, nurses, allied health and other HPs) perspectives of expanded services to be delivered through community pharmacy. METHODS: Australian rural and remote HPs participated in a questionnaire survey which explored views on expanded pharmacy services in their local communities. Potential expanded pharmacy services were provided, and participants were asked to indicate what expanded pharmacy would benefit their local community and their level of support for the services. Analysis of the data included frequency analyses and one-way ANOVA tests with post hoc Tukey's HSD tests using IBM SPSS Statistic 25. RESULTS: Health professionals (N = 121) from rural and remote locations participated. Sexually transmitted disease testing, vaccinations, diabetes and asthma management were the most frequently chosen services that HPs agreed would improve the health of people in their community. Doctors chose the least number of services (mean = 1 services) compared with all other HPs (mean => 5 services). Sixty-eight per cent of participants agreed/strongly agreed that providing these additional services would improve health, with participants (73%) agreeing/strongly agreeing that they would support the implementation of these additional services, not otherwise available in their community. Comparing professional groups, doctors were only half as supportive of expanded pharmacy services, when compared with all other HPs. CONCLUSION: This study confirms the importance of a collaborative, local model to deliver expanded pharmacy services for rural communities. Health professionals were found to largely support expanding pharmacy practice, agreeing about the improved access to health care that would be provided for people living in rural and remote Australia.

The Rural Pharmacy Practice Landscape: Challenges and Motivators.

BACKGROUND: Health outcome delivery for rural and remote Australian communities is challenged by the maldistribution of the pharmacy workforce. High staff turnover rates, reduced pharmacist numbers, and reliance on temporary staff have placed great strain on both state health services and rural community pharmacies. However, recent changes to the demographic profile of the rural pharmacist including a lower average age and increased time spent in rural practice highlights a more positive future for the delivery of better health outcomes for rural communities. The aim of this study was to investigate the factors that motivate and challenge pharmacists' choice to practice rurally. METHODS: Rural pharmacists were invited to participate in semi-structured interviews using purposive non-probability sampling. Twelve pharmacists were interviewed with early-, middle- and late-career pharmacists represented. Participants described their experiences of working and living in rural and remote locations. Three themes emerged: workforce, practice environment and social factors, which were examined to determine the underlying challenges and motivators impacting rural and remote pharmacy practice. RESULTS: Lack of staff presented a workforce challenge, while motivators included potential for expanded scope of practice and working as part of a multidisciplinary team. While social isolation has often been presented as a challenge, an emerging theme highlighted that this may no longer be true, and that notions of "rural and remote communities as socially isolated was a stigma that needed to be stopped". CONCLUSION: This study highlights that despite the challenges rural pharmacists face, there is a shift happening that could deliver better health outcomes for isolated communities. However, for this to gain momentum, it is important to examine both the challenges and motivators of rural pharmacy practice to provide a platform for the development and implementation of appropriate frameworks and programs to better support the rural pharmacy workforce.

Rural pharmacy workforce: Influence of curriculum and clinical placement on pharmacists' choice of rural practice.

OBJECTIVE: This two-phase study aimed to explore the influence of a university rural curriculum and clinical placements on pharmacists' choice to practise in a rural or remote area. DESIGN: A sequential mixed-methods approach involved the design of both a questionnaire and semistructured in-depth interviews to collect quantitative and qualitative data. SETTING: Regional, rural and remote practice areas according to the Pharmacy Access/Remoteness Index of Australia classifications. PARTICIPANTS: Ninety-two pharmacists from varied areas of practice, working in rural and remote locations across Australia, participated in the study. MAIN OUTCOME MEASURES: University curriculum and clinical placements during the degree and their influence on the current rural workforce. RESULTS: In the survey sample, two-thirds of the current rural pharmacy workforce's choice of practice location was significantly influenced by positive rural placement experiences. Rural practice was, however, not included in the curriculum for 50% of the rural workforce in the sample, although graduates from regional universities experienced up to 80% more exposure to rural curricula. In this sample, rural origin was also not found to be a significant determinant of rural practice, while rural lifestyle, family commitments, remuneration, career opportunities and other contractual agreements have had a greater influence than university education. CONCLUSION: Although the positive influence of rural placements has been identified, there is still a way to go in terms of the development of a meaningful rural curriculum. This highlights that universities have a role to play in addressing this issue to produce graduates who are better prepared for the opportunities and challenges of rural pharmacy practice.

Central serous retinopathy and hand-foot-mouth disease: coincidence or causation?

INTRODUCTION: The clinical and pathological correlation between hand-foot-mouth disease (HFMD) and ocular complications has not yet been established. However, individual case reports indicate a trend that may be the emergence of a new burden of the previous self-limiting virus. This virus is particularly prevalent in childcare centers and poses an infectious disease risk for this workplace. OBJECTIVES: The primary objective of this case report is to describe an unusual clinical record of a patient who developed central serous retinopathy while unwell with HFMD. Discussion of management strategies for this workplace, its staff, and visitors is also included. METHODS: This was an observational case report that was identified and reported retrospectively. For comparison, a search of the literature to identify similar ocular complications of HFMD was also undertaken. Results from this search, in addition to international data and prevention and management strategies are also provided. RESULTS: A total of 13 individual case reports with ocular associations, including this clinical record, were identified in the literature worldwide. The median age was 33 years, and three patients (23%) were female. No treatment or management guidelines for ocular complications of HFMD have been identified. CONCLUSION: Severe and potentially life-threatening complications of a seemingly harmless childhood illness are represented sporadically in the literature. The requirement for research and evaluation into this emerging occupational hazard area is necessary for improved prevention, management, and treatment strategies to be developed.