Local government stakeholders' perceptions of potential policy actions to influence both climate change and healthy eating in Victoria: A qualitative study.

ISSUE ADDRESSED: Climate change is a defining public health issue of the 21st century. Food systems are drivers of diet-related disease burden, and account for 30% of global greenhouse gas emissions. Local governments play a crucial role in improving both the healthiness and environmental sustainability of food systems, but the potential for their actions to simultaneously address these two issues is unclear. This study aimed to explore the perceptions of Australian local government stakeholders regarding policy actions simultaneously addressing healthy eating and climate change, and the influences on policy adoption. METHODS: We conducted 11 in-depth semi-structured interviews with stakeholders from four local governments in Victoria, Australia. Data were analysed using reflexive thematic analysis. We applied Multiple Streams Theory (MST) 'problem', 'politics and 'policy' domains to explain policy adoption influences at the local government level. RESULTS: Key influences on local government action aligned with MST elements of 'problem' (e.g., local government's existing risk reports as drivers for climate change action), 'policy' (e.g., budgetary constraints) and 'politics' (e.g., local government executive agenda). We found limited evidence of coherent policy action in the areas of community gardens, food procurement and urban land use. CONCLUSION: Barriers to further action, such as resource constraints and competing priorities, could be overcome by better tailoring policy action areas to community needs, with the help of external partnerships and local government executive support. SO WHAT?: This study demonstrates that Victorian local stakeholders believe they are well-positioned to implement feasible and coherent interventions that address both healthy eating and climate.

Funding community pharmacy dispensing: A qualitative exploration of current and alternate models leading to the development of quality focused funding principles.

BACKGROUND: Performance-linked remuneration for pharmacists' dispensing in which payment may be adjusted based on an outcome of the service, has been introduced by some funders in the US. However, in most countries, pharmacists' dispending is still remunerated on a set fee-for-service (sFFS) basis. OBJECTIVE: To assess sFFS and performance-linked payment concepts and identify quality-focused funding principles for dispensing within an Australian context. METHODS: Within an adaptation framework, the study used thematic analysis of interviews with Australian community pharmacy stakeholders to evaluate the existing sFFS dispensing payment model, determine the fit of key elements of a performance-linked payment model, and evaluate acceptance of a simple performance-linked model. We induced quality-focused dispensing payment principles from the data. RESULTS: sFFS funding is not ideal for either patients or the profession as it encourages pharmacists to dispense quickly rather than commit time and expertise in accordance with each patient's requirements. However, the lack of specificity and correlation between pharmacists' services and patient outcomes is an impediment to using performance-linked payment in Australia. CONCLUSIONS: Quality-focused principles within a fee-for-service model should separate payment for commercial aspects of dispensing from professional aspects, which should include a schedule of time-based payments linked to patient and medication risk factors.