Investigating the impact of primary care networks on continuity of care in English general practice: Analysis of interviews with patients and clinicians from a mixed methods study.

INTRODUCTION: In England, primary care networks (PCNs) offer opportunities to improve access to and sustainability of general practice through collaboration between groups of practices to provide care with a broader range of practitioner roles. However, there are concerns that these changes may undermine continuity of care. Our study investigates what the organisational shift to PCNs means for continuity of care. METHODS: The paper uses thematic analysis of qualitative data from interviews with general practitioners and other healthcare professionals (HCPs, n = 33) in 19 practices in five PCNs, and their patients (n = 35). Three patient cohorts within each participating practice were recruited, based on anticipated higher or lower needs for continuity of care: patients over 65 years with polypharmacy, patients with anxiety or depression and 'working age' adults aged between 18 and 45 years. FINDINGS: Patients and clinicians perceived changes to continuity in PCNs in our study. Larger-scale care provision in PCNs required better care coordination and information-sharing processes, aimed at improving care for 'vulnerable' patients in target groups. However, new working arrangements and ways of delivering care in PCNs undermine HCPs' ability to maintain continuity through ongoing relationships with patients. Patients experience this in terms of reduced availability of their preferred clinician, inefficiencies in care and unfamiliarity of new staff, roles and processes. CONCLUSIONS: New practitioners need to be effectively integrated to support effective team-based care. However, for patients, especially those not deemed 'vulnerable', this may not be sufficient to counter the loss of relationship with their practice. Therefore, caution is required in relation to designating patients as in need of, or not in need of continuity. Rather, continuity for all patients could be maintained through a dynamic understanding of the need for it as fluctuating and situational and by supporting clinicians to provide follow-up care. PATIENT AND PUBLIC INVOLVEMENT (PPI): A PPI group was recruited and consulted during the study for feedback on the study design, recruitment materials and interpretation of findings.

Developing a quality framework for community pharmacy: a systematic review of international literature.

OBJECTIVE: To identify the defining features of the quality of community pharmacy (CP) services and synthesise these into an evidence-based quality framework. DESIGN: Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES: International research evidence (2005 onwards) identified from six electronic databases (Embase, PubMed, Scopus, CINAHL, Web of Science and PsycINFO) was reviewed systematically from October 2022 to January 2023. Search terms related to 'community pharmacy' and 'quality'. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Titles and abstracts were screened against inclusion or exclusion criteria, followed by full-text screening by at least two authors. Qualitative, quantitative and mixed-method studies relevant to quality in CP were included. DATA EXTRACTION AND SYNTHESIS: A narrative synthesis was undertaken. Following narrative synthesis, a patient and public involvement event was held to further refine the quality framework. RESULTS: Following the title and abstract screening of 11 493 papers, a total of 81 studies (qualitative and quantitative) were included. Of the 81 included studies, 43 investigated quality dimensions and/or factors influencing CP service quality; 21 studies assessed patient satisfaction with and/or preferences for CP, and 17 studies reported the development and assessment of quality indicators, standards and guidelines for CPs, which can help define quality.The quality framework emerging from the global literature consisted of six dimensions: person-centred care, access, environment, safety, competence and integration within local healthcare systems. Quality was defined as having timely and physical access to personalised care in a suitable environment that is safe and effective, with staff competent in the dispensing process and pharmacy professionals possessing clinical knowledge and diagnostic skills to assess and advise patients relative to pharmacists' increasingly clinical roles. CONCLUSION: The emerging framework could be used to measure and improve the quality of CP services. Further research and feasibility testing are needed to validate the framework according to the local healthcare context.

Exploring UK undergraduate healthcare students' perspectives on how to effectively design IPE: A qualitative study.

Objectives: To explore healthcare undergraduates' views on how to design effective IPE. The need for interprofessional education implementation in undergraduate healthcare education is gaining wide recognition globally. Students' views about their learning experiences can offer useful insights to advance teaching and learning courses. Thus, in the IPE literature, students' views on how to effectively design IPE can help shape future IPE plans. Methods: Purposeful sampling was used to recruit healthcare students who attended IPE events across three UK institutions. Virtual focus groups were conducted, and audio recorded. Transcripts were thematically analysed and relevant themes were presented under three subheadings, pre, during and post IPE session. Results: Twenty-five students from medicine, nursing, pharmacy, midwifery and other disciplines participated in six focus groups. Students thought IPE should be offered consistently across the programme's years of study to ensure learning continuity. Students from programmes with higher placement hours (nursing and midwifery), suggested more IPE in placement. Pre-IPE sessions, introducing IPE to students attending for the first time was perceived to be important as the lack of awareness/understanding of IPE could adversely impact their willingness to attend and their engagement. During IPE, interaction with other students was perceived as the core of an effective IPE session. Students reported difficulties in communication with other students via online IPE sessions and thought they were less engaged compared to face-to-face sessions. Post-IPE, students valued reflective exercises, whereas traditional formal assessment was seen as a barrier to engagement with the learning. Conclusion: Students considered IPE valuable to prepare for future practice. However, students felt that IPE experiences could be enhanced with proper planning to ensure regular compulsory IPE exposure. For better IPE experiences, IPE design and delivery should be in line with each healthcare programme's unique learning and training curriculum.

Exploring factors influencing implementation of interprofessional education in undergraduate healthcare programmes: a multiple-case study.

Interprofessional education (IPE) can help prepare future graduates to work collaboratively in healthcare teams. Using a multiple-case study approach, we explored IPE across four United Kingdom (UK) Higher Education Institutions (HEIs) to identify factors affecting IPE implementation and outcomes. For each site, educators involved with IPE were surveyed and interviewed to explore IPE implementation. To examine outcomes, students took part in focus groups and accreditation reports published by professional regulators were explored. A total of five IPE courses were surveyed, six IPE leads were interviewed, three focus groups were conducted with students, and sixteen reports were reviewed. Regulators' standards mandating IPE and directives by the Deans were the main triggers for IPE initiation. In sites where the regulator's standards were perceived by educators as non-mandating IPE, some staff were less inclined to engage with IPE initiation, which adversely affected IPE planning and delivery. Students from such sites were less satisfied with their IPE experiences and uncertain about the purpose of IPE. Senior management (i.e. Dean) commitment and support is needed to establish IPE initiatives across the institution and cultivate a collaborative culture. The presence of a collaborative culture was associated with positive feedback from regulators and students regarding IPE.

Hospital-Acquired Infections Caused by Carbapenem-Resistant Enterobacteriaceae: An Observational Study.

Worldwide, hospital-acquired infections (HAIs) are continuously rising within healthcare settings, leading to high mortality and morbidity rates. Many hospitals have reported the spread of carbapenemases globally, specifically within the E. coli and K. pneumoniae species. This study was aimed at analyzing the state of hospital-acquired, carbapenem-resistant E. coli and K. pneumoniae in the United Kingdom between 2009 and 2021. Moreover, the study analyzed the most efficacious approaches to patient management for controlling the carbapenem-resistant Enterobacteriaceae (CRE) spread. Initially, 1094 articles were identified as relevant for screening, and among them, 49 papers were eligible for full-text screening, with a total of 14 articles meeting the inclusion criteria. The information was recorded from published articles through PubMed, the Web of Science, Scopus, Science Direct, and the Cochrane library and was used to search for hospital-acquired carbapenem-resistant E. coli and K pneumoniae in the UK between 2009 and 2021, in order to evaluate the spread of CRE in hospitals. The total number of carbapenem-resistant E. coli was 1083 and this was 2053 for carbapenem-resistant K. pneumoniae in more than 63 UK hospitals. KPC was the dominant carbapenemase produced by K. pneumoniae. The results showed that the treatment options considered depended on the type of carbapenemase produced; K. pneumoniae showed more resistance to a treatment options, i.e., Colistin, than the other carbapenemase. The current state of the UK is at minimal risk for a CRE outbreak; however, appropriate treatment and infection control measures are highly required to prevent this CRE spread at the regional and global levels. The present study findings have an important message for physicians, healthcare workers, and policymakers about hospital-acquired carbapenem-resistant E. coli and K. pneumoniae spread and approaches to patient management.

Integration of pharmacist independent prescribers into general practice: a mixed-methods study of pharmacists' and patients' views.

BACKGROUND: Since 2015, the National Health Service (NHS) has funded pharmacists to work in general practice (GP practice) to ease workload pressures. This requires pharmacists to work in new roles and be integrated effectively in GPs. Independent prescribing is a key part of the GP pharmacist role, but little is known about pharmacists' integration into GP practice as well as patients' perceptions and experiences of the care provided by GP pharmacists. This study aims to explore the perceptions of pharmacist independent prescribers (PIPs) about their integration into GP practice and gain insight into patients' perceptions about the care provided to them by pharmacists. METHODS: A mixed-methods study comprising semi-structured interviews with PIPs (n = 13) followed by questionnaire-based assessment of patients' (n = 77) evaluation of pharmacists' care was conducted between December 2019 and March 2020. Quantitative data were analysed using descriptive statistics. Interviews and open comments of the survey were thematically analysed. RESULTS: Pharmacist independent prescribers reported undertaking a range of patient-facing and non-clinical roles. Lack of understanding about PIPs' clinical role and working beyond their clinical area of competence were some of the barriers to their integration into GP practice. Most patients were satisfied with the consultations they received from pharmacists and reported confidence in the pharmacist's recommendations about their health conditions. However, a few patients (14%) felt they would still need to consult a general practitioner after their appointment and 11% were not sure if a further consultation was needed. CONCLUSIONS: Pharmacist independent prescribers provide a range of clinical services for the management of long-term conditions which appear to be recognised by patients. However, there is a need to address the barriers to PIPs' integration into GP practice to optimise their skill-mix and patient-centred care.

To be or not to be: The identity work of pharmacists as clinicians.

This study explores how pharmacists legitimise the expansion of their clinical work and considers its impact on pharmacists' professional identity work. In the context of pharmacy in the English NHS, there has been an ongoing policy shift towards pharmacists moving away from 'medicines supply' to patient-facing, clinical work since the 1950s. Pharmacists are continuously engaging in 'identity work' and 'boundary work' to reflect the expansion of their work, which has led to the argument that pharmacists lack a clear professional identity. Drawing insights from linguistics and specifically Van Leeuwen's 'grammar of legitimation', this study explains how the Pharmacy Integration Fund, a nationally funded learning programme, provides the discursive strategies for pharmacists to legitimise their identity work as clinicians.

Using normalisation process theory to understand implementation of integrated multi-sector pre-registration trainee pharmacy technician training.

BACKGROUND: The pre-registration trainee pharmacy technician (PTPT) integrated training programme is a workforce intervention designed to train PTPTs in multiple sectors. The programme recruited 35 PTPTs to 2-year training posts which involved employment in one sector, and a minimum of 12 weeks' work-based training in ≥2 further settings each year. AIM: To identify facilitating and inhibiting factors to implementation of the PTPT integrated training programme and make recommendations on ways to embed and maintain PTPT integrated training in routine practice. METHODS: Normalisation Process Theory (NPT) constructs were used as a framework for analysis. Semi-structured interviews (14 PTPTs, 15 supervisors) explored PTPTs' learning and practice experiences over their 2-year training. A survey explored training outcomes (confidence and preparedness to practise) of integrated (n = 31) and single sector PTPTs (n = 39). RESULTS: Whilst some understood the intervention well, others had differing understandings of its purpose and potential benefits (coherence). Educational and practice supervisors acknowledged the importance of regular communication but reported difficulties implementing this due to time constraints (cognitive participation). PTPTs benefitted from having an educational supervisor oversee learning and progress over 2-years, and a practice supervisor for their day-to-day learning. PTPTs' experiences of supervision were inconsistent due to variation in supervisors' availability, knowledge, experience, and level of support (collective action). Participants perceived the PTPT integrated training as supporting development of a flexible pharmacy technician workforce able to work across sectors. The survey found that integrated PTPTs felt significantly more prepared than single-sector PTPTs to work in different settings (reflective monitoring). CONCLUSIONS: PTPTs on the programme had better ability to work in different sectors. Improving implementation requires clear understanding of the intervention's purpose by all stakeholders; clarity on supervisors' roles/contributions; and effective communication between supervisors to create effective learning opportunities. Findings can inform implementation of future multi-sector education and training globally.

Contribution of supervision to the development of advanced practitioners: a qualitative study of pharmacy learners' and supervisors' views.

OBJECTIVE: To apply educational theory to explore how supervision can contribute to the development of advanced practitioners using the example of several postregistration primary care training pathways for pharmacy professionals (pharmacists and pharmacy technicians). DESIGN: Qualitative semistructured telephone interviews applying Billet's theory of workplace pedagogy for interpretation. SETTING: England. PARTICIPANTS: Fifty-one learners and ten supervisors. PRIMARY OUTCOME: Contribution of clinical and educational supervision to the development of advanced practitioners in primary care. RESULTS: Findings were mapped against the components of Billet's theory to provide insights into the role of supervision in developing advanced practitioners. Key elements for effective supervision included supporting learners to identify their learning needs (educational supervision), guiding learners in everyday work activities (clinical supervision), and combination of regular prearranged face-to-face meetings and ad hoc contact when needed (clinical supervision), along with ongoing support as learners progressed through a learning pathway (educational supervision). Clinical supervisors supported learners in developing proficiency and confidence in translating and applying the knowledge and skills they were gaining into practice. Learners benefited from having clinical supervisors in the workplace with good understanding and experience of working in the setting, as well as receiving clinical supervision from different types of healthcare professionals. Educational supervisors supported learners to identify their learning needs and the requirements of the learning pathway, and then as an ongoing available source of support as they progressed through a pathway. Educational supervisors also filled in some of the gaps where there was a lack of local clinical supervision and in settings like community pharmacy where pharmacist learners did not have access to any clinical supervision. CONCLUSIONS: This study drew out important elements which contributed to effective supervision of pharmacy advanced practitioners. Findings can inform the education and training of advanced practitioners from different professions to support healthcare workforce development in different healthcare settings.

Cross-sector pre-registration trainee pharmacist placements in general practice across England: A qualitative study exploring the views of pre-registration trainees and education supervisors.

The Pharmacy Integration Fund commissioned 95 cross-sector pre-registration trainee pharmacist placements across England, which incorporated trainees spending 3-6 months in general practice (GP), whilst employed in hospital or community pharmacy. Delivery models varied (blocks or split weeks/days); trainees had pharmacist tutors at the employing/base (hospital/community pharmacy) organisation and in GP. This study aimed to evaluate implementation of cross-sector pre-registration placements, and to identify barriers and enablers of a "successful" placement that achieved its intended outcomes. A qualitative study was undertaken, using semi-structured interviews with triads/dyads of trainee and pharmacist tutors at base and/or GP site. Interviews explored trainees' and tutors' GP placement experiences, and the contribution of GP placements to achieving intended learning outcomes. Data were thematically analysed. Thirty-four interviews (14 trainees, 11 base tutors, 9 GP tutors) were completed in 11 study sites (5 GP/hospital; 6 GP/community pharmacy). GP placements were perceived as valuable and producing well-rounded pre-registration trainees with a good understanding of two settings. Key benefits of GP placements were trainees' ability to work within multidisciplinary teams, and improved clinical and consultation skills. Contingency planning/flexibility was important when setting up cross-sector placements. GP tutor supervision which supported a gradual transition from shadowing to more independent clinical practice with feedback was perceived as valuable. Good collaboration between tutors at the base and GP site ensured joined-up learning across settings. All participants considered 13 weeks in GP an appropriate minimum duration; community trainees preferred longer duration (26 weeks) for more opportunities for clinical and consultation skills learning. Base and GP tutors would welcome clarity on which pre-registration competencies should be achieved in GP placements, which would also aid quality and consistency across providers. Findings from this study identified key attributes of a successful pre-registration cross-sector training experience. These findings can inform policy reforms including changes to initial education and training of pharmacists.

Using communities of practice as a lens for exploring experiential pharmacy learning in general practice: Are communities of practice the way forward in changing the training culture in pharmacy?

BACKGROUND: Currently, there is little experiential learning in general practice (GP) during UK undergraduate and postgraduate pharmacy education and training. AIM: To apply educational theories to explore pharmacy stakeholders' perceptions of placements in general practice and contribute to the development of a model of experiential learning for pharmacy. METHODS: Qualitative, semi-structured interviews, conducted as part of two studies exploring experiential learning in general practice, with learners and their GP based supervisors. Interviews explored experiences of learning and practice, and what aided or hindered this. An abductive approach to analysis combined inductive coding with deductive, theory-driven interpretation using Lave and Wenger's concept of "Communities of Practice". RESULTS: Forty-four interviews were conducted, with learners and placement supervisors. Participants valued placements for providing authentic patient-facing learning experiences in the workplace, facilitated through legitimate peripheral participation by supervisors and supported by the use of pre- and de-briefing. Learners benefitted from support from their supervisor(s) and other staff during their day-to-day learning (informal learning), whilst also having protected time with their supervisors to discuss learning needs or go through workplace-based assessments (formal learning). Lack of clarity regarding which and how competencies should be assessed / demonstrated in general practice challenged monitoring progress from peripheral to full participation. Findings suggest that GP placements provide opportunities for learning about the patient journey between care settings; to work effectively with multidisciplinary teams; and consolidation and application of consultation / communication skills learning. CONCLUSIONS: The learning culture of GP supports learners' development, providing time and opportunities for meaningful and authentic workplace learning, with healthcare professionals acting as supervisors and mentors. These findings can usefully inform implementation of meaningful learning opportunities in primary and secondary care for those involved in pharmacy education and training.

Applying a whole systems lens to the general practice crisis: cross-sectional survey looking at usage of community pharmacy services in England by patients with long-term respiratory conditions.

OBJECTIVE: UK policy initiatives aiming to extend community pharmacy services to moderate patient demands and to reduce general practitioners' (GPs) workload have had limited success. This study used marketing theory to identify factors that could influence patients to make better use of community pharmacies within the primary care pathway. DESIGN: Cross-sectional postal survey design applying the '7Ps marketing mix' ('product', 'price', 'place', 'promotion', 'people', 'process' and 'physical evidence'). SETTING: Greater Manchester, England. PARTICIPANTS: Patients with asthma or chronic obstructive pulmonary disease registered at two GP practices. PRIMARY OUTCOME: Patient preference for community pharmacy services. RESULTS: The response rate was 29% (289/1003). Most respondents preferred to use GP practices for invasive/diagnostic services (product) while preferring using community pharmacy for medicines supply and minor ailments (place). Stronger preference for using GP practices over community pharmacy was significantly associated with gender (male>female), age group (≥65 years) and healthcare services previously accessed at the pharmacy. Respondents perceived they would be more likely to use community pharmacy services if pharmacists offered them enough time to discuss any concerns (73.3%) (price), if community pharmacies had private/clean consultation rooms (70%-73%) (physical evidence) and if pharmacy staff had strong interpersonal skills (68%-70%) (people). Respondents were divided on likelihood of using community pharmacy services if pharmacists could access their whole medical record but wanted pharmacists to add information about their visit (59.6%) (process). Respondents would be encouraged to use community pharmacy for healthcare services if they were offered services by pharmacy staff or recommended/referred to services by their GP (44%) (promotion). CONCLUSIONS: Using the 7Ps marketing mix highlighted that community pharmacies having staff with strong interpersonal skills, good quality consultation rooms and integrated information systems could positively influence patients to use community pharmacies for management of long-term conditions. There are opportunities for community pharmacies to alleviate GP workload, but a whole system approach will be necessary.

Independent prescribing in primary care: A survey of patients', prescribers' and colleagues' perceptions and experiences.

Besides doctors and dentists, an increasing range of healthcare professionals, such as nurses, pharmacists and podiatrists, can become independent prescribers (IPs). As part of an evaluation for independent prescribing funded training, this study investigated views and experiences of IPs, their colleagues and patients about independent prescribing within primary care. Questionnaires capturing quantitative and qualitative data were developed for IPs, their colleagues and patients, informed by existing literature and validated instruments. IPs were identified following independent prescribing training funded by Health Education England Northwest in 2015-2017. Quantitative data were analysed using descriptive statistics and qualitative data were analysed thematically. Twenty-four patients, 20 IPs and 26 colleagues responded to the questionnaires. Most patient respondents had a long-term medical condition (n = 17) and had regular medicines prescribed (n = 21). IPs were nurses (n = 14), pharmacists (n = 4), one podiatrist (n = 1) and one was unknown. Half of the IPs were current prescribers (n = 10), the other half were still training (to become) IPs (n = 10). Colleague respondents were doctors and nurses (n = 15) other healthcare professionals (n = 8) and practice managers (n = 3). Both current IPs (n = 9) and colleague respondents (n = 25) (strongly) agreed that independent prescribing improved the quality of care provided for patients. Nearly all colleagues were supportive of independent prescribing and believed that they worked well with IPs (n = 25). Patients' perceptions and experiences of their consultations with the IP were mostly positive with the vast majority of respondents (strongly) agreeing that they were very satisfied with their visit to the IP (n = 23). Key barriers and enablers to independent prescribing were centred on IPs' knowledge, competence and organisational factors such as workload, effective teamwork and support from their colleagues. Findings from this study were mainly positive but indicate a need for policy strategies to tackle longstanding barriers to independent prescribing. However, a larger sample size is needed to confirm findings.

Community pharmacy integration within the primary care pathway for people with long-term conditions: a focus group study of patients', pharmacists' and GPs' experiences and expectations.

BACKGROUND: This study aimed to use marketing theory to examine the views of patients, pharmacists and general practitioners (GPs) on how community pharmacies are currently used and to identify how community pharmacy services may be better integrated within the primary care pathway for people with long-term conditions (LTCs). METHODS: A qualitative research design was used. Two focus groups were conducted with respiratory patients (n = 6, 5) and two with type 2 diabetes patients (both n = 5). Two focus groups were held with pharmacists (n = 7, 5) and two with GPs (both n = 5). The "7Ps marketing mix" ("product", "price", "place", "promotion", "people", "process", "physical evidence") was used to frame data collection and analysis. Data was analysed using thematic analysis. RESULTS: Due to the access and convenience of community pharmacies ("place"), all stakeholder groups recommended using community pharmacies over GP practices for services such as management of minor ailments, medication reviews and routine check-ups for well managed LTCs ("product"). All stakeholder groups preferred pharmacy services with clear specifications which focused on specific interventions to reduce variability in service delivery and quality ("process"). However, all stressed the importance of having an appropriate system to share relevant information, allowing pharmacists and GPs two-way flow ("process"). Pharmacists and GPs mentioned difficulties in collaborating with each other due to inter-professional tensions arising from funding conflicts, which leads to duplication of services and inefficient workflow within the primary care pathway ("people"). Patients and GPs were sometimes doubtful of community pharmacies' potential to expand services due to limited space, size and poor quality consultation rooms ("physical evidence"). However, all stakeholder groups recommended promoting community pharmacy services locally and nationally ("promotion"). Patients felt the most effective form of promotion was first-hand experience of high quality pharmacy services and peer word-of-mouth. The added value of using pharmacy services was faster access and convenience for patients, and freeing up GPs' time to focus on more complex patients ("value"). CONCLUSIONS: Using the 7Ps marketing mix highlighted factors which could influence utilisation and integration of community pharmacy services within the primary care pathway for patients with LTCs. Further research is needed to identify their relative importance.

Solidarity or dissonance? A systematic review of pharmacist and GP views on community pharmacy services in the UK.

There has been a strong policy emphasis over the past decade on optimising patient-centred care and reducing general practitioners' (GPs') workload by extending community pharmacy services and collaboration between pharmacists and GPs. Our aim was to review current evidence of pharmacists' and GPs' views of extended community pharmacy services and pharmacists' roles in the United Kingdom (UK). A systematic review was undertaken looking at UK studies investigating pharmacists' and/or GPs' views of community pharmacy services or roles from 2005 to 2017. A range of databases were searched including EMBASE, PubMed, Scopus, Web of Science, International Pharmaceutical Abstracts (IPA), PsycINFO, Science Direct and The Cumulative Index to Nursing and Allied Health Literature (CINAHL). In addition, reference lists of included studies were screened and grey literature was searched. Following the application of inclusion/exclusion criteria, the quality of papers was critically analysed, findings were extracted into a grid and subjected to narrative synthesis following thematic analysis. The search strategy yielded a total of 4,066 unique papers from which 60 were included. Forty-seven papers covered pharmacists' views, nine combined both pharmacists' and GPs' views and four covered GPs' views. Study designs included interviews (n = 31, 52%), questionnaire surveys (n = 17, 28%) and focus groups (n = 7, 12%). Three main themes emerged from the data: "attitudes towards services/roles", "community pharmacy organisations" and "external influences". Pharmacists and GPs perceived a number of barriers to successful implementation and integration of pharmacy services. Moreover, collaboration between pharmacists and GPs remains poor despite the introduction of extended services. Overall, extending community pharmacy services require quality-driven incentives and joint working between community pharmacists and GPs to achieve better integration within the patient's primary care pathway.

Patient and public perspectives of community pharmacies in the United Kingdom: A systematic review.

BACKGROUND: The United Kingdom has been at the forefront of enhancing pharmacist roles and community pharmacy services, particularly over the past decade. However, patient and public awareness of community pharmacy services has been limited. OBJECTIVE: To identify and synthesize the research literature pertaining to patient and public perspectives on: existing community pharmacy services, extended pharmacist roles and strategies to raise awareness of community pharmacy services. SEARCH STRATEGY: Systematic search of 8 electronic databases; hand searching of relevant journals, reference lists and conference proceedings. INCLUSION CRITERIA: UK studies investigating patient or public views on community pharmacy services or pharmacist roles from 2005 to 2016. DATA EXTRACTION AND SYNTHESIS: Data were extracted into a grid and subjected to narrative synthesis following thematic analysis. MAIN RESULTS: From the 3260 unique papers identified, 30 studies were included. Manual searching identified 4 additional studies. Designs using questionnaires (n = 14, 41%), semi-structured interviews (n = 8, 24%) and focus groups (n = 6, 18%) made up the greatest proportion of studies. Most of the studies (n = 28, 82%) were published from 2010 onwards and covered perceptions of specific community pharmacy services (n = 31). Using a critical appraisal checklist, the overall quality of studies was deemed acceptable. Findings were grouped into 2 main themes "public cognizance" and "attitudes towards services" each with 4 subthemes. DISCUSSION AND CONCLUSIONS: Patients and the public appeared to view services as beneficial. Successful integration of extended pharmacy services requires pharmacists' clinical skills to be recognized by patients and physicians. Future research should explore different approaches to increase awareness.

Development and utilization of the Medicines Use Review patient satisfaction questionnaire.

The Medicines Use Review is a community pharmacy service funded in the United Kingdom to improve patients' adherence to medication and reduce medicines waste. The objective was to develop, pilot, and utilize a new Medicines Use Review patient satisfaction questionnaire. A questionnaire for patient self-completion was developed using a published framework of patient satisfaction with the Medicines Use Review service. The questions were validated using the content validity index and the questionnaire piloted through three pharmacies (February-April 2016). The revised questionnaire contained 12 questions with responses on a 5-point Likert scale, and a comments box. The questionnaire was distributed to patients following a Medicines Use Review consultation via community pharmacies (June-October 2016). Exploratory factor analysis and Cronbach's α were performed to investigate the relationships between the items and to examine structural validity. The survey results were examined for patients' reported satisfaction with Medicines Use Reviews, while the handwritten comments were thematically analyzed and mapped against the questionnaire items. An estimated 2,151 questionnaires were handed out, and a total of 505 responses were received indicating a 24% response rate. Exploratory factor analysis revealed two factors with a cumulative variance of 68.8%, and Cronbach's α showed high internal consistency for each factor (α=0.90 and α=0.89, respectively). The survey results demonstrated that patients could show a high degree of overall satisfaction with the service, even if initially reluctant to take part in a Medicines Use Review. The results support the Medicines Use Review patient satisfaction questionnaire as a suitable tool for measuring patient satisfaction with the Medicines Use Review service. A wider study is needed to confirm the findings about this community pharmacy-based adherence service.