The development, feasibility and acceptability of a coach-led intervention to ease novice community pharmacists' transition to practice.

BACKGROUND: Despite reported benefits of transition support programmes for other healthcare professionals, no evidence-based support interventions exist to ease newly-registered novice community pharmacists' (NCPs) transition into practice. OBJECTIVES: To develop an intervention to provide psychosocial support, support the development of professional behaviours and skills of novice pharmacists in community pharmacy and conduct an evaluation. METHODS: The Medical Research Council (MRC) guidance for developing complex interventions was applied to develop a 17-week, pharmacist coach-led intervention, using a social media group, a face-to-face introductory workshop, two webinars, weekly case studies, portfolios (reflective logs and development plans) and a handbook. Twelve newly-registered NCPs participated. A coach log and semi-structured interviews collected data on feasibility, acceptability and perceived impact. RESULTS: Findings suggest the intervention was feasible and highly acceptable to NCPs, who perceived the coach and social media group to be the most valuable components. The coach was described as non-judgemental, approachable and collaborative. Provision of guided one-to-one reflection was viewed as useful for debriefing, feedback and meaningful reflection, and supported development of reflection-in-action. The face-to-face workshop was considered important for establishing rapport and trust. The social media group was most valued for providing an accessible, confidential and responsive support network, in which NCPs felt psychologically safe to learn. This component was reported to present opportunities for developmental discourse and shared reflection with peers, thus reducing the sense of professional isolation. NCPs reported that the intervention led to increases in meaningful learning, confidence, critical reasoning, self-awareness and self-reflection. The webinars and handbook were identified as the least valuable components. CONCLUSIONS: A transition-support intervention using an experienced pharmacist coach, delivered within a safe, supportive, albeit online facilitated learning environment, appeared feasible and valuable in supporting guided reflection and developmental discourse. This facilitates transformative learning, and supports NCPs to gain proficiency and become independent reflective practitioners.

Supporting patients with long-term conditions in the community: Evaluation of the Greater Manchester Community Pharmacy Care Plan Service.

The Greater Manchester Community Pharmacy Care Plan (GMCPCP) service provided tailored care plans to help adults with one or more qualifying long-term condition (hypertension, asthma, diabetes and COPD) to achieve health goals and better self-management of their long-term conditions. The service ran between February and December 2017. The aim of this study was to investigate the impact of the service on patient activation, as measured by the PAM measure (primary outcome). Secondary outcomes included quality of life (EQ-5D-5L, EQ-VAS), medication adherence (MARS-5), NHS resource use and costs, systolic and diastolic blood pressure, HDL cholesterol ratio levels and body mass index (BMI). A before and after design was used, with follow-up at 6-months. A questionnaire was distributed at follow-up and telephone interviews with willing participants were used to investigate patient satisfaction with the service. The study was approved by the University of Manchester Research Ethics Committee. Quantitative data were analysed in SPSS v22 (IBM). A total of 382 patients were recruited to the service; 280 (73%) remained at follow-up. Ten patients were interviewed and 43 completed the questionnaire. A total of 613 goals were set; mean of 1.7 goals per patient. Fifty percent of goals were met at follow-up. There were significant improvements in PAM, EQ-5D-5L and EQ-VAS scores and significant reductions in systolic blood pressure, BMI and HDL cholesterol ratio at follow-up. Mean NHS service use costs were significantly lower at follow-up; with a mean decrease per patient of £236.43 (±SD £968.47). The mean cost per patient for providing the service was £203.10, resulting in potential cost-savings of £33.33 per patient (SD ± 874.65). Questionnaire respondents reported high levels of satisfaction with the service. This study suggests that the service is acceptable to patients and may lead to improvements in health outcomes and allows for modest cost savings. Limitations of the study included the low response rate to the patient questionnaire.

Community pharmacists at transition to independent practice: Isolated, unsupported, and stressed.

While there is evidence from nursing and medicine that transition to independent practitioner is challenging and has implications for patient care, there is little research exploring novice community pharmacists' (NCPs) transition. This study aimed to identify the challenges faced by NCPs at transition to independent practitioner and perceptions of the relative importance of these challenges. Nominal group discussions were held between November 2015 and April 2016, in North West England, with purposively sampled NCPs, early career pharmacists, work-based preregistration tutors, and pharmacy support staff. In response to the question "What are the challenges faced by NCPs at transition?" participants individually wrote down and subsequently called out, in round-robin fashion, then discussed, and broadly categorised challenges before ranking them in order of importance. Discussions were audio-recorded with consent, transcribed, and analysed thematically. Twenty-five participants from independent, supermarket, and small and large multiple pharmacies took part in five nominal group discussions. Challenges experienced through interacting with the workplace environment were identified as: (in order of importance) relationship management; confidence; decision-making; being in charge and accountable; and adapting to the workplace. With the exception of disagreement between pharmacists and pharmacy support staff regarding whether adapting to the team was challenging for NCPs, all participants reported challenges experienced through interacting with the workplace environment. Challenges were described as inducing psychosocial stress, particularly because NCPs acquired immediate professional accountability, worked in isolation from experienced peers, and faced job-related pressures. Interpretation of the findings suggests that the Karasek job-demand-control-support (JDCS) model of occupational stress provides valuable insight about transition for NCPs. NCPs' jobs are classified as high strain, where high workplace demands coupled with NCPs' lack of control in being able to meet demands, together with isolation and lack of support, result in transition being characterised as causing isostrain, where the workplace becomes a "noxious" environment.

What can community pharmacy learn from the experiences of transition to practice for novice doctors and nurses? A narrative review.

OBJECTIVES: In the absence of literature reporting the transition experiences of novice community pharmacists, peer-reviewed evidence on the transition experiences of novice doctors and nurses was identified and reviewed. Specific objectives included identifying the challenges to transition and their perceived impact, before considering the implications for novice community pharmacists. METHODS: The electronic databases MEDLINE, EMBASE, CINAHL, PsycINFO and ScienceDirect were searched for full peer-reviewed original research papers published 1990-March 2015, reporting the transition experiences of novice doctors and nurses. A narrative review following coding of themes was undertaken to synthesise findings with transferability. KEY FINDINGS: Twenty-five papers using qualitative and quantitative methods were retrieved from nursing (18) and medicine (6). Challenges were categorised into three themes: personal experiences (where acquiring professional accountability, failing to meet expectations, and emotional, cognitive and physical demands of the job heightened stress), social experiences (where support and acceptance at work were hindered by organisational culture, hierarchy or interpersonal conflict) and challenges from job-related experiences (high workloads, task complexity, staffing, rotations and shift patterns). Challenging transitions were perceived by novice practitioners and their peers as impeding learning, impairing performance and having negative implications for patient care. CONCLUSIONS: While some of these findings may be transferable to community pharmacy settings, contextual differences exist: relative isolation from professional peers, commercially driven private-sector settings, full and immediate acquisition of professional accountability and the lack of clinical career pathways or formalised support. Given these differences, is it appropriate that 'day-one' community pharmacists are fully and immediately accountable? Empirical research exploring transition to practice in the community pharmacy setting is needed.