Self-care of long-term conditions: patients' perspectives and their (limited) use of community pharmacies.

Background Self-care support is an 'inseparable' component of quality healthcare for long-term conditions (LTCs). Evidence of how patients view and use community pharmacy (CP) to engage in self-care of LTCs is limited. Objective To explore patients' perspectives of engaging in self-care and use of CP for self-care support. Setting England and Scotland. Method Qualitative design employing semi-structured interviews. LTCs patients were recruited via general practitioners (GPs) and CPs. Interviews were conducted between May 2013 and June 2014; they were audio-recorded, transcribed verbatim and analysed thematically. Results Twenty-four participants were interviewed. Three main themes emerged: engaging in self-care, resources for self-care support and (limited) use of community pharmacy. Participants' LTC 'lived experience' showed that self-care was integral to daily living from being diagnosed to long-term maintenance of health/wellbeing; self-care engagement was very personal and diverse and was based on beliefs and experiences. Healthcare professionals were viewed as providing information which was considered passive and insufficient in helping behavioural change. Non-healthcare sources (family, carers, friends, internet) were important in filling active support gaps, particularly lifestyle management. Participants' use of, and identified need for, community pharmacy as a resource for self-care support of LTCs was limited and primarily focussed on medicines supply. There was low awareness and visibility of CPs' potential roles and capability. Conclusion CP needs to reflect on patients' low awareness of its expertise and services to contribute to self-care support of LTCs. Rethinking how interventions are designed and 'marketed'; incorporation of patients' perspectives and collaboration with others, particularly GPs, could prove beneficial.

How do community pharmacists conceptualise and operationalise self-care support of long-term conditions (LTCs)? An English cross-sectional survey.

OBJECTIVES: To explore community pharmacists' contributions to self-care support of long-term conditions by; investigating their conceptual understanding of self-care principles; identifying self-care support activities they considered important and their engagement in them; and examining barriers and enablers. METHODS: A questionnaire was developed using existing literature and qualitative interviews, piloted and distributed online to a random sample of 10 000 community pharmacists in England between August and November 2014. The questionnaire contained sections addressing the above objectives. Data were analysed using descriptive statistics; free text comments were analysed using content analysis. KEY FINDINGS: A total of 609 responses were received; 334 completed all sections of the survey. Responses to statements exploring conceptual understanding showed that respondents were more likely to agree with self-care principles about patients taking responsibility and being more actively involved in their health and care; they agreed less with self-care principles promoting patient autonomy and independence. Respondents considered medicines-related self-care support activities as a lead role for community pharmacy, which they said they engaged in regularly. Whilst many agreed that other self-care support activities such as supporting self-monitoring and collaborative care planning were important, they indicated only limited engagement. Respondents identified access to patient records and availability of private consultation rooms as their main barriers and enablers, respectively; working relationship with GPs and skill-mix in community pharmacy were viewed as both barriers and enablers. CONCLUSIONS: Community pharmacists in this study conceptualised and operationalised self-care support of long-term conditions (LTCs) from a narrow, medicines-focussed perspective, rather than from a multifaceted, patient-focussed perspective. A concerted and coherent strategy that builds on the strengths, and tackles the identified barriers is needed if community pharmacy is to improve contributions to self-care support of LTCs.

Using longitudinal mixed methods to study the development of professional behaviours during pharmacy work-based training.

Recent longitudinal investigations of professional socialisation and development of professional behaviours during work-based training are lacking. Using longitudinal mixed methods, this study aimed to explore the development of professional behaviours during a year of intensive work-based (pre-registration) training in pharmacy. Twenty trainee pharmacists and their tutors completed semi-structured interview and professional behaviour questionnaires at four time points during 2011/2012: months 1, 4 and 9 during training and 4 months after registration; tutors participated in months 1 and 9. Interviews were analysed thematically using template analysis, and questionnaires were analysed using ANOVA and t-tests. Self-assessed (trainee) and tutor ratings of all elements of professional behaviours measured in questionnaires (appearance, interpersonal/social skills, responsibility, communication skills) increased significantly from the start of pre-registration training to post-registration. Some elements, for example, communication skills, showed more change over time compared with others, such as appearance, and continued to improve post-registration. Qualitative findings highlighted the changing roles of trainees and learning experiences that appeared to facilitate the development of professional behaviours. Trainees' colleagues, and particularly tutors, played an essential part in trainees' development through offering support and role modelling. Trainees noted that they would have benefited from more responsibilities during training to ease the transition into practising as a responsible pharmacist. Longitudinal mixed methods can unpack the way in which professional behaviours develop during work-based training and allow researchers to examine changes in the demonstration of professional behaviours and how they occur. Identifying areas less prone to change allows for more focus to be given to supporting trainees in areas where there is a development need, such as communication skills and holding increasing responsibility.

Exploring the process of professional socialisation and development during pharmacy pre-registration training in England.

OBJECTIVES: To explore the process of professional socialisation in pharmacy trainees during pre-registration training. METHODS: A prospective, longitudinal qualitative design was used. A purposive sample of 20 trainees from community and hospital pharmacy in North West England was recruited. A total of 79 semi-structured interviews were conducted with trainees on three occasions during training and once four months after training. Data were analysed thematically using template analysis. KEY FINDINGS: Early on in training, non-pharmacists played a significant role in socialising trainees into the work setting; pharmacists played the stronger role towards the end. Pre-registration tutors were strong role models throughout training. Training experiences differed between settings, where services provided and patient mix varied. Hospital trainees learnt about specialist medicines on ward rotations. Community trainees developed knowledge of over-the-counter, and less complex, medicines. In hospital, trainees were exposed to a range of role models in comparison to community where this was generally limited to a small pharmacy team. Newly qualified pharmacists were challenged by having full responsibility and accountability. CONCLUSION: This study showed the experiences encountered by trainees that affect their professional socialisation. More standardisation across training sites may reduce the variation in experiences and professional socialisation and development. Formal training for pre-registration tutors and support staff that play a key role in supporting trainees could be considered. Support for newly qualified pharmacists may allay the challenging transition they face when entering practice.

Job characteristics, well-being and risky behaviour amongst pharmacists.

Healthcare practitioners' fitness to practise has often been linked to their personal and demographic characteristics. It is possible that situational factors, such as the work environment and physical or psychological well-being, also have an influence on an individual's fitness to practise. However, it is unclear how these factors might be linked to behaviours that risk compromising fitness to practise. The aim of this study was to examine the association between job characteristics, well-being and behaviour reflecting risky practice amongst a sample of registered pharmacists in a region of the United Kingdom. Data were obtained from a cross-sectional self-report survey of 517 pharmacists. These data were subjected to principal component analysis and path analysis, with job characteristics (demand, autonomy and feedback) and well-being (distress and perceived competence) as the predictors and behaviour as the outcome variable. Two aspects of behaviour were found: Overloading (taking on more work than one can comfortably manage) and risk taking (working at or beyond boundaries of safe practice). Separate path models including either job characteristics or well-being as independent variables provided a good fit to the data-set. Of the job characteristics, demand had the strongest association with behaviour, while the association between well-being and risky behaviour differed according to the aspect of behaviour being assessed. The findings suggest that, in general terms, situational factors should be considered alongside personal factors when assessing, judging or remediating fitness to practise. They also suggest the presence of different facets to the relationship between job characteristics, well-being and risky behaviour amongst pharmacists.

Restructuring supervision and reconfiguration of skill mix in community pharmacy: Classification of perceived safety and risk.

BACKGROUND: Broadening the range of services provided through community pharmacy increases workloads for pharmacists that could be alleviated by reconfiguring roles within the pharmacy team. OBJECTIVES: To examine pharmacists' and pharmacy technicians (PTs)' perceptions of how safe it would be for support staff to undertake a range of pharmacy activities during a pharmacist's absence. Views on supervision, support staff roles, competency and responsibility were also sought. METHODS: Informed by nominal group discussions, a questionnaire was developed and distributed to a random sample of 1500 pharmacists and 1500 PTs registered in England. Whilst focused on community pharmacy practice, hospital pharmacy respondents were included, as more advanced skill mix models may provide valuable insights. Respondents were asked to rank a list of 22 pharmacy activities in terms of perceived risk and safety of these activities being performed by support staff during a pharmacist's absence. Descriptive and comparative statistic analyses were conducted. RESULTS: Six-hundred-and-forty-two pharmacists (43.2%) and 854 PTs (57.3%) responded; the majority worked in community pharmacy. Dependent on agreement levels with perceived safety, from community pharmacists and PTs, and hospital pharmacists and PTs, the 22 activities were grouped into 'safe' (n = 7), 'borderline' (n = 9) and 'unsafe' (n = 6). Activities such as assembly and labeling were considered 'safe,' clinical activities were considered 'unsafe.' There were clear differences between pharmacists and PTs, and sectors (community pharmacy vs. hospital). Community pharmacists were most cautious (particularly mobile and portfolio pharmacists) about which activities they felt support staff could safely perform; PTs in both sectors felt significantly more confident performing particularly technical activities than pharmacists. CONCLUSION: This paper presents novel empirical evidence informing the categorization of pharmacy activities into 'safe,' 'borderline' or 'unsafe.' 'Borderline' activities will deserve particular attention, especially where they are part of processes, e.g. dispensing. This categorization could help inform reconfiguration of skill mix in community pharmacy and thus make an important contribution to the rebalancing medicines legislation agenda and pharmacist supervision.

From "retailers" to health care providers: Transforming the role of community pharmacists in chronic disease management.

Community pharmacists are the third largest healthcare professional group in the world after physicians and nurses. Despite their considerable training, community pharmacists are the only health professionals who are not primarily rewarded for delivering health care and hence are under-utilized as public health professionals. An emerging consensus among academics, professional organizations, and policymakers is that community pharmacists, who work outside of hospital settings, should adopt an expanded role in order to contribute to the safe, effective, and efficient use of drugs-particularly when caring for people with multiple chronic conditions. Community pharmacists could help to improve health by reducing drug-related adverse events and promoting better medication adherence, which in turn may help in reducing unnecessary provider visits, hospitalizations, and readmissions while strengthening integrated primary care delivery across the health system. This paper reviews recent strategies to expand the role of community pharmacists in Australia, Canada, England, the Netherlands, Scotland, and the United States. The developments achieved or under way in these countries carry lessons for policymakers world-wide, where progress thus far in expanding the role of community pharmacists has been more limited. Future policies should focus on effectively integrating community pharmacists into primary care; developing a shared vision for different levels of pharmacist services; and devising new incentive mechanisms for improving quality and outcomes.

A qualitative study exploring community pharmacists' awareness of, and contribution to, self-care support in the management of long-term conditions in the United Kingdom.

BACKGROUND: Self-care support refers to activities aimed at educating, training and empowering patients with skills and ability to manage [and monitor] their long-term conditions (LTCs). While self-care support by health care professionals has emerged as a distinct concept in the management of LTCs, evidence of community pharmacy's contribution is sparse. OBJECTIVE: The aim was to explore community pharmacy's contribution to self-care support of LTCs. The objectives were to explore how community pharmacists conceptualize self-care support of LTCs and how they operationalize the core elements of this in their practice. METHODS: Semi-structured interviews were conducted with community pharmacists in England (n = 12) and Scotland (n = 12). A framework consisting of the core elements of self-care support (information and advice; skills training and support; technology; support networks; and collaborative care planning) was developed from the literature and was used to structure the interviews and analysis. Analysis was done thematically using the interpretative phenomenological analysis technique. RESULTS: The three main themes that emerged were conceptualization; operationalization of the core elements; and barriers to providing self-care support. Participants conceptualized self-care of LTCs as patients taking responsibility for their own health, performing activities that improved their LTCs and that enabled them to become more independent in managing their LTCs. Their views on self-care support did not reflect this conceptual understanding but was described primarily as providing patients with information and advice rather than actively supporting them. Participants' views of operationalizing the core elements of self-care support was found to be medicines focused, opportunistic and dependent on the services they provided, rather than being patient-centered and proactive. The barriers to providing self-care support of LTCs in community pharmacy were described as priority accorded to dispensing activities, the structure of the community pharmacy contract, lack of incentives to provide self-care support and patients' expectations and lack of awareness of community pharmacy's role in LTCs management. CONCLUSION: Community pharmacists' theoretical understanding of self-care was not reflected in the ways that they portrayed their contributions to self-care support. The current ways in which community pharmacy delivers its services for patient care may need to be re-configured in order to fit into the holistic self-care support paradigm.

Changes to supervision in community pharmacy: pharmacist and pharmacy support staff views.

Pharmacists now offer increasing levels and ranges of clinical, diagnostic and public health services, which may require a pharmacist to be absent from the pharmacy premises. Currently, in the UK, many pharmacy activities legally require the direct supervision and physical presence of the pharmacist. This study aimed to explore the potential for changes to supervision, allowing pharmacist absence, and greater utilisation of pharmacy support staff. Four nominal group discussions were conducted in May 2012 with community pharmacists (CPs), community pharmacy support staff, hospital pharmacists and hospital pharmacy support staff, involving 21 participants. Participants were asked to generate pharmacy activities, which they felt could/could not be safely performed by support staff in the absence of a pharmacist, followed by a discussion of these items and voting using an agreement scale. A written record of the items generated and voting scores was made and the group discussion elements were audio-recorded, transcribed verbatim and analysed thematically. The selling of general sales list medicines, assembly of prescriptions and provision of public health services received a high level of agreement between groups, as activities that could be performed. There was greater disagreement about the safety of support staff selling pharmacy medicines and handing out checked and bagged prescription items to patients. Group discussion revealed some of the main challenges to supervision changes, including CPs' perceptions about their presence being critical to patient safety, reluctance to relinquish control, concerns about knowing and trusting the competencies of support staff, and reluctance by support staff to take greater professional responsibility. The findings of this study aim to inform a future consultation on changes to pharmacy supervision in the UK. The empowerment of pharmacy technicians as a professional group may be key to any future change; this may require clarity of their professional responsibilities, enhanced career progression and appropriate remuneration to match greater responsibility.

Risk factors for hospital admissions associated with adverse drug events.

STUDY OBJECTIVE: To identify predictors of hospital admissions associated with adverse drug events (ADEs) and to determine the preventability of ADEs in patients admitted to two hospitals. DESIGN: Prospective observational study. SETTING: Medical admission units at two British National Health Service hospitals in the United Kingdom. PATIENTS: 3904 adults age 16 years or older who were admitted to the two hospitals between June 2006 and November 2007. MEASUREMENTS AND MAIN RESULTS: Clinical pharmacists identified hospital admissions associated with drug-related problems by using medical record review, supplemented by patient interview for those identified as having an ADE. The contribution of ADEs to hospital admission and the causality, severity, and preventability of the events were independently assessed by a multidisciplinary clinical team. Multivariate logistic regression was used to identify predictors of hospital admissions associated with ADEs, and a maximum-likelihood multinomial model was used to examine predictors of the preventability of ADEs. Of the 3904 patients included in the analysis, 439 (11.2%) were judged by the review panel to have experienced ADEs. Of these, 209 patients (47.6%) experienced preventable ADEs. Four independent variables were found to have significant relationships with ADE admissions and preventability of ADEs: patient age, length of time since starting new drug, total number of prescription drugs, and hospital site. Drug classes most commonly associated with preventable ADEs were antiplatelet drugs, anticoagulants, diuretics (loop and thiazide diuretics), angiotensin-converting enzyme inhibitors, and antiepileptic drugs. CONCLUSION: Adverse drug events are an important cause of hospital admission. Better systems for health care practitioners to identify patients at high risk of preventable hospital admissions associated with ADEs (e.g., age > 65 years old, receiving more than five drugs, and starting new high-risk drugs) should be implemented in order to minimize the risks to patients and the burden on the health care system.

An exploration of the utility of appraisals for the revalidation of pharmacy professionals in community pharmacy in Great Britain.

BACKGROUND: With revalidation in pharmacy in the United Kingdom fast approaching, appropriate systems of revalidation in community pharmacy are required. With little known about the potential use of appraisals for evaluating fitness to practice in pharmacy professionals (pharmacists and pharmacy technicians) in this sector, research was undertaken to explore their potential utility in a revalidation process. OBJECTIVES: To examine existing structures and processes in community pharmacy appraisals in Great Britain (ie, England, Scotland, and Wales) and consider the views of pharmacy stakeholders on if, and how, appraisals could contribute to revalidation of pharmacy professionals. METHODS: Semi-structured telephone interviews were conducted with senior staff (eg, superintendents and professional development managers) from chain community pharmacies as well as pharmacy managers/owners from independent pharmacies. Senior staff from locum agencies and pharmacy technician stakeholders were also interviewed. RESULTS: Appraisals were in place for pharmacists in most chain pharmacies but not in independent pharmacies. Locum pharmacists were not appraised, either by the companies they worked for or by the locum agencies. Pharmacy managers/owners working in independent pharmacies were also not appraised. Pharmacy technicians were appraised in most chain pharmacies but only in some independent pharmacies. Where appraisals were in operation, they were carried out by line managers who may or may not be a pharmacist. Appraisals did not seem to cover areas relevant to fitness to practice but instead focused more on performance related to business targets. This was particularly true for those in more senior positions within the organization such as area managers and superintendent pharmacists. CONCLUSIONS: Existing systems of appraisal, on their own, do not seem to be suitable for revalidating a pharmacy professional. Considerable changes to the existing appraisal systems in community pharmacy and employer engagement may be necessary if they are to play a role in revalidation.

Existing arrangements for monitoring community pharmacies in England: can they have a role in the revalidation of pharmacists?

BACKGROUND: Maintaining and regulating professional competence in health care is a growing concern. Tasked with developing a system of revalidation for pharmacy professionals, the pharmacy regulator in Great Britain commissioned a series of studies to evaluate existing sources of evidence as potential contributors to the revalidation process. OBJECTIVES: To explore the utility of existing regulatory inspections and service commissioners' contract monitoring processes in the community pharmacy sector as sources of evidence of the fitness to practice of pharmacists in England. METHODS: Thirteen semistructured telephone interviews conducted with representatives of the regulatory Inspectorate and community pharmacy commissioners. RESULTS: Interviewees described current processes for inspecting and monitoring community pharmacy premises and the services they provided. Their focus was primarily on the pharmacy and not on the pharmacist. Views were given as to how the roles of the Inspectorate and service commissioners might be developed to incorporate aspects of revalidation. Particular issues were raised in relation to the revalidation of self-employed locum and independent owner pharmacists. CONCLUSIONS: Existing inspection and contract monitoring processes have little utility in providing evidence of the fitness to practice of individual community pharmacists in England. However, there may be potential for the Inspectorate and service commissioners to develop a role in revalidation, particularly for locum pharmacists and/or independent pharmacy owners. Moreover, they may take a role in providing the infrastructure required to support the process of revalidation for community pharmacists. Current financial pressures and restructuring in the National Health Service, however, are obstacles to the development of revalidation processes.

Pharmacists' and pharmacy technicians' views on a process of revalidation of pharmacy professionals in Great Britain.

BACKGROUND: Revalidation will be introduced for pharmacy professionals in Great Britain. However, what pharmacists and technicians understand about it as a process remains unexplored. OBJECTIVES: This study aimed to explore the views of pharmacists and technicians about the revalidation of fitness to practice. Views were gathered on the sources of evidence that could be used, assessment methods, who should undertake the assessment, and how often it should occur. METHODS: A multiple methods study was conducted with community and hospital pharmacists and technicians. It included 6 focus groups, 14 one-to-one interviews, and a postal survey sent in March 2009 to a 10% randomly selected sample of 4640 practising pharmacists and 738 technicians working in England, Scotland, and Wales. RESULTS: Twenty-nine pharmacists and 16 technicians participated in the focus groups and interviews; 1206 (26.4%) pharmacists and 240 (32.8%) technicians returned a completed questionnaire. A large majority of both pharmacists (86%) and technicians (81%) were in favor of continuing professional development (CPD) records being used as evidence to inform revalidation, but only a small proportion of both groups agreed that patient feedback should be used. Evidence from appraisals and peers/colleagues was also well supported. Technicians were significantly more likely than pharmacists to indicate that their assessment for revalidation should be undertaken by their main employer. Although most technicians (49%) believed that revalidation should take place every 2-3 years, most pharmacists (58%) believed that it should occur only every 5 years. CONCLUSIONS: Pharmacists and technicians do not share the same views on all aspects of revalidation, suggesting that 1 single model may not be desirable or practicable. Both groups identified CPD, appraisal, and feedback from peers as possible components of revalidation, but concerns about impartiality and independence of assessors were raised.

Ensuring continuing fitness to practice in the pharmacy workforce: Understanding the challenges of revalidation.

BACKGROUND: Revalidation is about assuring that health practitioners remain up to date and fit to practice, and demonstrating that they continue to meet the requirements of their professional regulator. OBJECTIVES: To critically discuss issues that need to be considered when designing a system of revalidation for pharmacy professionals. Although providing international context, the article focuses in particular on Great Britain (GB), where both pharmacists (Phs) and pharmacy technicians (PTs) are regulated. METHODS: Following a brief historical overview, the article draws on emerging evidence in context. RESULTS: Revalidation may involve discrete periodic assessment or a continuous process of assessment against clearly identified standards. The evolving scope of pharmacy practice involves increasingly clinical roles and also practitioners in nonpatient-facing roles. The potential risk to patients and the public may require consideration. Although revalidation, or systems for recertification/relicensure, exist in numerous jurisdictions, most center on the collection of continuing education credits; continuous professional development and reflective practice are increasingly found. Revalidation may involve assessment of other sources, such as appraisals or monitoring visits. Existing revalidation systems are coordinated centrally, but particularly in larger jurisdictions, like GB, where approximately 67,000 pharmacy professionals are regulated, some responsibility may need to be devolved. This would require engagement with employers and contracting organizations to ensure suitability and consistency. Existing systems, such as company appraisals, are unfit for the assessment of fitness to practice owing to a focus on organizational/business targets. Certain groups of pharmacy professionals may pose particular challenges, such as self-employed locums, pharmacy owners, those working in different sectors, or returning after a break. CONCLUSIONS: To ensure proportionality, it must be considered whether the same standards and/or sources of evidence should apply to all pharmacy professionals, either dependent on whether they are patient facing, their scope of practice, or whether Phs and PTs should be treated differently.

Revalidation arrangements for pharmacy professionals in industry and academia in Great Britain: a qualitative study.

BACKGROUND: Pharmacy, like other health professions in Great Britain (GB), is currently considering potential future revalidation arrangements for its members. To date, evidence about performance appraisal arrangements for pharmacy professionals working in nonpatient-facing sectors has been scarce. OBJECTIVES: This study aimed to explore the use of appraisals and other sources of evidence for the purposes of revalidating pharmacy professionals working in the pharmaceutical industry and in academia. METHODS: A qualitative study was undertaken; the sampling strategy was purposive and telephone interviews were carried out with pharmacy professionals working in pharmaceutical companies and schools of pharmacy in GB. The interviews were semistructured and the topic guides were designed to elicit participants' experiences of appraisal systems and views about the relevance of such systems to revalidation. The data generated were analyzed using the framework technique. RESULTS: Fourteen pharmacists and pharmacy technicians working in pharmaceutical companies and schools of pharmacy in GB took part in interviews. All participants had experience of appraisals but did not tend to link these to revalidation. Other sources of evidence relating to work performance were described and some aspects of pharmaceutical industry requirements were seen as potentially relevant to revalidation. The importance of being assessed by someone with an adequate understanding of the area of practice was emphasized in both sectors. CONCLUSIONS: Although industry and academia are "nonpatient-facing" sectors, much work undertaken within them is still professional pharmacy practice. There are defined governance roles in industry, which need to be undertaken by reliable and competent practitioners. Those responsible for any future revalidation system in pharmacy must ensure it is underpinned by an adequate and up to date understanding of the context and nature of the work undertaken by those it covers to ensure that measures of fitness to practice are valid.

Career breaks and changes of sector: challenges for the revalidation of pharmacists.

BACKGROUND: Taking a career break or moving between sectors of practice (for example, between patient-facing and non-patient-facing roles) often has been assumed to pose a risk for pharmacists' fitness to practice. However, it is not clear what the nature of that risk is, or what its implications are for professional revalidation. OBJECTIVES: To explore: (i) the experiences of pharmacists who either return to practice following a career break or move from one sector of practice to another; and (ii) the experiences of those who support or observe pharmacists undergoing one of these changes. METHODS: Eighteen registered pharmacists in Northern Ireland, all of whom had either undergone a change in practice themselves or had supported another pharmacist through a change in practice, took part in a telephone-based interview. During the interviews, each participant was invited to reflect upon his or her experiences of the change and suggest ways in which such processes should be handled in the future. The interview transcripts were thematically analysed using template analysis. RESULTS: A number of themes captured the issues discussed relating to changes in practice. Firstly, there is a variety of circumstances surrounding a change in practice; secondly, there are various ways in which a pharmacist can prepare for a change in practice; thirdly, a number of factors were thought to facilitate or hinder the process. Finally, training and development needs were identified for pharmacists undergoing a change. CONCLUSIONS: A revalidation scheme for pharmacists should make provision for registrants who have taken a career break or changed sector. Such registrants would benefit from resources to support them through the change in practice; these resources could come from peers, employers, or the regulator.

Pharmacy technicians' views of learning and practice implementation.

OBJECTIVE: Registered pharmacy technicians are a new group of regulated healthcare professionals in Great Britain, who fall under the same requirements for undertaking and recording of continuing professional development (CPD) as pharmacists. Little is known about this group of pharmacy professionals, their understanding of CPD and learning, or how they implement their learning into practice. This study aimed to address this. METHODS: A questionnaire was developed and sent to all 216 attendees of an interactive continuing education workshop provided in 12 different geographical locations in England. KEY FINDINGS: Over a third (n = 146; 67.6%) responded. The majority (94.5%) were female, aged between 40 and 49 years (43.8%), and had qualified less than 10 years ago (49.4%). Most worked in community (56.2%) or hospital (19.9%) pharmacy. When asked about whether they had implemented any of the workshop learning into practice, 84.2% ticked at least one option from a predetermined list, and 83.6% provided detailed descriptions of a situation, what they did and its outcome. These were grouped into two themes: people and places. Places referred to comments made about changes to systems, operations or equipment within the workplace; people concerned changes within respondents themselves or others, such as staff or customers. More than two-thirds (70.3%) had used their learning to create a CPD record, and those who had not (n = 43) gave lack of time but also lack of understanding as reasons. CONCLUSIONS: This study has provided detailed insights into pharmacy technicians' learning, reflection and practice implementation following an interactive workshop.

Characterizing healthcare quality in the community pharmacy setting: insights from a focus group study.

BACKGROUND: There is currently no common frame of reference defining community pharmacy quality. It can therefore be difficult to know whether the provision of care meets minimum standards and how to improve quality of care. OBJECTIVE: The aim of this research was to develop a conceptual framework characterizing healthcare quality in the community pharmacy setting. METHODS: Ten focus group discussions with 47 participants were conducted across the northwest of England, United Kingdom. All participants had experiences of health care provided by community pharmacies and included patients and their carers, pharmacists and pharmacy staff, and National Health Service staff who commissioned pharmacy services. Constant comparative analysis was used to analyze the verbatim transcripts. RESULTS: Community pharmacy quality can be conceptualized as dynamic with 3 interdependent dimensions. Each dimension was associated with structures, processes, and outcomes. The first dimension (accessibility) emphasized that in addition to patients requiring access to the available services, medicines, and health care advice, it was equally important for pharmacy personnel to have access to adequate structures to provide quality health care. The second dimension (effectiveness) highlighted a shift away from simply supplying medicines to supplying medicines appropriately, from passively providing services and information to individualizing advice to achieve intended outcomes, and from having structures available to using them purposefully to achieve outcomes. The third dimension (positive perceptions of the experience) enabled patients and carers to better care for themselves and for others, and it influenced future access. At the same time, when pharmacy personnel believed themselves to be valued and that they had done a good job, they felt motivated to continue to provide high-quality care. CONCLUSIONS: All 3 dimensions should be considered when the term quality is used in the context of community pharmacy. This research can be used as a springboard for similar studies in other sectors or jurisdictions wishing to characterize quality for their health care services. In particular, this research provides a common frame of reference for those interested in the provision and assessment of quality health care from community pharmacies.

Integration and differentiation: a conceptual model of general practitioner and community pharmacist collaboration.

BACKGROUND: The drive for integrative systems and collaboration across organizations and professions involved in the provision of health and social care has led to the development of a number of scales and models that conceptualize collaborative behavior. Few models have captured the dynamics of the collaboration between community pharmacy and general medicine, 2 professional groups that are increasingly being encouraged to adopt more collaborative practices to improve patient care. OBJECTIVES: This article presents a new model of collaboration derived from interviews with general practitioners (GPs) and community pharmacists in England involved in service provision that required some form of collaboration. METHODS: Qualitative interviews were conducted with purposive samples of 13 GPs and 18 community pharmacists involved in the provision of local pharmaceutical services pilots and 14 GPs and 13 community pharmacists involved in the provision of repeat dispensing. RESULTS: The model highlights key components of collaboration, including the importance of trust, communication, professional respect, and "knowing" each other. It is argued here that previous models fail to recognize the asymmetry and differentiation between GPs and community pharmacists, including differences in perception toward and importance assigned to trust and communication. GPs were found to adopt demarcation strategies toward community pharmacies and pharmacists, with independent pharmacies being favored over multiple chains and regular pharmacists favored over locum/sessional pharmacists. This differentiation was repeatedly highlighted by GPs and found to affect their ability or willingness to collaborate. CONCLUSION: The model provides a foundation for the future development of strategy and research focused on the improvement or study of collaborative relationships between community pharmacy and general practice.