AimThe aim of this study was to identify published evidence to inform the development of expanded practice services in rural community pharmacies.Data sourcesThe search strategy was applied to the following electronic databases: MEDLINE, CINAHL, Emcare, Cochrane and Google Scholar.Study selectionIn all, 508 studies were evaluated against inclusion and exclusion criteria, with 29 eligible studies finally included in the review. Services provided needed to meet the described definition of ‘expanded practice’ and be applied in a rural community pharmacy setting. Expanded services were evaluated against at least one of the following: effectiveness, enablers, barriers and feasibility.ResultsThe studies included in this review were conducted in the US (n = 15), Australia (n = 8), Canada (n = 2), New Zealand (n = 1), England (n = 1), Croatia (n = 1) and Ghana (n = 1). All studies were conducted within the past 22 years, with 11 published since 2015. Cardiovascular disease (n = 7), diabetes/metabolic syndrome (n = 4), respiratory disease (n = 6) and vaccinations (n = 5) were the most common diseases or health service targeted in the interventions. Study design varied, reflected in the methodological quality, which included experimental studies (n = 27) and retrospective observational cohort studies (n = 2). Expanded pharmacy services identified included delivery of immunisations and the screening and management of chronic and infectious diseases, such as osteoporosis, asthma, chronic obstructive pulmonary disease, malaria, diabetes and cardiovascular and kidney disease.ConclusionsPharmacists providing these services have an opportunity to improve health outcomes for rural populations.

Elders who shared so much of their ideas at the conception of this project and are continuing to teach us how to provide a better service. We would also like to acknowledge the Hospital and Health Service who supported this project.

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Introduction: Rural areas depend on a specific evidence base that directly informs their unique health systems and population health context. Developing this evidence base and its translation depends on a trained rural health academic workforce. However, to date, there is limited description of this workforce and the field of rural health research. This study aimed to characterise this field to inform how it can be fostered. Methods: Qualitative semi-structured interviews of 50-70 minutes duration were conducted with 17 early career rural health researchers based in Australian rural and remote communities, to explore their professional background, training and research experiences. Results: Six key themes emerged: becoming a rural health researcher; place-based research that has meaning; generalist Rural and Remote Health rrh.org.au

Background: The field of rural health research is critical for informing health improvement in rural places but it involves researching in small teams and distributed sites that may have specific sustainability challenges. We aimed to evaluate this to inform how to sustain the field of rural health research. Methods: We conducted In-depth semi-structured interviews of 50-70 minutes with 17 rural early career researchers who were from different research sites across rural Australia. Data were thematically coded. Results: Seven sustainability challenges were noted, namely recognition, workload, networks, funding and strategic grants, organisational culture, job security, and career progression options. Rural researchers were poorly recognised for their work and researchers were not extended the same opportunities enjoyed by staff at main campuses. Unpredictable and high workloads stemmed from community demand and limited staff. Strategic grant opportunities failed to target the generalist, complex research in this field and the limited time researchers had for grant writing due to their demands within small academic teams. Limited collaboration with other sites increased dissatisfaction. In the face of strong commitment to rural 'places' and their enthusiasm for improving rural health, fixed-term contracts and limited career progression options were problematic for researchers and their families in continuing in these roles. Conclusion: A comprehensive set of strategies is needed to address the sustainability of this field, recognising its value for rural self-determination and health equity. Hubs and networks could enable more cohesively planned, collaborative research, skills sharing, senior academic supervision and career development. Targeted funding, fit to the context and purpose of this field, is urgent. Inaction may fuel regular turnover, starting after a researcher's first years, losing rich academic theoretical and contextual knowledge that is essential to address the health of rural populations.

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.

Background: Pharmacists internationally have successfully expanded their role to provide service delivery to remote rural communities. Aim: This study evaluated Australian rural community pharmacists' perspectives of expanded services, to identify priorities, areas of concern, enablers and barriers to their implementation. Method: A self-administered questionnaire was distributed to rural and remote Australian (all states and territories) pharmacists between September and December 2019; respondents were asked to rank health issues and the expanded pharmacy services that could potentially address these issues in their communities. Questions were also included to evaluate health service accessibility, skills/knowledge, workspace limitations, time and support for the implementation of these services. Potential associations between demographic factors and responses were also assessed. Results: Of the 92 returned responses analysed, the top three heath concerns were: Mental health, Cardiovascular disease and Diabetes. Depression screening/referral, diabetes management and vaccinations were the top three areas rated for expanded services. There was agreement (90%; 83/92) that pharmacists had the skills and knowledge for implementation, while time and space were reported as barriers for 50% (46/92) and 25% (23/92) of pharmacists, respectively. The majority of the pharmacists (80%; 74/92) felt services were not easily accessible, and all (92/92, 100%) agreed that service provision would improve community health outcomes. Conclusion: Rural pharmacists were supportive of the delivery of expanded pharmacy services, describing improved health outcomes and increased access to health services as potential benefits. Successful implementation of these expanded services would require both an understanding of pharmacist resources available and local community health needs.

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 Rural and Remote Health rrh.org.au