A qualitative exploration of the enablers and barriers to the provision of outpatient clinics by hospital pharmacists

Abstract

Background With increasing demands on the National Health Service (NHS), Scottish Government-led pharmacy strategy has prioritised the development and expansion of outpatient services. Pharmacist-led outpatient clinics have been shown to reduce hospital admissions and improve patient outcomes. However, expanding these contemporary models of care has proved challenging, and there are few qualitative data about the factors affecting the provision of these. Aim This study aimed to explore the enablers and barriers to hospital pharmacists providing outpatient clinics within the largest health authority in Scotland, NHS Greater Glasgow & Clyde (NHSGGC). Method Between August and October 2020, one-to-one semi-structured interviews were conducted virtually using the videoconferencing platform Microsoft Teams ® , with NHSGGC hospital pharmacists who did or did not provide clinics. Audio-and video-recordings of the interviews were transcribed verbatim and underwent thematic analysis. Results 16 hospital pharmacists were interviewed; 50% were clinic providers and 50% were not. Analysis generated seven themes: clinical or service need, individual factors, clinic structure and processes, additional clinical skills and training, competing priorities, macro-level pharmacy working, and external stakeholder relationships. Many of these were interdependent and had the potential to be an enabler or a barrier to clinic provision, depending on the context or individual. ConclusionThe enablers and barriers to hospital pharmacists providing outpatient clinics are multifaceted, incorporating individual, systematic and professional factors. The implementation of new national professional curricula may help address many of these factors, however prospective research needs to accompany this vision.

The Collaborative Care Model: Realizing healthcare values and increasing responsiveness in the pharmacy workforce

“…The uptake of leadership skills training is suboptimal, a gulf of leadership skills development commonly opens up early in the career of most Scottish pharmacists, and many struggle to implement leadership skills in day-to-day practice. [56][57][58] Pharmacists identify that they do not understand the common vision and purpose of their teams. 56 Pharmacists also commonly identify a training gap in their skills of population-level care delivery.…”

“…60 Gaps in the availability of mentors can affect the development of clinical skills and services. 58 Given the lack of expectation around individual development beyond post-registration foundation training, the uptake of personal continuing professional development activities is variable across the workforce. 61 These problems manifest in the inability of many pharmacists to adapt to change and develop new roles 58,62 and a predomination of a strong external locus of control in the workforce 58 ; this may be in part due to difference in belief over whose role it is to drive service development.…”

“…61 These problems manifest in the inability of many pharmacists to adapt to change and develop new roles 58,62 and a predomination of a strong external locus of control in the workforce 58 ; this may be in part due to difference in belief over whose role it is to drive service development. 58 These issues precipitate in a number of critical strategic flaws:…”

“…43 Differences in training and development of staff, including a lack of defined service specification, roles and responsibilities, 69 and a lack of a co-produced team vision culminate in the lack of an overall strategic cohesion, unwarranted variation in service delivery, and ultimately unwarranted differences in care provision. 43,58,70 • Lack of Adaptability: The 'Atomistic' Model focuses on the problems of yesterday, with a static vision. The information loss blunts the ability of local services to react to changes in population need or to directly implement new improved therapies.…”

“…The information loss blunts the ability of local services to react to changes in population need or to directly implement new improved therapies. 58 This tension between Leader/Manager(s) and the remaining staff body has created an epidemic crisis of confidence with decision making and a prevalent fear of change amongst many pharmacists. 36,58,71,72 • Isolation: An isolation myth persists, that individual workers are responsible just for the prosecution of their day-to day-tasks.…”