Qualitative meta-synthesis of barriers and facilitators that influence the implementation of community pharmacy services: perspectives of patients, nurses and general medical practitioners

Abstract

ObjectivesThe integration of community pharmacy services (CPSs) into primary care practice can be enhanced by assessing (and further addressing) the elements that enable (ie, facilitators) or hinder (ie, barriers) the implementation of such CPSs. These elements have been widely researched from the perspective of pharmacists but not from the perspectives of other stakeholders who can interact with and influence the implementation of CPSs. The aim of this study was to synthesise the literature on patients’, general practitioners’ (GPs) and nurses’ perspectives of CPSs to identify barriers and facilitators to their implementation in Australia.MethodsA meta-synthesis of qualitative studies was performed. A systematic search in PubMed, Scopus and Informit was conducted to identify studies that explored patients’, GPs’ or nurses’ views about CPSs in Australia. Thematic synthesis was performed to identify elements influencing CPS implementation, which were further classified using an ecological approach.ResultsTwenty-nine articles were included in the review, addressing 63 elements influencing CPS implementation. Elements were identified as a barrier, facilitator or both and were related to four ecological levels: individual patient (n=14), interpersonal (n=24), organisational (n=16) and community and healthcare system (n=9). It was found that patients, nurses and GPs identified elements reported in previous pharmacist-informed studies, such as pharmacist’s training/education or financial remuneration, but also new elements, such as patients’ capability to follow service's procedures, the relationships between GP and pharmacy professional bodies or the availability of multidisciplinary training/education.ConclusionsPatients, GPs and nurses can describe a large number of elements influencing CPS implementation. These elements can be combined with previous findings in pharmacists-informed studies to produce a comprehensive framework to assess barriers and facilitators to CPS implementation. This framework can be used by pharmacy service planners and policy makers to improve the analysis of the contexts in which CPSs are implemented.

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

“…Furthermore, there have been concerns over the retail context of community pharmacies introducing structural and organisational barriers to integration between community pharmacies and GP practices (Jacobs et al., ; Royal Pharmaceutical Society, ). Consequently, pharmacists have been sceptical towards role expansion (Anderson, Blenkinsopp, & Armstrong, ; Eades et al., ; Hall, Donovan, & Wilkes, ) and GPs have been reluctant to accept extended services despite their potential to reduce their pressure and workload (Dhillon, Hattingh, Stafford, & Hoti, ; Hossain et al., ; McGrath et al., ; Smith, Cannon‐Breland, & Spiggle, ).…”

Competence, competition and collaboration: Perceived challenges among Swedish community pharmacists engaging in pharmaceutical services provision and research

“…Collaboration within local healthcare is important for the provision of CPSs and for the development of services that are relevant for practice . The views regarding other healthcare are ambivalent: On the one hand, the respondents regard the collaboration as necessary to manage their workload, attract patients and adapt services to local practice.…”

Support for Australian carers from community pharmacy: Insight into carer perspectives of a novel service

“…Some carers could visualise pharmacies assisting with some aspects of care co‐ordination, such as access to services, while others questioned whether this was within the scope of pharmacy practice. While there are many factors influencing the implementation of Australian community pharmacy services (Hossain et al, ), consumer expectations and perceptions of the pharmacist's role can hinder or enable service success. Further work in showcasing to carers what pharmacists can do for them, beyond medication supply, is warranted.…”

“…Further work in showcasing to carers what pharmacists can do for them, beyond medication supply, is warranted. It is also evident that community pharmacy services need to meet the needs of the individual consumer, as well as the existing gaps in healthcare practice (Hossain et al, ). With respect to our study, there was some consensus that this individualised service was suitably placed within the pharmacy setting, with an acknowledgement that some carers may need more support than others, although they may be resistant to obtaining support for various reasons, such as pride or independence (Ploeg et al, ).…”