Systematic review of expanded practice in rural community pharmacy

Abstract

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.

Expanded practice in rural community pharmacy in Australia: pharmacists’ perspectives

“…[7][8][9] Internationally, rural pharmacists are achieving these outcomes by expanding their role in service delivery to address health needs in rural locations, including services such as disease screening, chronic disease clinics, and point-of-care testing. 10 Positive patient outcomes have been reported from the evaluation of these services. Outcomes reported have included a 20% reduction in cardiovascular risk; faster identification and management of infectious diseases including malaria, Human Immunodeficiency Virus (HIV), respiratory and urinary tract infections (RTIs, UTIs); and significantly improved management of chronic diseases including asthma, chronic obstructive pulmonary disease (COPD), cardiovascular disease, depression, and diabetes.…”

Health professional perspectives of expanded practice in rural community pharmacy in Australia

“…Expanded pharmacy services are evolving internationally and the potential benefits for rural and remote communities in Australia have been highlighted. [ 14 ] This study has demonstrated both supportive and opposing viewpoints, with significant differences in responses found for occupation, gender and rurality variables. Interest in pharmacists providing expanded services including sexually transmitted disease testing, vaccinations, diabetes and asthma management were found.…”

Role Theory: A Framework to Explore Health Professional Perceptions of Expanding Rural Community Pharmacists’ Role

“…Rural pharmacists in Australia are widely recognised as the most accessible healthcare provider with the potential to deliver a much greater role in the health system [ 8 ]. This is common across many countries including Canada and New Zealand that share similar rural issues including a lack of access to health professionals working across vast distances and the consequent emergence of health professionals working to their full scope of practice [ 10 ]. The development of expanded services provided by rural pharmacists internationally is demonstrating small but positive impacts on health outcomes in rural and remote communities [ 10 , 14 ].…”

“…Various prescribing models including, adapting a prescription and initiating/managing drug therapy have been implemented internationally [ 2 ]. In addition, rural community pharmacists worldwide have been trialling and providing expanded services, which include point-of-care testing for chronic disease management (e.g., HbA1c/cholesterol/spirometry), infectious diseases (e.g., malaria/HIV), disease screening, immunisation and mental health management [ 10 ].…”

“…This expansion of the role of the pharmacist has resulted in various terms being put forward to describe these new roles, including expanded pharmacy practice, pharmacists’ full scope of practice, extended practice and a rural scope of practice for pharmacists, all implying the provision of services in addition to medication management [ 10 , 11 , 12 , 13 , 14 ]. These terms are often used interchangeably and with little clarity surrounding their definition [ 10 , 11 , 12 , 13 , 14 ]. The terms are distinct from advanced practice which describes an acquired higher level of expertise to achieve a higher performance level [ 13 ].…”