Understanding perceptions of involving community pharmacy within an integrated care model: a qualitative study

Abstract

Background: Over the past several years, there has been more emphasis on integration within health care. Community pharmacy is often under-represented within integrated care models. This study explored stakeholder perceptions and enablers of including community pharmacy within an integrated care model. Methods: A qualitative study was undertaken. Participants were recruited through professional networks and social media, as well as snowball recruitment from other participants. They included community pharmacists, clinicians, and decision-makers working in Ontario, Canada. Data were collected using telephone interviews completed with a semi-structured interview guide based on Consolidated Framework for Implementation Research from June to September 2018. Data were analysed inductively and deductively following the Qualitative Analysis Guide of Leuven. An additional theoretical framework (Rainbow Model of Integrated Care) was used to categorize enablers. Results: Twenty-two participants were interviewed including nine pharmacists, seven clinicians, and six decisionmakers. Three key themes were identified: 1) Positive value of including pharmacy in integrated care models; 2) One model does not fit all; and 3) Conflict of interest. Four key enablers were identified reflecting functional and normative factors: functional-1) remuneration, 2) technology; normative-3) engagement, and 4) relationships. While both functional and normative factors were discussed, the latter seemed to be more important to facilitate the inclusion of community pharmacy. Many participants characterized community pharmacists' lack of skills or confidence to provide patient care. Conclusions: This study confirms previously known views about concerns with community pharmacy's conflict of interest. However, discordant perceptions of conflict of interest and negative perceptions about capabilities of community pharmacy need to be addressed for successful integration. Normative enablers, such as culture, are likely important for organizational integration and require additional inquiry.

A Conceptual Framework of the Way Forward to a Community Pharmacist–General Practitioner Collaborative Medication Therapy Management Model for Chronic Diseases in Malaysian Primary Care: A Qualitative Study

“…This study offered similar results to ours regarding various discordant perceptions, concerns, and conflicts of interest. 29 However, we noted one formidable difference: nearly all developed countries have a perfect DS system in practice whereas, in Malaysia, this issue has emerged as a major barrier to collaboration. An important point to establish here is that the barriers to and facilitators of collaboration identified in this study are somehow similar to those enlisted in a recent systematic review that summarized factors affecting collaboration between CPs and GPs around the globe.…”

Understanding the factors influencing community pharmacist retention – A qualitative study

“…This viewpoint is consistent with reports from other jurisdictions where pharmacists also perceived that their knowledge and skills are underutilized and unrecognized, and a sense that their professional identity was one of being ‘shopkeepers’. 20 , 44 With employers, a lack of acknowledgement of their professional expertise together with the deficits in support, augmented the perception of being undervalued. Aspden et al (2021) reported similar viewpoints from New Zealand pharmacists who reported a lack of recognition of pharmacy from the public and other healthcare professionals in addition to lack of support from management within the profession itself.…”

Case management programs for people with complex needs: Towards better engagement of community pharmacies and community-based organisations

“…There is growing recognition that integrating care can improve patients’ outcomes, especially among those with complex health and social needs [ 25 ]. By ensuring communication and collaboration between professionals of various organisations, and the participation of every stakeholder, case managers are “searching for connections between the healthcare system and other human service systems to improve outcomes”, which correspond precisely to the definition of integrated care as stated by Leutz [ 10 ].…”

“…Community pharmacies are private organisations committed to maintaining the overall health of their patients through a variety of interventions: medical information review and treatment follow-up, preparation of medication, adjustment and initiation of treatment, and daily consultations with people who have questions [ 23 ]. Community pharmacists are indispensable partners for patients with polypharmacy [ 24 , 25 ]. They educate and advise people on the use of over-the-counter or prescribed medication and natural health products; support people seeking solutions to minor health problems; contribute to patients’ education regarding healthy lifestyles; and if necessary, refer patients to other health and social services [ 23 ].…”