Implementation of pharmacist-led services in primary care: A mixed-methods exploration of pharmacists’ perceptions of a national educational resource package

Main Article Content

Keywords

Pharmacists, General Practice, Primary Health Care, Pharmaceutical Services, Delivery of Health Care, Regional Health Planning, Perception, Program Evaluation, Surveys and Questionnaires, Qualitative Research, Scotland

Abstract

Background: To help alleviate the global pressure on primary care, there has been an increase in the number of clinical pharmacists within primary care. Educational resources are necessary to support this workforce and their development within this role. An educational resource package was developed in Scotland to support the General Practice Clinical Pharmacists (GPCPs), containing a hard copy Competency and Capability Framework (CCF), an online platform (TURAS) and both clinical and educational supervisors in 2016.


Objective: To examine the implementation of a competency-based educational resource package through the exploration of pharmacists’ perceptions of its adoption, acceptability, appropriateness, and feasibility.


Methods: Participants were GPCPs who had been part of a national training event between 2016 and 2018. The participants were given the opportunity to complete an online questionnaire or a semi-structured telephone interview. Both data collection tools were based on Proctor’s model of implementation outcomes: adoption, acceptability, appropriateness and feasibility. Areas covered included GPCPs’ perceptions and level of adoption of the educational resource package developed to support them in their role.


Results: Of a potential 164 participants, 52 (31.7%) completed the questionnaire and 12 (7.3%) completed the interview. GPCPs indicated widespread adoption and were accepting of the resources; however, it was suggested that its value was undermined, as it was not associated with a qualification. The appropriateness and feasibility of the resources depended on GPCPs’ individual situation (including current role, previous job experience, time available, support received from peers and supervisors, and perceptions of resources available).


Conclusions: The suitability of the CCF was evidenced by participants’ adoption and acceptance of the resource, indicating the necessity of a competence-based framework to support the GPCPs’ role. However, its suitability was hindered in terms of varied perceptions of appropriateness and feasibility. Despite the limited sample size, the results indicate that the value of these resources should be promoted across primary care; nevertheless further facilitation is required to allow GPCPs to fully engage with the resources.

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References

1. Barnes E, Ashraf I, Din A. New roles for clinical pharmacists in general practice. Prescriber. 2017;28(4):26-29. https://doi.org/10.1002/psb.1558
2. Bradley F, Seston E, Mannall C, Cutts C. Evolution of the general practice pharmacist's role in England: a longitudinal study. Br J Gen Pract. 2018;68(675):e727-e734. https://doi.org/10.3399/bjgp18x698849
3. Maskrey M, Johnson CF, Cormack J, Ryan M, Macdonald H. Releasing GP capacity with pharmacy prescribing support and New Ways of Working: a prospective observational cohort study. Br J Gen Pract. 2018;68(675):e735-e742. https://doi.org/10.3399/bjgp18x699137
4. Stewart D, Maclure K, Newham R, et al. A cross-sectional survey of the pharmacy workforce in general practice in Scotland. Fam Pract. 2020;37(2):206-212. https://doi.org/10.1093/fampra/cmz052
5. Kjosavik SR. Ongoing recruitment crisis In Norwegian general practice. Scand J Prim Health Care. 2018;36(2):107-108. https://doi.org/10.1080/02813432.2018.1462294
6. MacIsaac P, Snowdon T, Thompson R, Crossland L, Veitch C. General practitioners leaving rural practice in Western Victoria. Aust J Rural Health. 2000;8(2):68-72. https://doi.org/10.1046/j.1440-1584.2000.00232.x
7. Marchand C, Peckham S. Addressing the crisis of GP recruitment and retention: a systematic review. Br J Gen Pract. 2017;67(657):e227-e237. https://doi.org/10.3399/bjgp17x689929
8. Gardiner M, Sexton R, Durbridge M, Garrard K. The role of psychological well-being in retaining rural general practitioners. Aust J Rural Health. 2005;13(3):149-155. https://doi.org/10.1111/j.1440-1854.2005.00677.x
9. Owen K, Hopkins T, Shortland T, Dale J. GP retention in the UK: a worsening crisis. Findings from a cross-sectional survey. BMJ Open. 2019;9(2):e026048. https://doi.org/10.1136/bmjopen-2018-026048
10. Snell R, Langran T, Donyai P. Patient views about polypharmacy medication review clinics run by clinical pharmacists in GP practices. Int J Clin Pharm. 2017;39(6):1162-1165. https://doi.org/10.1007/s11096-017-0538-z
11. Ryan K, Patel N, Lau WM, Abu-Elmagd H, Stretch G, Pinney H. Pharmacists in general practice: a qualitative interview case study of stakeholders' experiences in a West London GP federation. BMC Health Serv Res. 2018;18(1):234. https://doi.org/10.1186/s12913-018-3056-3
12. Hampson N, Ruane S. The value of pharmacists in general practice: perspectives of general practitioners-an exploratory interview study. Int J Clin Pharm. 2019;41(2):496-503. https://doi.org/10.1007/s11096-019-00795-6
13. Develin A. Pharmacists in general practice – ACT pilot program: my journey so far. J Pharm Pract Res. 2017;47(4):308-312. https://doi.org/10.1002/jppr.1367
14. Anderson C, Zhan K, Boyd M, Mann C. The role of pharmacists in general practice: A realist review. Res Social Adm Pharm. 2019;15(4):338-345. https://doi.org/10.1016/j.sapharm.2018.06.001
15. The Scottish Government. The 2018 general medical services contract in Scotland 2018. Edinburgh: The Scottish Government; 2017.
16. Hendry C, Lauder W, Roxburgh M. The dissemination and uptake of competency frameworks. J Res Nurs. 2007;12(6):689-700. https://doi.org/10.1177%2F1744987107079652
17. Benson H, Lucas C, Benrimoj SI, Williams KA. The development of a role description and competency map for pharmacists in an interprofessional care setting. Int J Clin Pharm. 2019;41(2):391-407. https://doi.org/10.1007/s11096-019-00808-4
18. Koster A, Schalekamp T, Meijerman I. Implementation of Competency-Based Pharmacy Education (CBPE). Pharmacy (Basel). 2017;5(1):10. https://doi.org/10.3390/pharmacy5010010
19. von Treuer KM, Reynolds N. A Competency model of psychology practice: Articulating complex skills and practices. Front Educ. 2017;2(54). https://doi.org/10.3389/feduc.2017.00054
20. Mucalo I, Hadžiabdić MO, Govorčinović T, Šarić M, Bruno A, Bates I. The Development of the Croatian Competency Framework for Pharmacists. Am J Pharm Educ. 2016;80(8):134. https://doi.org/10.5688/ajpe808134
21. Udoh A, Bruno-Tomé A, Ernawati DK, Galbraith K, Bates I. The effectiveness and impact on performance of pharmacy-related competency development frameworks: A systematic review and meta-analysis. Res Social Adm Pharm. 2021;17(10):1685-1696. https://doi.org/10.1016/j.sapharm.2021.02.008
22. Sokhi J, Desborough J, Norris N, Wright DJ. Learning from community pharmacists' initial experiences of a workplace-based training program. Curr Pharm Teach Learn. 2020;12(8):932-939. https://doi.org/10.1016/j.cptl.2020.04.017
23. Lim A, Arora G, McInerney B, Vienet M, Stewart K, Galbraith K. Evaluation of a new educational workplace-based program for provisionally registered pharmacists in Australia. Curr Pharm Teach Learn. 2020;12(12):1410-1416. https://doi.org/10.1016/j.cptl.2020.07.008
24. Benson H, Lucas C, Williams KA. Establishing consensus for general practice pharmacist education: A Delphi study. Curr Pharm Teach Learn. 2020;12(1):8-13. https://doi.org/10.1016/j.cptl.2019.10.010
25. Karampatakis GD, Ryan K, Patel N, Stretch G. Capturing pharmacists' impact in general practice: an e-Delphi study to attempt to reach consensus amongst experts about what activities to record. BMC Fam Pract. 2019;20(1):126. https://doi.org/10.1186/s12875-019-1008-6
26. Hazen A, de Groot E, de Gier H, Damoiseaux R, Zwart D, Leendertse A. Design of a 15-month interprofessional workplace learning program to expand the added value of clinical pharmacists in primary care. Curr Pharm Teach Learn. 2018;10(5):618-626. https://doi.org/10.1016/j.cptl.2018.01.006
27. Jorgenson D, Dalton D, Farrell B, Tsuyuki RT, Dolovich L. Guidelines for pharmacists integrating into primary care teams. Can Pharm J (Ott). 2013;146(6):342-352. https://doi.org/10.1177/1715163513504528
28. Groen A, Lucas C, Benson H, Alsubaie M, Boyd MJ. A systematic review of postgraduate training programmes directed at pharmacists entering primary care. Pharm. Educ. 2020;20:313-323. https://doi.org/10.46542/pe.2020.201.313323
29. NHS Education for Scotland. General practice clinical pharmacist: Competency and capability framework. Edinburgh: NHS Education for Scotland; 2016.
30. Falender CA, Shafranske EP. Clinical supervision: the state of the art. J Clin Psychol. 2014;70(11):1030-1041. https://doi.org/10.1002/jclp.22124
31. Day E, Brown N. The role of the educational supervisor: A questionnaire survey. Psychiatr Bull R Coll Psychiatr. 2000;24(6):216-218.
32. Proctor E, Silmere H, Raghavan R, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2011;38(2):65-76. https://doi.org/10.1007/s10488-010-0319-7
33. Blanchard CM, Duboski V, Graham J, et al. A mixed methods evaluation of the implementation of pharmacy services within a team-based at-home care program [published online, 2021 Mar 2]. Res Social Adm Pharm. 2021;[ahead of print]. https://doi.org/10.1016/j.sapharm.2021.02.017
34. Schoonenboom J, Johnson RB. How to Construct a Mixed Methods Research Design. Kolner Z Soz Sozpsychol. 2017;69(Suppl 2):107-131. https://doi.org/10.1007/s11577-017-0454-1
35. Weiner BJ, Lewis CC, Stanick C, et al. Psychometric assessment of three newly developed implementation outcome measures. Implement Sci. 2017;12(1):108. https://doi.org/10.1186/s13012-017-0635-3
36. Santos JRA. Cronbach’s alpha: A tool for assessing the reliability of scales. J Exten. 1999;37(2):1-5.
37. Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs. 2008;62(1):107-115. https://doi.org/10.1111/j.1365-2648.2007.04569.x
38. Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013;13:117. https://doi.org/10.1186/1471-2288-13-117
39. Clarke V, Braun V. Thematic analysis. In: Encyclopaedia of critical psychology. New York, NY: Springer; 2014.
40. Udoh A, Bruno-Tomé A, Ernawati DK, Galbraith K, Bates I. The development, validity and applicability to practice of pharmacy-related competency frameworks: A systematic review. Res Social Adm Pharm. 2021;17(10):1697-1718. https://doi.org/10.1016/j.sapharm.2021.02.014
41. Butterworth J, Sansom A, Sims L, Healey M, Kingsland E, Campbell J. Pharmacists' perceptions of their emerging general practice roles in UK primary care: a qualitative interview study. Br J Gen Pract. 2017;67(662):e650-e658. https://doi.org/10.3399/bjgp17x691733
42. Nabhani-Gebara S, Fletcher S, Shamim A, et al. General practice pharmacists in England: Integration, mediation and professional dynamics. Res Social Adm Pharm. 2020;16(1):17-24. https://doi.org/10.1016/j.sapharm.2019.01.014
43. Kilminster SM, Jolly BC. Effective supervision in clinical practice settings: a literature review. Med Educ. 2000;34(10):827-840. https://doi.org/10.1046/j.1365-2923.2000.00758.x
44. Buist E, McLelland R, Rushworth GF, et al. An evaluation of mental health clinical pharmacist independent prescribers within general practice in remote and rural Scotland. Int J Clin Pharm. 2019;41(5):1138-1142. https://doi.org/10.1007/s11096-019-00897-1
45. Blondal AB, Sporrong SK, Almarsdottir AB. Introducing Pharmaceutical Care to Primary Care in Iceland-An Action Research Study. Pharmacy (Basel). 2017;5(2):23. https://doi.org/10.3390/pharmacy5020023
46. Powell BJ, Proctor EK, Glass JE. A Systematic Review of Strategies for Implementing Empirically Supported Mental Health Interventions. Res Soc Work Pract. 2014;24(2):192-212. https://doi.org/10.1177/1049731513505778