Pharmacy Practice <p><strong>Pharmacy Practice</strong> is a free full-text peer-reviewed journal with a scope on pharmacy practice. <strong>Pharmacy Practice</strong> is published quarterly. <strong>Pharmacy Practice <span style="text-decoration: underline; color: #ff0000;">does not charge and will never charge any publication fee or article processing charge (APC) to the author</span><span style="text-decoration: underline;"><span style="color: #ff0000; text-decoration: underline;">s</span></span></strong>.</p> Centro de Investigaciones y Publicaciones Farmaceuticas en-US Pharmacy Practice 1885-642X <p>The authors hereby transfer, assign or otherwise convey to Pharmacy Practice (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print or epublish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to <strong>Pharmacy Practice</strong> with this document.</p> <p>Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a <a href="" target="_blank" rel="noopener">Creative Commons Attribution License</a> (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</p> <p><strong><span class="label">Author Self-Archiving Policy</span></strong></p> <p><span class="label"><strong>Pharmacy Practice</strong> permits and encourages authors to post and archive the<strong> final </strong>PDFs of their respective articles submitted to the journal on personal websites or institutional repositories after publication, while providing bibliographic details that credit its publication in this journal.</span></p> Is my paper relevant for an international audience? <p>This is the first question one should consider before submitting a paper to an international journal. The answer is simple: If researchers or practitioners from another country can learn something from your paper that can influence a practice or a research they are involved in, then your paper is relevant for an international audience. There are many elements that can influence in this cross-border transferability. One could think that having a big “n”, or performing complex statistical calculations, or using complicated study designs makes the paper more attractive to colleagues from other countries. These elements can help, but they are not sufficient. On the other hand, one could think that a study performed in a small hospital in a given country will never be of interest for these foreign colleagues. That is not necessarily correct. Let’s burst some myths.</p> Fernando Fernandez-Llimos Copyright (c) 2020 Pharmacy Practice and the Authors 2020-04-29 2020-04-29 18 2 1924 1924 10.18549/PharmPract.2020.2.1924 Patient experience with clinical pharmacist services in Travis County Federally Qualified Health Centers <p><strong>Background</strong>: Positive patient experiences with care have been linked to improved health outcomes. Patient experience surveys can provide feedback about the level of patient-centered care provided by clinical pharmacists and information about how to improve services.</p> <p><strong>Objectives</strong>: Study objectives are: 1) To describe patient experience with clinical pharmacist services in a federally qualified health center (FQHC). 2) To determine if demographic or health-related factors were associated with patient experience.</p> <p><strong>Methods</strong>: This cross-sectional survey included adult patients who were English or Spanish speaking, and completed a clinical pharmacist visit in March or April 2018. Patient experience was evaluated, on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree), with 10 items using four domains: pharmacist-patient interaction information provision, support for self-care, and involvement in decision making. In addition, one item was used to rate the overall experience. Demographic and health-related variables were also collected. Eligible patients completed the survey after their clinical pharmacist visit. Descriptive and inferential statistics, as well as Cronbach’s alpha for scale reliability, were employed.</p> <p><strong>Results</strong>: Respondents (N=99) were 55.4 (SD=12.1) years and 53.1% were women. Overall, patients rated their experiences very high with the 10-item scale score of 4.8 (SD=0.4) out of 5 points and the overall experience rating of 4.9 (SD=0.4) out of 5 points. With the exception of race, there were no differences between patient experience and demographic and health-related variables. African Americans had significantly (p=0.0466) higher patient experience scores compared to Hispanics.</p> <p><strong>Conclusions</strong>: Patients receiving care in a FQHC highly rated their experience with clinical pharmacists. This indicates that clinical pharmacists provided a high level of patient-centered care to a diverse group.</p> Jennifer Shin Leticia Moczygemba Jamie C. Barner Aida Garza Sara Linedecker-Smith Maaya Srinivasa Copyright (c) 2020 Pharmacy Practice and the Authors 2020-04-23 2020-04-23 18 2 1751 1751 10.18549/PharmPract.2020.2.1751 Inpatient self-administered medication under the supervision of a multidisciplinary team: a randomized, controlled, blinded parallel trial <p><strong>Background</strong>: Self-administered medication (SAM) is encouraged in many hospitals worldwide as it increases patients’ knowledge and understanding of their medication, but the effects on other outcomes, e.g. compliance or medication errors, were unclear.</p> <p><strong>Objectives</strong>: To compare medication knowledge, adherence, medication errors, and hospital readmission among inpatients receiving SAM education under the supervision of a multidisciplinary team (study group) with those receiving routine nurse-administered medication (control group).</p> <p><strong>Methods</strong>: This study was a PROBE design. Inpatients with chronic diseases were randomly allocated (1:1) to either the study group or the control group using stratified-block randomization. Knowledge of medications was measured at hospital discharge and at the first two follow-up visits; adherence was measured at the first two follow-up visits, medication errors while in hospital, and hospital readmission within 60 days after discharge. For normally distributed continuous outcomes, mean difference and 95%CI were estimated; otherwise the median and the Mann-Whitney test p-value were reported. The percentage difference and 95%CI were reported for binary outcomes.</p> <p><strong>Results</strong>: 70 patients were randomized (35 in each group); all received complete follow-up. Both groups were similar at baseline. Mean (SD) age (years) were 59.2 (11.0) for the study group and 58.3 (12.0) for the control group. Percentages of females in the respective groups were 54.3 and 60.0. Mean time from discharge to the first follow-up visit was two weeks in both groups and time to the second follow-up visit were 68.8 days (study group) and 55.0 days (control group). The study group had significantly higher medication knowledge than the control group at hospital discharge (of the 10-point scale, medians, 8.56 and 6.18, respectively, p&lt;0.001). The corresponding figures were similar in both groups at the first follow-up visit (medians, 8.25 and 6.26, respectively, p&lt;0.001). Adherence to medication at the first visit in the study group (percentage mean 92.50% (SD=5.33%)) was significantly higher than that in the control group (79.60% (SD=5.96%)), percentage mean difference 12.90%, [95%CI 10.20%:15.60%], p&lt;0.001. Medication knowledge and adherence were sustained at the second follow-up visit. During hospitalization, no medication errors were found in the study group, and minimal errors occurred in the control group (1.48%, [95%CI 0.68%:2.28%] of doses administered, p=0.001). Hospital readmission within 60 days after discharge was significantly lower in the study group (11.4%) than that in the control group (31.4%), percentage difference 20.0% (95%CI 1.4%:38.6%), 1-side Fisher exact p=0.039.</p> <p><strong>Conclusions</strong>: Among in-patients with chronic diseases, SAM program significantly increased knowledge of and adherence to prescribed medications. Medication errors regarding administration errors were infrequent but significantly higher in the control group. SAM reduced hospital readmission within 60 after discharge.</p> Ronee Kaday Chaveewan Ratanajamit Copyright (c) 2020 Pharmacy Practice and the Authors 2020-04-19 2020-04-19 18 2 1766 1766 10.18549/PharmPract.2020.2.1766 Training upcoming academicians through interviews of pharmacy resident teaching certificate leaders <p><strong>Background</strong>: Discovering methods of Residency Teaching Certificate Programs (RTCPs) will allow for collaboration in developing best practices to ensure both high quality of programming and outcomes for participants.</p> <p><strong>Objective</strong>: The primary objective of this project is to describe and compare how RTCPs are conducted in the state of Ohio. Secondarily, to identify current practices in assessing RTCPs in both programmatic effectiveness and individual resident teaching outcomes.</p> <p><strong>Methods</strong>: The seven coordinators of the seven Ohio RTCPs (n=7) were contacted via email and asked to participate in an IRB-approved interview, either in-person or telephonically. Standardized questions were developed to inquire about six categories of interest: demographics/background, administration/logistics, content, assessment of the resident, program financing, and program continuous quality improvement (CQI). All seven programs participated in interviews. Data was coded by multiple members of the research team for presentation in aggregate form.</p> <p><strong>Results</strong>: RTCPs include seminar days at the respective pharmacy colleges; however, the number, length, and content of seminars vary. The majority of programs (n=5) stated using inherited curriculum and materials passed down from previous coordinators. While each RTCP requires participants to submit a teaching portfolio, only three of seven programs assess the summative portfolios. All programs (n=7) award participants a certificate based on completion of requirements without a defined minimum performance standard. Two programs are collecting participant feedback after every session for CQI however no programs are completing an annual programmatic assessment of resident outcomes. The majority of coordinators (n=7) are interested in collaborating and sharing “best practices” between RTCPs in the state.</p> <p><strong>Conclusions</strong>: Although published and available resources exist surrounding the development and delivery of RTCPs, in Ohio, their use varies greatly. The most striking outcomes highlighted the lack of resident and program assessment of outcomes in RTCPs.&nbsp; The research has brought forth ideas of ways to improve these programs through resident assessment, program assessment and also leads to reflection and innovation around the best way to deliver these programs.</p> Emily Eddy Brittany Long Lindsey Peters Jennifer Grundey Michelle Musser Karielle Shaffery Copyright (c) 2020 Pharmacy Practice and the Authors 2020-04-20 2020-04-20 18 2 1769 1769 10.18549/PharmPract.2020.2.1769 FDA collaboration to improve safe use of fluoroquinolone antibiotics: an ex post facto matched control study of targeted short-form messaging and online education served to high prescribers <p><strong>Objective</strong>: This <em>ex post facto</em> matched control study was conducted to evaluate the effect of targeted short-form messages or continuing medical education (CME) on fluoroquinolone prescribing among high prescribers.</p> <p><strong>Methods</strong>: A total of 11,774 Medscape healthcare provider (HCP) members prescribing high volumes of fluoroquinolones were randomized into three segments to receive one of three unique targeted short-form messages, each delivered via email, web alerts, and mobile alerts. Some HCPs receiving targeted short-form messages also participated in CME on fluoroquinolone prescribing. A fourth segment of HCPs participated in CME only. Test HCPs were matched to third-party-provider prescriber data to identify control HCPs. We used prescriber data to determine new prescription volume; percentage (%) of HCPs with reduced prescribing; new prescription volume for acute bacterial sinusitis (ABS), uncomplicated urinary tract infection (uUTI), and acute bacterial exacerbations of chronic bronchitis in those with chronic obstructive pulmonary disease (ABECB-COPD). Open rates for emailed targeted short-form messages were also measured.</p> <p><strong>Results</strong>: Targeted short-form messages and CME each resulted in significant new prescription volume reduction versus control. Combining targeted short-form messages with CME yielded the greatest percentage of test HCPs with reduced prescribing (80.1%) versus controls (76.2%; p&lt;0.0001). New prescription volume decreased significantly for uUTI and ABS following exposure to targeted short-form messages, CME, or both. Targeted short-form messages containing comparative prescribing information with or without clinical context were opened at slightly higher rates (10.8% and 10.6%, respectively) than targeted short-form messages containing clinical context alone (9.1%).</p> <p><strong>Conclusions</strong>: Targeted short-form messages and CME, alone and in combination, are associated with reduced oral fluoroquinolone prescribing among high prescribers.</p> John Whyte Scott Winiecki Christina Hoffman Kaushal Patel Copyright (c) 2020 Pharmacy Practice and the Authors 2020-04-24 2020-04-24 18 2 1773 1773 10.18549/PharmPract.2020.2.1773 Effect of different splitting techniques on the characteristics of divided tablets of five commonly split drug products in Jordan <p><strong>Objective</strong>: To determine the accuracy, variability, and weight uniformity of tablet subdivision techniques utilized to divide the tablets of five drug products that are commonly prescribed for use as half tablets in Jordan.&nbsp;</p> <p><strong>Methods</strong>: Ten random tablets of five commonly subdivided drug products were weighed and subdivided using three subdivision techniques: hand breaking, kitchen knife, and tablet cutter. The five commonly subdivided drug products (warfarin 5 mg, levothyroxine 50 μg, levothyroxine 100 μg, candesartan 16 mg, and carvedilol 25 mg) were weighed. The weights were analyzed for acceptance, accuracy, and variability. Weight variation acceptance criteria were adopted in this work as a tool to indicate the properness of the subdivision techniques used to produce acceptable half tablets. Other relevant physical characteristics of the five products such as tablet shape, dimensions, face curvature, score depth, and crushing strength were measured.&nbsp;</p> <p><strong>Results</strong>: All tablets were round in shape, had weights that ranged between 100.63 mg (standard deviation=0.99) and 379.04 mg (standard deviation=3.00), and had crushing strengths that ranged between 23.29 N (standard deviation=3.58)and 103.35 N (standard deviation=14.98). Both candesartan and carvedilol were bi-convex in shape with an extent of face curvature equal to about 33%. In addition, percentage score depth of the tablets had a range between 0% and 24%. The accuracy and variability of subdivision varied according to the subdivision technique used and tablet characteristics. Accuracy range was between 81% and 109.8%. Moreover, the relative standard deviation was between 1.5% and 17.4%. Warfarin 5 mg subdivided tablets failed the weight variation test regardless of the subdivision technique used. Subdivision by hand produced half tablets that were acceptable for levothyroxine 50 μg and levothyroxine 100 μg. Subdivision by knife produced half tablets that were acceptable only for candesartan tablets. However, the tablet cutter produced half tablets that passed the weight variation test for four out of the five drug products tested in this study.</p> <p><strong>Conclusions</strong>: The tablet cutter performed better than the other subdivision techniques used. It produced half tablets that passed the weight uniformity test for four drug products out of the five.</p> Shadi F. Gharaibeh Linda Tahaineh Copyright (c) 2020 Pharmacy Practice and the Authors 2020-04-23 2020-04-23 18 2 1776 1776 10.18549/PharmPract.2020.2.1776 Barriers to healthcare access for Arabic-speaking population in an English-speaking country <p><strong>Objective</strong>: To identify barriers to healthcare access, to assess the health literacy levels of the foreign-born Arabic speaking population in Iowa, USA and to measure their prevalence of seeking preventive healthcare services.</p> <p><strong>Methods</strong>: A cross-sectional study of native Arabic speaking adults involved a focus group and an anonymous paper-based survey. The focus group and the Andersen Model were used to develop the survey questionnaire. The survey participants were customers at Arabic grocery stores, worshippers at the city mosque and patients at free University Clinic. Chi-square test was used to measure the relationship between the characteristics of survey participants and preventive healthcare services. Thematic analysis was used to analyze the focus group transcript.</p> <p><strong>Results</strong>: We received 196 completed surveys. Only half of the participants were considered to have good health literacy. More than one-third of the participants had no health insurance and less than half of them visit clinics regularly for preventive measures. Two participant enabling factors (health insurance and residency years) and one need factor (having chronic disease(s)) were found to significantly influence preventive physician visits.</p> <p><strong>Conclusions</strong>: This theory-based study provides a tool that can be used in different Western countries where Arabic minority lives. Both the survey and the focus group agreed that lacking health insurance is the main barrier facing their access to healthcare services. The availability of an interpreter in the hospital is essential to help those with inadequate health literacy, particularly new arriving individuals. More free healthcare settings are needed in the county to take care of the increasing number of uninsured Arabic speaking patients.</p> Ali A. Al Jumaili Kawther K. Ahmed Dave Koch Copyright (c) 2020 Pharmacy Practice and the Authors 2020-05-15 2020-05-15 18 2 1809 1809 10.18549/PharmPract.2020.2.1809 Exploring learning needs for general practice based pharmacist: Are behavioural and influencing skills needed? <p><strong>Background</strong>: Embedding pharmacists in general practice has been shown to create cost efficiencies, improve patient care and free general practitioner capacity. Consequently, there is a drive to recruit additional pharmacists to work within general practices. However, equipping pharmacists with behaviour and influencing skills may further optimise their impact. Key elements which may enhance behaviour and influencing skills include self-efficacy and resilience.</p> <p><strong>Objective</strong>: This study aimed to: 1) Assess general practice pharmacists’ self-efficacy and resilience. 2) Explore differences primarily between pharmacists reporting lower and higher self-efficacy, secondarily for those reporting lower and higher scores for resilience.</p> <p><strong>Methods</strong>: All 159 NHS Greater Glasgow and Clyde general practice pharmacists were invited to complete an online survey in May 2019. The survey captured anonymised data covering: demographics; professional experience; qualifications, prescribing status and preferred learning styles. Unconscious learning needs for behavioural and influencing skills were assessed using validated tools: the new general self-efficacy scale (GSES) and short general resilience scale (GRIT). Participants’ responses were differentiated by the lowest quartile and higher quartiles of GSES and GRIT scores, and analysed to identify differences.</p> <p><strong>Results</strong>: The survey was completed by 57% (91/159) of eligible pharmacists; mean age 38 (range 24-60) years; 91% were of white ethnicity and 89% female. The median time qualified was 14 (1-38) years and 3 (1-22) years working in general practices. Overall pharmacists scored well on the GSES, mean 25 (SD 3; 95%CI 24.4-25.6), and GRIT, mean 30 (SD 4; 95%CI 29.6-30.4), out of a maximum 32 and 40 respectively. A significant positive correlation between GSES and GRIT scores was found (Pearson’s r=0.284, p=0.006). However, no significant differences were identified between pharmacists scoring in the lower and upper quartiles by GSES or GRIT. Overall respondents reported their preferred learning styles were activists (46%) or pragmatists (29%). The majority (91%) preferred blended learning methods as opposed to 38% or less for a range of online methods.</p> <p><strong>Conclusions</strong>: General practice pharmacists on average scored highly for self-efficacy and resilience. Higher scores did not appear to be associated with demographic, years of practice, professional or educational experience. Prospective interventions to support those with lower scores may enhance and optimise pharmacists’ effectiveness in general practice.</p> Chris F. Johnson Jan Smith Heather Harrison Richard Hassett Copyright (c) 2020 Pharmacy Practice and the Authors 2020-05-04 2020-05-04 18 2 1814 1814 10.18549/PharmPract.2020.2.1814 The impact of a self-management educational program coordinated through WhatsApp on diabetes control <p><strong>Background</strong>: Social media can effectively mediate digital health interventions and thus, overcome barriers associated with face-to-face interaction.</p> <p><strong>Objective</strong>: To assess the impact of patient-centered diabetes education program administered through WhatsApp on glycosylated hemoglobin (HbA1c) values, assess the correlation, if any, between health literacy and numeracy on intervention outcomes</p> <p><strong>Methods</strong>: During an ‘intervention phase’ spread over six months, target diabetic patients (N=109) received structured education through WhatsApp as per the American Association of Diabetes Educators Self-Care Behaviors recommendations. The control group with an equal number of participants received ‘usual care’ provided by health professionals void of the social media intervention. Changes in HbA1c levels were recorded thrice (at baseline, 3 and 6 months) for the test group and twice (baseline and 6 months) for the control group. Change in HbA1c values were compared and statistical significance was defined at p&lt;0.05. Baseline health literacy and diabetes numeracy were assessed for both groups (N=218) using the Literacy Assessment for Diabetes (LAD), and the Diabetes Numeracy Test (DNT), respectively, and values were correlated with HbA1c change p&lt;0.05. Participants’ satisfaction with the intervention was also assessed.</p> <p><strong>Results</strong>: The average age of respondents was 41.98 (SD 15.05) years, with a diabetes history of 10.2 (SD 8.5) years. At baseline, the average HbA1c in the control and test groups were 8.4 (SD 1.06) and 8.5 (SD 1.29), respectively. After six months, a significant drop in HbA1c value was noticed in intervention group (7.7; SD 1.35; p= 0.001); with no significance in the control group (8.4; SD 1.32; p=0.032, paired t-test). Moreover, the reduction in HbA1c was more in the test group (0.7%) than the control group (0.1%) with a difference of 0.6% which is considered clinically significant. There was no significant correlation between LAD score and HbA1c at baseline (r=-0.203, p=0.064), 3 months (r=-0.123, p=0.266) and 6 months (r=-0.106, p= 0.337) Pearson correlation. A similar result was observed with DNT, where DNT score and HbA1c at baseline, 3 months and 6 months showed no correlation (r=0.112, 0.959 and 0.886; respectively) with HbA1c levels. Eighty percent of the respondents found the social media intervention ‘beneficial’ and suggested it be used long term.</p> <p><strong>Conclusions</strong>: Diabetes education via WhatsApp showed promising outcomes regardless of the level of patients’ health literacy or numeracy.</p> Muaed Al Omar Sanah Hasan Subish Palaian Shrouq Mahameed Copyright (c) 2020 Pharmacy Practice and the Authors 2020-05-03 2020-05-03 18 2 1841 1841 10.18549/PharmPract.2020.2.1841 Cost of hospitalisation and length of stay due to hypoglycaemia in patients with diabetes mellitus: a cross-sectional study <p><strong>Objective</strong>: This study aims to estimate the length of stay and hospitalisation cost of hypoglycaemia, and to identify determinants of variation in the length of stay and hospitalisation cost among individual patients with type 1 or 2 diabetes mellitus.&nbsp;</p> <p><strong>Methods</strong>: A cross-sectional study was conducted using inpatients records for patients with diabetes mellitus who had been hospitalised due to hypoglycaemic events in two private hospitals in Amman, Jordan between January 2009 and May 2017. All hospitalisation costs were inflated to the equivalent costs in 2017. Hospitalisation cost was estimated from the patient’s perspective in Jordanian dinars (JOD). Descriptive analyses and correlation between sociodemographic or clinical characteristics with the cost and length of stay were explored. Predictors of hypoglycaemic hospitalisation cost and length of stay were determined using logistic regression.</p> <p><strong>Results</strong>: During the study period a total of 126 patients with diabetes mellitus were hospitalised due to an incident of hypoglycaemia. The mean patient age was 64.2 (SD=19.6) years; half were male. Patients admitted for hypoglycaemia stayed in hospital for a median duration of two days (IQR=2 days). The median cost of hospitalisation for hypoglycaemia was 163.2 JOD (USD 230.1) (IQR=216.3 JOD). We found that the Glasgow coma score was positively associated with length of stay (0.345, p=0.008), and older age was correlated with higher hospitalisation cost (0.207, p=0.02). Patients with a family history of diabetes had higher hospitalisation costs and longer duration of stay (0.306 and 0.275, p&lt;0.05). In addition, being a male patient (0.394, p&lt;0.05) and with an absence of smoking history was associated with longer duration of stay (0.456, p&lt;0.01), but not with higher hospitalisation cost.</p> <p><strong>Conclusions</strong>: Costs associated with the incidence of hypoglycaemic events are not low and constitute a large cost component of managing and treating diabetes mellitus. Male patients and patients having a family history of diabetes should receive extra care and education on the prevention of hypoglycaemic events, and a treatment de-intensification approach should be considered if necessary, so we can prevent its associated hospitalisation costs and length of stay.</p> Abdallah Y. Naser Hassan Alwafi Zahra Alsairafi Copyright (c) 2020 Pharmacy Practice and the Authors 2020-05-25 2020-05-25 18 2 1847 1847 10.18549/PharmPract.2020.2.1847 Advanced pharmacy practice experiences (APPE) in academia as strategy to fill the gap on transgender health Jonathan Figueroa-Colon Mayra Vega Gerena Copyright (c) 2020 Pharmacy Practice and the Authors 2020-05-04 2020-05-04 18 2 1921 1921 10.18549/PharmPract.2020.2.1921 Community pharmacy and primary health care in Sweden - at a crossroads <p>The overall goal of Swedish health care is good health and equitable care for the whole population. The responsibility for health is shared by the central government, the regions, and the municipalities. Primary care accounts for approximately 20 percent of all expenditures on health care. About 16% of all physicians work in primary health. The regions have also employed a large number of clinical pharmacists, usually hospital-based, but many perform a variety of different primary care services, the most common of which is patient medication reviews. Swedish primary health care is at a crossroads facing extensive challenges, due to changes in demography and demanding financial conditions. These changes necessitate large transformations in health services and delivery. Current Government inquiries have primarily focused on two ways to meet the challenges; a shift towards more local care requiring a transfer of resources from hospital care, and a further development of structured digi-physical care, that is both digital (“online doctors”) and physical accessibility of care. While primary care at present is undergoing processes of change, community pharmacy has done so during the past decade since the re-regulation of the Swedish pharmacy market. A monopoly was replaced by a competitive system, where five pharmacy chains now share most of the market, a competition that has made community pharmacy very commercialized. A number of different, promising primary care services are being offered, but they are usually delivered on a small scale due to a lack of remuneration and philosophy of providers. Priority is given to sales and fast dispensing of prescriptions, often with a minimum of counseling. Reflecting primary health care, community pharmacy in Sweden is at a crossroads but currently has a golden opportunity to choose a route of collaboration with primary health care in its current transformation into more local and digi-physical care. A major challenge is that primary health care inquires, strategic plans, and national policy documents usually do not include community pharmacy as a partner. Hence, community pharmacy have to be proactive and seize this chance of changes in primary health policy and organization in order to become an important link in the chain of health care delivery, or there is a significant risk that it will predominantly remain a retail business.</p> Tommy Westerlund Bertil Marklund Copyright (c) 2020 Pharmacy Practice and the Authors 2020-05-02 2020-05-02 18 2 1927 1927 10.18549/PharmPract.2020.2.1927 Primary health care policy and vision for community pharmacy and pharmacists in Australia <p>There is evidence that the Australian Government is embracing a more integrated approach to health, with implementation of initiatives like primary health networks (PHNs) and the Government’s Health Care Homes program. However, integration of community pharmacy into primary health care faces challenges, including the lack of realistic integration in PHNs, and in service and remuneration models from government. Ideally, coordinated multidisciplinary teams working collaboratively in the community setting are needed, where expanding skills are embraced rather than resisted. It appears that community pharmacy is not sufficiently represented at a local level. Current service remuneration models encourage a volume approach. While more complex services and clinical roles, with associated remuneration structures (such as, accredited pharmacists, pharmacists embedded in general practice and residential aged care facilities) promote follow up, collaboration and integration into primary health care, they potentially marginalize community pharmacies. Community pharmacists’ roles have evolved and are being recognized as the medication management experts of the health care team at a less complex level with the delivery of MedChecks, clinical interventions and medication adherence services. More recently, vaccination services have greatly expanded through community pharmacy. Policy documents from professional bodies highlight the need to extend pharmacy services and enhance integration within primary care. The Pharmaceutical Society of Australia’s Pharmacists in 2023 report envisages pharmacists practising to full scope, driving greater efficiencies in the health system. The Pharmacy Guild of Australia’s future vision identifies community pharmacy as health hubs facilitating the provision of cost-effective and integrated health care services to patients. In 2019, the Australian Government announced the development of a Primary Health Care 10-Year Plan which will guide resource allocation for primary health care in Australia. At the same time, the Government has committed to conclude negotiations on the 7th Community Pharmacy Agreement (7CPA) with a focus on allowing pharmacists to practice to full scope and pledges to strengthen the role of primary care by better supporting pharmacists as primary health care providers. The 7CPA and the Government’s 10-year plan will largely shape the practice and viability of community pharmacy. It is essential that both provide a philosophical direction and prioritize integration, remuneration and resources which recognize the professional contribution and competencies of community pharmacy and community pharmacists, the financial implications of service roles and the retention of medicines-supply roles.</p> Sarah Dineen-Griffin Shalom I. Benrimoj Victoria Garcia-Cardenas Copyright (c) 2020 Pharmacy Practice and the Authors 2020-05-15 2020-05-15 18 2 1967 1967 10.18549/PharmPract.2020.2.1967