Piloting extended community pharmacy services

Abstract

Previous studies reported that community pharmacists in Malta are in favour of expanding their roles and consumers agree with extended services provided by community pharmacists. A framework consisting of standard operating procedures (SOPs) for provision of extended community pharmacy services, including medicine use review (MUR), patient review, and advice and treatment services, was proposed in a previous study. This research addressed piloting of standardised extended community pharmacy services to assess feasibility and outcomes. The study was conducted in four phases. Phase I: The proposed SOPs were appraised and observation was conducted in the study setting, which was a community pharmacy selected by convenience sampling. During the observation, extended services to be piloted were identified according to infrastructure present in terms of space, time, staff, equipment, and other logistics. Phase II: Eleven extended services were identified, and the corresponding SOPs were updated reflecting patient impact and practicality. A new SOP (urinalysis) and pharmacist checklists were compiled. Phase III: Face and content validity of the SOPs and checklists were assessed by 4 community pharmacists and 3 general practitioners (GP). Phase IV: Feasibility testing, which involved piloting the SOPs and checklists, was conducted over 300 hours (September 2023-January 2024), targeting at least 10 participants for each service by purposive sampling. Time taken and outcomes of service implementation were assessed. The infrastructure present comprised a private consultation area, one pharmacy support staff, medical devices/consumables, documentation forms, medicines information resources, computer/software, and medical waste management logistics. Key updates to the SOPs were providing participants with outcome of review and/or test results, development of MUR form, result sheets and SOAP form, referring to accessible evidence-based guidelines during service provision for drug-related problems and to support decision-making at the point of care, and review of treatment options to reflect current practice. SOPs and checklists were rated highly (>4 out of 5) by the validation panel for relevance of content, comprehensibility, and presentation. Eighty-eight out of the targeted 120 participants were recruited; number of participants (n) and time (mean M, range R, in minutes) for the services piloted were: MUR (n=10, M=14, R=7-24), patient review services (n=22, M=21, R=14-28), including blood pressure (BP) measurement (n=10, M=23, R=18-28), urinalysis (n=10, M=15, R=14-17), weight management (n=2, M=24, R=22-27), and advice/treatment services (n=56, M=17, R=11-26), including eye conditions (n=10, M=15, R=11-21), ear conditions (n=10, M=16, R=13-21), sore throat, (n=10, M=14, R=13-16), skin conditions (n=10, M=15, R=13-21), urinary tract infection (n=10, M=17, R=11-26), routine immunisation (n=3, M=14, R=12-16), smoking cessation (n=2, M=18, R=17-20), international travel health (n=1, M=25). Non-pharmacological advice was provided to all participants, non-prescription pharmacotherapy dispensed in 42 participants, and 44 were referred to a GP. Examples of reasons for referral were side-effects, drug interactions, abnormal urinalysis, elevated BP, and red flag symptoms. Most participants (n=87) were satisfied with pharmacist interventions. Availability of the appropriate infrastructure and utilisation of practical SOPs and checklists support the feasibility and successful implementation of extended community pharmacy services within a collaborative care context. Implementation of community pharmacy extended services led to pharmacist interventions which were accepted by patients.