Provider status: Speaking with one voice

We’re ‘all in’ on this one, but we’ll need your help!

APhA advances provider status initiative

Edwin Leigh Newcomb 1882-1950: Pharmacy's many-sided man

State-related actions on compounding pharmacy

The ‘perfect storm’ may hit pharmacy

About the Authors

Pharmacy practice is witnessing considerable changes in concept and practice in Egypt in recent years. Egypt has the highest number of pharmacists per capita and community pharmacies in the Middle East and North Africa region. Literally, all medicines are freely sold without a prescription irrespective of their status as prescription drugs or over-the-counter drugs; and the pharmacist plays a key role in recommending basic medicines to the public. Community pharmacies are widely distributed throughout the country and more accessible healthcare facility to the community that offering clinical, diagnostic and public health services. The concept of pharmaceutical care has not also been acknowledged yet at community pharmacies; and most community pharmacies lack computerized systems and modern technologies, as well as lack of qualified pharmacists who could deliver clinical pharmacy services. Despite laws and regulations exist; there is a lack of enforcement of those regulations to ensure good pharmacy practice at community pharmacies. The aim of the review was to describe the current status of community pharmacy in Egypt and their preparedness to deliver clinical pharmacy services.

To review the current status of Danish community pharmacy in both practice and research and discuss future trends. Denmark has a social welfare system that provides health care, social services, and pensions to its population. Medical care and surgery are free. Prescription medicines are reimbursed by an average of 56%. Community pharmacies are privately owned, but the health authorities regulate drug prices and the number of pharmacies. At present, Denmark has 322 pharmacies, corresponding to 1 pharmacy per 16,700 inhabitants. All pharmacies provide prescription and over-the-counter products, advice about medicine use, dose dispensing, generic substitutions, and administration of individual reimbursement registers. Except for very simple processes, compounding is centralized at 3 pharmacies. Many pharmacies offer measurement of blood glucose, blood pressure, and cholesterol, and 60% offer inhalation counseling, a reimbursed service. Research in pharmacy practice is well established and conducted primarily at universities and at Pharmakon A/S, which is owned by the Danish Pharmaceutical Association. Extended services in clinical pharmacy are priorities for all Danish pharmacy organizations. Reimbursement is sought at the national level, as well as from payers in the new local authority structures in Denmark. The trend in research focuses on collaborative health care, on developing and documenting the value of community pharmacy services, and on optimizing services and strengthening implementation. Denmark has few, but large, community pharmacies and a long tradition of research and development resulting in several well-documented cognitive and clinical services. However, few services are reimbursed and implementation is still a challenge.

From a political and governance perspective Spain is a decentralized country with 17 states [comunidades autónomas] resulting in a governmental structure similar to a federal state. The various state regional health services organizational and management structures are focused on caring for acute illnesses and are dominated by hospitals and technology. In a review by the Interstate Council, a body for intercommunication and cooperation between the state health care services and national government, there is a move to improve health care through an integrative approach between specialized care and primary care at the state level. Community pharmacy does not appear to have a major role in this review. Primary health care is becoming more important and leading the change to improve the roles of the health care teams. Primary care pharmacists as the rest of public health professionals are employed by the respective states and are considered public servants. Total health care expenditure is 9.0% of its GDP with the public health sector accounting for the 71% and the private sector 29% of this expenditure. Community pharmacy contracts with each state health administration for the supply and dispensing of medicines and a very limited number of services. There are approximately 22,000 community pharmacies and 52,000 community pharmacists for a population of 47 million people. All community pharmacies are privately owned with only pharmacists owning a single pharmacy. Pharmacy chain stores are not legally permitted. Community pharmacy practice is based on dispensing of medications and dealing with consumer minor symptoms and requests for nonprescription medications although extensive philosophical deep debates on the conceptual and practical development of new clinical services have resulted in national consensually agreed classifications, definitions and protocolized services. There are a few remunerated services in Spain and these are funded at state, provincial or municipal level. There are no health services approved or funded at a national level. Although the profession promulgates a patient orientated community pharmacy it appears to be reluctant to advocate for a change in the remuneration model. The profession as a whole should reflect on the role of community pharmacy and advocate for a change to practice that is patient orientated alongside the maintenance of its stance on being a medication supplier. The future strategic position of community pharmacy in Spain as a primary health care partner with government would then be enhanced.

Improving health equity requires engagement with partners outside of the clinical health system to address the socio-political-economic and structural drivers that shape health equity. Health systems need to focus on learning with communities to impact these conditions. The learning health system will need to evolve to a learning community to advance health equity. We describe the experience of researchers, educators, clinicians, and community members ("four pillars") working together to develop the Dartmouth Health Center for Advancing Rural Health Equity. Structures and processes were co-designed to create an infrastructure that supports partnerships dedicated to improving rural health equity through community-based projects, education and training, and advocacy efforts. Co-designing an infrastructure to support enduring partnerships between research, education, clinical service, and community can support learning and improvement activities focused on improving health equity.

Ideally the mission of every academic health center should encompass the core values of the Community Access to Child Health (CATCH) Program: improving child health, increasing access to health care, and promoting advocacy at the community level. As university hospitals face challenges to improve child health through research, clinical service, and teaching, promoting advocacy at the community level should occur as a natural progression. Certainly, many of the key findings of the CATCH evaluation as they apply to pediatricians in practice apply just as well to pediatricians in the academic setting. Pediatric faculty with exposure to community child health issues early in their careers seem to be more likely to advance efforts within the CATCH agenda. Relationships of individual faculty in academic institutions to local and/or state public health agencies can play a key role in enabling community projects to be successful. Finally, because medical students and residents spend a majority of their time in contact with academic faculty, the role of the academic institution in introducing advocacy skills is apparent. Throughout the brief history of CATCH, it is apparent that one of the major keys to success is the leadership of individuals willing to dedicate their energy and professional careers to children's issues. Creative partnerships involving community and medical liaisons often gave CATCH projects the innovative boost they needed to prosper. Of particular importance is the recognition that CATCH has an evolving definition. Like any program, CATCH is dependent on the interests of its leaders, the needs of the community it serves, and the power of its financial supporters. …

In Italy both the consumption of antibiotics and the prevalence of bacterial resistance are higher than in other European countries. In 2017, the first National Action Plan on Antimicrobial Resistance (PNCAR) was adopted in Italy. In response to the PNCAR two national reports on antibiotic use in the human setting have been published. This article's aim is to describe the pattern of antibiotic consumption in the community setting in Italy from 2013 to 2018. To analyse the consumption for reimbursed antibiotics dispensed by community pharmacies different data sources were used. Consumption was measured in terms of defined daily dose (DDD), prescriptions or prevalence of use. In 2018, the consumption of antibiotics in Italy amounted to 16.1 DDD per 1000 inhabitants per day. The rates of consumption by geographical area were: 12.7 DDD in the north, 16.9 in the centre and 20.4 in the south. The use was greater in the extreme age groups than in the population aged from 20 to 64 years. The consumption was higher in winter season, with high peaks in the incidence of flu syndromes. In the paediatric population, a utilization rate of 1010 prescriptions per 1000 children, with a prevalence of use of 40.8%, was found. The study provides useful information on the geographical variability of antibiotic use in Italy to guide decision makers in the introduction of tailored interventions, as suggested by PNCAR, aimed at promoting a more rational use of antibiotics for humans and reducing antimicrobial resistance.

BackgroundCombinations of professional and commercial communication are typically very controversial, particularly in health care communication on the Internet. Websites of licensed community pharmacies on the other hand tend to raise remarkably little controversy, although they typically contain controversial combinations of clinical and commercial services previously unprecedented in professional health care communication.ObjectiveThe aim of this study was to fill the void of knowledge about the combination of clinical and commercial services presented on the websites of licensed community pharmacies.MethodsA content analysis of clinical and commercial services presented in a random sample of 200 licensed community pharmacy websites from Great Britain, the Netherlands, the Canadian provinces British Columbia and Manitoba, and the Australian states New South Wales and Western Australia was conducted.ResultsThe top five specific services mentioned on the community pharmacy websites were cosmetic products (126/200, 63.0%), medication refill request options (124/200, 62.0%), over-the-counter medicine (115/200, 57.5%), complementary and alternative medicine (107/200, 53.5%), and home medical aids (98/200, 49.0%). On average, 72.5% (145/200) of the community pharmacy websites across the 4 countries included a combination of clinical and commercial services. A combination of clinical and commercial services was more often present on chain pharmacy websites (120/147, 82.8%) than single pharmacy websites (25/53, 47%; P<.001), and most often on the Canadian community pharmacy websites, followed by the Australian, British, and Dutch pharmacy websites, respectively (P<.02). Furthermore, more than half of the pharmacies’ homepages contained a combination of clinical and commercial images (107/200, 53.5%), and almost half of the homepage menus contained a combination of clinical and commercial items (99/200, 49.5%). The latter were, again, more common on chain pharmacy than single pharmacy websites (P<.001), with significant differences between countries (P<.001).ConclusionsA considerable share of websites of licensed community pharmacies in Great Britain, the Netherlands, Canada, and Australia combine clinical services with commercial services. Previous research into the presence of a combination of commercial and professional services suggests that such a combination may lead to increased interest in commercial services that may be unnecessary or inappropriate to patients’ health.

Pharmacists’ awareness and confidence in performing Pharmacists’ Patient Care Process–related activities

In some countries, such as Portugal, clinical pharmacy services in the hospital setting may be implemented to a lower extent than desirable. Several studies have analysed the perceived barriers to pharmacy service implementation in community pharmacy. To identify the barriers towards the implementation of advanced clinical pharmacy services at a hospital level in Portugal, using medication follow-up as an example. Hospital pharmacies in Portugal. A qualitative study based on 20 face-to-face semi-structured interviews of strategists and hospital pharmacists. The interview guide was based on two theoretical frameworks, the Borum's theory of organisational change and the Social Network Theory, and then adapted for the Portuguese reality and hospital environments. A constant comparison process with previously analysed interviews, using an inductive approach, was carried out to allow themes to emerge. Themes were organised following the Leavitt's Organizational Model: functions and objectives; hospital pharmacist; structure of pharmacy services; environment; technology; and medication follow-up based on the study topic. Barriers towards practice change. Medication follow-up appeared not to be a well-known service in Portuguese hospital pharmacies. The major barriers at the pharmacist level were their mind-set, resistance to change, and lack of readiness. Lack of time, excessive bureaucratic and administrative workload, reduced workforce, and lack of support from the head of the service and other colleagues were identified as structural barriers. Lack of access to patients' clinical records and cumbersome procedures to implement medication follow-up were recognised as technological barriers. Poor communication with other healthcare professionals, and lack of support from professional associations were the major environmental barriers. Few of the barriers identified by Portuguese hospital pharmacists were consistent with previous reports from community pharmacy. The mind-set of pharmacists and predetermined attitudes are recognised as barriers that can give rise to new perceived barriers.