Original Research
Community pharmacy in Australia: A health hub destination of the future

https://doi.org/10.1016/j.sapharm.2012.11.003Get rights and content

Abstract

Background

Rates of chronic illness are rising in Australia and as medications are frequently used in the management of a range of chronic conditions, community pharmacists are in an ideal position to better assist these consumers. There is currently limited information as to how pharmacy can do this from the perspective of consumer health organizations, health advocates and professional support organizations.

Objectives

To explore new roles, opportunities and any associated barriers for community pharmacy to better assist consumers with chronic illnesses.

Methods

Representatives of non-government consumer health organizations (n = 10) were interviewed from the key health priority areas emphasized by the Australian government. Health advocates (n = 3), innovative health care professionals (n = 4) and representatives of health care professional organizations (n = 4) from pharmacy and medicine also participated. Interviews were analyzed via thematic analysis.

Results

Twenty-one in-depth interviews were conducted. The core finding was the potential for community pharmacies to become a health hub destination, whereby pharmacy staff assist consumers with chronic conditions to: navigate the health system (e.g., provide information on support services), manage their medications, and provide health advocacy. Participants expressed their concern that consumers may not be aware of the breadth of the pharmacist's expertise and that further collaboration is needed with non-government consumer health organizations and other health providers. Emphasis was placed on the improvement of the pharmacist's current role, particularly in the area of medication advice and accessibility, with the current pharmacy remuneration model identified as a barrier to becoming a health hub destination.

Conclusion

The eventual progression toward a health hub destination was seen to be important to better assist consumers with chronic conditions. This focuses on a more proactive approach to care encompassing simple advice, referrals to consumer health organizations and ultimately, health advocacy. However, further research is required into how community pharmacy can become a health hub given that this is a new concept and there are existing professional barriers.

Introduction

The increasing prevalence of chronic illnesses is of global significance, causing an estimated 36 million deaths in 2008.1 Given that the majority of Australians reported the presence of one or more long-term conditions in 2007–2008,2 and health expenditure exceeded $100 billion for the first time in this period,3 appropriate and effective delivery of health care for consumers with chronic illness is of paramount importance. Currently, many Australians regularly visit their community pharmacy for advice and to obtain medication to treat or relieve symptoms or prevent the progression of chronic conditions. As community pharmacy has been viewed as highly accessible,4, 5 pharmacists clearly have a role to play in improving the health care for these consumers.6 In particular, the pharmacy profession has been shifting toward care delivery that is more patient-centered,7 with pharmacists in many countries providing management programs for chronic conditions including asthma, arthritis, mental illness, diabetes, cardiovascular health and osteoporosis.8 In Australia, while community pharmacists are still focused on dispensing medication, they have also integrated a range of professional services into their practice such as medication reviews and disease-specific management programs.9 The expansion of the pharmacist's role is strongly advocated by two peak pharmacy organizations in Australia,5, 10 and the suitability of pharmacists to provide professional services in the primary care setting is well articulated in the literature.4, 11 Previous studies have also shown that the provision of disease-specific services in community pharmacy is generally well received by users,12 due to the accessibility and convenience of these services.13

Another key source of support for consumers with chronic conditions is consumer health organizations (e.g., Parkinson's Australia, Alzheimer's Australia). These organizations provide psychosocial support and a range of informational resources to better enable consumers and their carers to manage their conditions.14 These groups are in a unique position to gain further understanding of what their consumer members need from the health system, including community pharmacy.15 Furthermore, these organizations may also refer their members to community pharmacy for additional services. Therefore, it would be valuable to seek their opinions of the role that community pharmacy can play to better assist the consumers they represent. However, there is limited information on the perceived role of community pharmacy from the perspective of consumer health organizations. One Australian report explored the views of consumer health organizations in relation to consumers' experiences, expectations and needs of community pharmacy. Personalized service from the pharmacist and greater provision of medication information were key recommendations from the focus groups.16 Similarly, professional organizations, government bodies and consumer health organizations identified the need for improvements in relation to pharmacist engagement within the community, the level of privacy and provision of written and verbal information to support consumers.16 Another Australian project reported that ‘community pharmacy may not be initially seen as part of the central strategy by patient support organizations’.17

Despite the evolving role of the pharmacist in chronic disease management, they are underutilized as health care professionals.18 Although the reasons for underutilization are complex, one very important issue is the lack of consumer awareness of the breadth of skills pharmacists have.19, 20 Research suggests that consumers perceive the pharmacist's primary role as medication providers,7, 12 or mainly view the community pharmacy as a place to purchase quality medications.12 One Australian study has also corroborated the belief that the core function of a pharmacy is the provision of medicine and advice, highlighting the limited awareness of consumers and consumer advocates (e.g., support group representatives) about the services offered by community pharmacy.17 There is clearly a misalignment between how consumers (and their advocates) view the pharmacist's role and what pharmacists can actually offer.

Given that the Australian government has emphasized the management of chronic illness as a strategic priority area,21 there is a significant opportunity for community pharmacy to be of greater assistance to these consumers. However, considering the lack of knowledge about the role of community pharmacy, it is necessary to first understand the perspectives of those who will influence the utilization of such services in the future (i.e., non-government consumer health organizations, health advocates and health care professional organizations). Consequently this raises the question: how can community pharmacy better assist consumers with chronic illness to manage their condition(s)?

The aim of this exploratory study was to identify the views of key stakeholders (i.e., individuals representing non-government consumer health organizations and health advocates) with respect to the role of community pharmacy in supporting consumers with chronic illness(s). The study also sought to identify the opportunities and barriers for community pharmacy in chronic illness management from the viewpoints of health care professional organizations from pharmacy and medicine. Furthermore, the themes identified will be used to develop an interview guide for a much larger study involving consumers with chronic illness(s) and carers.

Section snippets

Study design

A list of non-government consumer health organizations, health care professional organizations, health advocates and innovative health care professionals were obtained by the following methods: prior researcher knowledge from working in the health sector, discussion with a Reference Group comprising of members with knowledge in the field and recommendations from study participants. Additional participants were also identified during the completion of the in-depth interviews via a snowball

Study participants

Participants (n = 21) included three board members (policy development) and seven personnel (program implementation) from non-government consumer health organizations (CHO), with two of these participants representing a culturally and linguistically diverse (CALD) organization. Three consumer health advocates (HA) were recruited including two consumer health organization representatives and an individual not aligned with a particular organization. Three representatives of pharmacy

Discussion

This study set out to explore the perspectives of non-government consumer health organizations and health advocates as to how community pharmacy can better assist consumers with chronic illness. Overall the core finding of this study was the potential for community pharmacies to move beyond medication supply and become a health hub destination that assisted consumers with chronic conditions across three key domains: health care system navigation, medication management and eventually, health

Conclusion

This study confirms the need for pharmacists to extend their health care role in chronic illness management, a need emphasized by professional pharmacy organizations over the last decade. Pharmacists can better support consumers with chronic illness by assisting them to navigate a disconnected health system in two ways: via a clinical triage role by referring consumers to health care professionals, and recommending non-government consumer health organizations with an emphasis on a holistic

Acknowledgments

The authors are grateful to all participants who gave their time and shared their views with us. In addition, we would like to thank Dr. Shane Scahill for providing feedback on the manuscript.

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    Sources of funding: This project is funded by the Australian Government Department of Health and Ageing as part of the Fifth Community Pharmacy Agreement Research and Development Program managed by The Pharmacy Guild of Australia.

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