Boosting remunerated services provision

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Interns enable greater service provision in community pharmacies – more so than pharmacy size or banner group status, say study authors

A cross-sectional study conducted by researchers from Curtin University, Perth, and the University of Sydney has investigated what factors lead to higher intensity of service provision in community pharmacies.

Over 200 community pharmacies in WA responded to the survey, representing about a third of those in the state. Among the sample, over half (55.1%) were banner group members.

Around 73% (151) of community pharmacy respondents reported providing the MedsCheck service. This meant about one-quarter did not provide MedsCheck services at all and more than one-third also provided no Diabetes MedsCheck services.

Intensity of government-funded MedsCheck and Diabetes MedsCheck services was calculated as the average number provided each month, ranging from 0 (none) to 4 (9–11).

The median score for MedsCheck among the sample was 1, indicating an average of fewer than 3 services per month.

Respondents also recorded the average number of Diabetes MedsCheck services each month, ranging from 0 (none) to 5 (12–15) per month. The median score was 1, indicating an average of fewer than 3 services per month.

The researchers said possible explanations of low intensity of provision of MedsCheck and/or Diabetes MedsCheck services were caps on remuneration; and business rules that meant a single pharmacist could not dispense medicines and provide the services concurrently.

“Managers would have to ‘workaround’ these factors including the ‘walk-in’ nature of these services which makes resource allocation challenging,” said the authors.

A broad range of government unremunerated, less frequently provided enhanced services (asthma screening, blood glucose testing, cholesterol testing and smoking cessation) were available at least once per week across almost half (47%) of the respondent community pharmacies.

The measure of intensity of unfunded chronic disease services for each pharmacy was the sum of the four services and ranged between a score of 0 and 15. The median was 2 and the mean (SD) score was 2.21 (2.51).

Pharmacies that maximised the provision of remunerated services were more likely to have the self-efficacy, capacity and resources to successfully provide unremunerated services.

Researchers found the inclusion of interns in the business specifically enabled greater service provision—not the size of pharmacy, the distance to the nearest pharmacy, being in a banner group, the number of full-time equivalent pharmacists; or the number of pharmacy assistants.

“The employment of pharmacy interns in community pharmacies was independently associated with higher intensity of MedsCheck and Diabetes MedsCheck services provision,” said the authors.

“Such a staffing structure was also associated with a higher intensity provision of unremunerated chronic disease screening and management services.

“Simply, having interns appeared to motivate, facilitate and/or reduce barriers to the provision of funded services,” they said.

“This is an important finding and highlights the importance of community pharmacy’s capacity to prioritise and deliver professional services in conjunction with the administrative and professional tasks required to appropriately dispense medicines.”

The intensity of MedsCheck and Diabetes MedsCheck with unremunerated services, and the perception that pharmacists required further training to perform enhanced services, was negatively predictive of intensity of unremunerated service provision.

“This makes sense, since it would be expected that in pharmacies where pharmacists provided more services more frequently, they would be more comfortable with their level of training and vice versa,” said the authors.

A separate recent Western Australian study found that 46% of respondents agreed that lack of knowledge to perform pharmaceutical services was a barrier to services provision.

Findings in 2002 revealed this to be around 39% Australia-wide. “This lack of change since 2002, could relate to many new enhanced and extended services having been introduced in Australia over the past decade,” said the researchers.

“The outcome may cause pharmacists to perceive a continuing requirement for additional training for provision of these services. This barrier has however, also been widely reported internationally.”

Findings from this study should be taken into account by policymakers and the profession when implementing and facilitating professional pharmacy services, the authors suggested.

This research was published in the journal Research in Social and Administrative Pharmacy.

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