Developing a quality framework for community pharmacy which acknowledges the importance of integration with the wider healthcare system: Findings from a systematic review of international literature

Introduction:Increasing patient demand on healthcare systems worldwide has driven the expansion of community pharmacy (CP) services into clinical areas once only the remit of medical practitioners. However, research suggests inconsistencies int he quality of care provided across different CPs and a need for integration with the wider healthcare system. As the role of CP continues to expand, there is a need to ensure CPs provide high-quality services, meet patient needs and integrate across patients’ primary care pathways. Yet there is no agreed framework for defining quality of care in CP.

Objectives:To identify the defining features of the quality of CP and synthesise these into a quality framework, the dimensions of which are relevant to integrated primary care and CP service provision.

Methods: A systematic review was conducted (October 2022‒January 2023). Six electronic databases were searched (Embase, PubMed, Scopus, CINAHL, Web of Science, PsycINFO) using search terms relating to “community pharmacy” and “quality”. Titles and abstracts were screened against an inclusion/exclusion criterion followed by full-text screening. A narrative synthesis was undertaken.

Results: Following title and abstract screening of 11,493 papers, 165 papers were assessed for eligibility via full-text reading, with 81 studies (qualitative and quantitative) included in the review.

Features of quality identified from the literature were mapped across six potential dimensions:

•Access: structural and procedural components of quality such as opening hours, waiting time, physical access, availability of medicines and availability of pharmacy staff to provide services.

•Environment: the impact of facilities, equipment, and pharmacy layout on providing quality healthcare services.

•People-centred care: pharmacy staff providing patients with personalised care, establishing a patient-pharmacist relationship, and always demonstrating professionalism. •Effectiveness: competence of pharmacy staff in the dispensing process, pharmacy professionals’ clinical knowledge and diagnostic skills to assess and refer patients.

•Safety: identifying errors and intervening; accuracy in compounding; adequate information sharing between pharmacy staff when exchanging shifts; and having internal mechanisms designed to minimise patient risks.

•Integration: ways to establish and sustain the community pharmacist-general practitioner (GP; family doctor/physician) relationship; areas for collaboration between CP and GP beyond traditional dispensing; incentivisation for collaboration between CP and GP; and information sharing between community pharmacy and other primary care providers.

External and internal factors influencing the quality and integration of healthcare services provided by CP were also identified, comprising organisational culture; staffing levels and skill mix; training of pharmacy staff; workload; monitoring quality; remuneration; type of pharmacy; and service commissioning.

Conclusions: In the absence of an agreed quality framework for community pharmacy, this review identified dimensions of quality that can act as a framework for improving healthcare services provided by CP and their integrated health service provision. The next step will be to further develop and validate these dimensions of the framework in England with patients, healthcare professionals, decision and policy makers in CP, general practice and the wider healthcare system.