Exploring the contributions of community pharmacy in supporting people with long-term conditions (LTCs): A future model of care based on ‘self-care'?

Focal pointsThe purpose of the study was to explore community pharmacy's contributions in supporting self-care of people with LTCsCurrent services to support self-care are fragmented and product-centred, and may not fully engage the whole pharmacy teamThere is a need for more integrated and coherent approaches to delivering support services to people with long term conditions in the community pharmacyIntroductionSelf-care support has emerged as a holistic approach of supporting people with long-term conditions (LTCs) and reducing its burden on healthcare professionals (HCPs)1. Community pharmacy currently provides essential, advanced and enhanced services to support people with LTCs. Community pharmacy's role in supporting self-care of LTCs is primarily provided through services around medication reviews and medicines management. The overall aim of this study was to explore the roles and contributions of community pharmacy in supporting self-care for people with LTCs.MethodsThe study is part of a larger exploratory qualitative research programme involving community pharmacists, primary care doctors and nurses, and people living with LTCs. Community pharmacists were recruited by purposive sampling from England (Greater Manchester) and Scotland (Glasgow, Tayside) between January and March 2013. Participants were selected to allow for maximal variation2 in pharmacy types (multiples and independents), location (urban, rural, supermarket), area (deprived, affluent, mixed) and pharmacist demographics (ethnicity, age, gender). Semi-structured interviews were conducted face-to-face at participants’ places of work or other agreed location. The topic guide evolved iteratively and focused on questions around approaches in managing and supporting people with LTCs, definition/description of self-care, practices and challenges for holistically supporting self-care, and roles of other pharmacy support staff. Interviews were audio-recorded, transcribed verbatim and data were managed using the QSR NVIVO software (version 10). Data analysis was thematic using template analysis technique. NHS Research Ethics and R&D approvals were obtained.ResultsInterviews were conducted with 24 community pharmacists (12 in England, 12 in Scotland). All participants gave detailed accounts of how they support people with LTCs, and the roles and contribution of other pharmacy support staff. Well established medications related services such as the chronic medication service (CMS) in Scotland and medicines use reviews (MUR) and new medicines service (NMS) in England were the main ways that pharmacists support people with LTCs. These services tended to focus mainly on how medications should be used safely and effectively, while lifestyle and behaviour change interventions were not targeted during consultations, but only discussed opportunistically. Services that target lifestyle changes such as stop smoking and weight management services were mostly delivered by other trained support staff and were often completely separate from MURs, NMS and CMS consultations. In addition, pharmacists did not always fully appreciate the roles that other support staff could play in supporting people with LTCs. For example, with home delivery services, they did not readily recognize their delivery drivers as a part of their support staff, although most acknowledged that the drivers often form unique relationships with patients and are sometimes the only social contact for some of them and hence, may potentially become ‘self-care messengers’.ConclusionThis study suggests that current community pharmacy services that support people with LTCs are mostly fragmented and product-centred and are not optimally positioned to meet the needs of patients. Preliminary findings indicated that community pharmacy needs to plan and provide integrated and coherent approaches to supporting self-care. These approaches should go beyond individual episodes of medicines related activities, and involve all grades of staff interacting with an individual patient or carer. This paper only represents the views of pharmacists, but planned work will explore the views of people with LTCs and other healthcare professionals.References1. De Silver, D., Evidence: helping people help themselves. A review of the evidence considering whether it is worthwhile to support self-management. 2011, The Health Foundation: London.2. Creswell, J.W., Qualitative inquiry & research design: choosing among five approaches. 2006, SAGE Publications, Inc. Thousand Oaks, California