Experiences of a community pharmacy service to support adherence and self-management in chronic heart failure
Background Heart failure (HF) is common, disabling and deadly. Patients with HF often have poor self-care and medicines non-adherence, which contributes to poor outcomes. Community pharmacy based cognitive services have the potential to help, but we do not know how patients view community-pharmacist-led services for patients with HF. Objective We aimed to explore and portray in detail, the perspectives of patients receiving, and pharmacists delivering an enhanced, pay for performance community pharmacy HF service. Setting Community pharmacies and community-based patients in Greater Glasgow and Clyde, Scotland. Methods Focus groups with pharmacists and semi-structured interviews with individual patients by telephone. Cross sectional thematic analysis of qualitative data used Normalization Process Theory to understand and describe patient’s reports. Main outcome measure Experiences of receiving and delivering an enhanced HF service. Results Pharmacists voiced their confidence in delivering the service and highlighted valued aspects including the structured consultation and repeated contacts with patients enabling the opportunity to improve self care and medicines adherence. Discussing co-morbidities other than HF was difficult and persuading patients to modify behaviour was challenging. Patients were comfortable discussing symptoms and medicines with pharmacists; they identified pharmacists as fulfilling roles that were needed but not currently addressed. Patients reported the service helped them to enact HF medicines and HF self care management strategies. Conclusion Both patients receiving and pharmacists delivering a cognitive HF service felt that it addressed a shortfall in current care. There may be a clearly defined role for pharmacists in supporting patients to address the burden of understanding and managing their condition and treatment, leading to better self management and medicines adherence. This study may inform the development of strategies or policies to improve the process of care for patients with HF and has implications for the development of other extended role services.
KeywordsAdherence Community pharmacy Heart failure Patient views Scotland Self-care
Our friend and collaborator, Prof Steve Hudson, died during the course of this project. The authors are indebted to Steve for his general guidance, support and good humour.
Conflicts of interest
There are no conflicts of interest to report.
NHS Greater Glasgow and Clyde. The principal author’s time was funded by The National Research Scotland Fellowship Scheme.
- 1.Hobbs FD, Kenkre JE, Roalfe AK, David RC, Hare R, Davies MK. Impact of heart failure and left entricular systolic dysfunction on quality of life: a cross-sectional study comparing common chronic cardiac and medical disorders and a representative adult population. Eur Heart J. 2002;23(23):1867–76.PubMedCrossRefGoogle Scholar
- 3.NHS Information Centre. National Heart Failure Audit 2010 [accessed 2nd Nov 2013]. Leeds: NHS IC. Available from: http://www.wales.nhs.uk/sites3/Documents/490/National%20Heart%20Failure%20Audit%20Report%202009-10.pdf.
- 17.Boswell KA, Cook CL, Burch SP, Eaddy MT, Cantrell CR. Associating medication adherence with improved outcomes: a systematic literature review. Am J Pharm Benefits. 2012;4(4):e97–108.Google Scholar
- 24.NHS Quality Improvement Scotland. The coronary heart disease (CHD) Improvement Management Programme. CHD Resource Pack version 1. Edinburgh: NHS QIS; 2009. ISBN 0-7559-4376-7.Google Scholar
- 25.Scottish Intercollegiate Guidelines Network. Management of Chronic Heart Failure: A national clinical guideline. SIGN 95. Edinburgh: SIGN;2007. ISBN 1899893946.Google Scholar
- 26.National Institute for Health and Care Excellence. Chronic heart failure: Management of chronic heart failure in adults in primary and secondary care. CG108. London: National Institute for Health and Care Excellence; 2008. ISBN 1-84257-323-3.Google Scholar
- 27.Ritchie J, Lewis J, editors. Qualitative Research Practice: A Guide for Social Science Students and Researchers. London: Sage; 2003 ISBN 0761971106.Google Scholar
- 29.Daly J, Kellehear A, Gliksman M. The public health researcher: a methodological approach. Melbourne: Oxford University Press; 1997 ISBN 232324510.Google Scholar
- 30.Joffe H. Thematic Analysis. In: Harper D, Thompson AR, editors. Qualitative Research Methods in Mental Health and Psychotherapy: A Guide for Students and Practitioners Chichester: Wiley, 2011; ch15. doi: 10.1002/9781119973249.
- 35.Milfred-LaForest SK, Chow SL, DiDomenico RJ, Dracup K, Ensor CR, Gattis-Stough W, et al. Clinical pharmacy services in heart failure: an opinion paper from the Heart Failure Society of America and American College of Clinical Pharmacy Cardiology Practice and Research Network. J Card Fail. 2013;19(5):354–69.PubMedCrossRefGoogle Scholar
- 36.Alston CL, Paget GC, Halvorson B, Novelli B, Guest J, McCabe P, et al. Communicating with patients on health care evidence. Discussion paper. 2012 [Accessed Nov 2nd 2013]. Washington DC: Institute of Medicines. Available at: http://www.iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/VSRT-Evidence.pdf.
- 44.Correspondent Scotland. New remuneration structure on the cards in Scotland. Pharm Journal. 2013;290:628.Google Scholar
- 46.Gidman W, Ward P, McGregor L. Understanding public trust in services provided by community pharmacists relative to those provided by general practitioners: a qualitative study. BMJ Open [online journal]. 2012;2(3):3000939 [Accessed 2nd Nov 2013];2(3). Available at: http://bmjopen.bmj.com/content/2/3/e000939.full.
- 52.NHS Scotland. Building a Health Service Fit for the Future. A National Framework for Service Change in the NHS in Scotland. Edinburgh: Scottish Executive; 2005. ISBN 0755946693.Google Scholar