Exploring pharmacists’ views on an in-pharmacy medication review program in Australia using a mixed-methods design

Abstract

Background MedsCheck is an in-pharmacy medication review program funded by the Australian Government. It is intended to improve patient understanding of medicines and resolve adherence issues. Objective To explore MedsCheck from the community pharmacists’ perspective, focusing on the perceived effectiveness of the program, barriers to its optimal delivery, and the integration with other services. Setting Individual interviews in one territory and a national online survey of Australian community pharmacists. Method Using a mixed-method triangulation design, the interviews and the survey were conducted concurrently. The interviews were semi-structured, transcribed verbatim and thematically analysed. The survey, comprising closed and open-ended questions, was quantitatively and thematically analysed. The findings were first analysed separately and finally integrated by searching for convergence, complementarity, and discrepancy. Main outcome measure Pharmacists’ perceptions of the effectiveness and barriers of MedsCheck. Results Eight interviews were conducted, and 232 survey responses collected. In the interviews, themes related to perceived benefits (appreciation, reduced confusion, and strengthening relationships), barriers (lack of controls, lack of staff, lack of awareness, and lack of understanding of scope of services), and the integration with other services (strong link with dose administration aids) emerged, which mostly correlated with the survey’s results. Ten percent of surveyed respondents did not provide the MedsCheck service; their main reason being insufficient staffing. Of the pharmacists offering the service, 76% strongly agreed that patients were benefitting. MedsCheck reviews were usually initiated by pharmacy staff. Fifty-three percent of respondent pharmacists never or only sometimes reported the review outcomes to the patient’s general practitioner. Conclusion The pharmacists believed that MedsCheck is useful to improve patients’ understanding and management of their medicines. However, there are currently barriers to the effective delivery of the service, including workload issues, lack of patient awareness, and the service’s integration with the broader care of the patient. If these were appropriately addressed, the in-pharmacy medication review program could help pharmacists to better engage with patients and general practitioners and enhance understanding of medication and adherence.

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References

  1. 1.

    Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37–43.

    Article  Google Scholar 

  2. 2.

    Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA. 2005;294(6):716–24.

    CAS  Article  Google Scholar 

  3. 3.

    Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17:230.

    Article  Google Scholar 

  4. 4.

    Pasina L, Brucato AL, Falcone C, Cucchi E, Bresciani A, Sottocorno M, et al. Medication non-adherence among elderly patients newly discharged and receiving polypharmacy. Drugs Aging. 2014;31(4):283–9.

    CAS  Article  Google Scholar 

  5. 5.

    World Health Organization. Adherence to long-term therapies: evidence for action. Geneva, Switzerland: World Health Organization; 2003. https://apps.who.int/iris/bitstream/handle/10665/42682/9241545992.pdf. Accessed 09 Nov 2019.

  6. 6.

    Lim R, Semple S, Ellett LK, Roughead L. Medicine safety: take care. Canberra, Australia: Pharmaceutical Society of Australia; 2019. https://www.psa.org.au/wp-content/uploads/2019/01/PSA-Medicine-Safety-Report.pdf. Accessed 09 Nov 2019.

  7. 7.

    Wilhelmsen NC, Eriksson T. Medication adherence interventions and outcomes: an overview of systematic reviews. Eur J Hosp Pharm. 2019;26(4):187–92.

    Article  Google Scholar 

  8. 8.

    Mossialos E, Courtin E, Naci H, Benrimoj S, Bouvy M, Farris K, et al. From “retailers” to health care providers: transforming the role of community pharmacists in chronic disease management. Health Policy. 2015;119(5):628–39.

    Article  Google Scholar 

  9. 9.

    Department of Health and Ageing. Home medicines review program qualitative research project final report. In: For consumers. Australian Government, Canberra, Australia. 2009. https://www1.health.gov.au/internet/main/publishing.nsf/Content/hmr-qualitative-research-final-report. Accessed 09 Nov 2019.

  10. 10.

    Jokanovic N, Tan ECK, van den Bosch D, Kirkpatrick CM, Dooley MJ, Bell JS. Clinical medication review in Australia: a systematic review. Res Social Adm Pharm. 2016;12(3):384–418.

    Article  Google Scholar 

  11. 11.

    Department of Health and Ageing. Medication use review (MedsCheck) and diabetes medication management services (Diabetes MedsCheck). In: For consumers. Australian Government, Canberra, Australia. 2014. https://www1.health.gov.au/internet/main/publishing.nsf/Content/fifth-community-pharmacy-agreement-mur. Accessed 09 Nov 2019.

  12. 12.

    Pharmaceutical Society of Australia. Guidelines for pharmacists providing MedsCheck and Diabetes MedsCheck services. Canberra, Australia: Pharmaceutical Society of Australia; 2017. https://my.psa.org.au/s/article/Guidelines-for-pharmacists-providing-MedsCheck-and-Diabetes-MedsCheck-services. Accessed 05 Oct 2018.

  13. 13.

    The 6CPA. Chronic Pain MedsCheck trial. In: Medication adherence and medication management programs. The 6CPA, Canberra, Australia. 2019. http://6cpa.com.au/pharmacy-trial-program/chronic-pain-medscheck-trial/. Accessed 12 Nov 2019.

  14. 14.

    Pharmacy Guild of Australia. Sixth community pharmacy agreement. Canberra, Australia: Pharmacy Guild of Australia; 2015. https://www.guild.org.au/migration/community-pharmacy-agreement. Accessed 05 Oct 2018.

  15. 15.

    Pharmacy Programs Administrator. MedsCheck and Diabetes MedsCheck. Pharmacy Programs Administrator, Melbourne, Australia. 2018. https://www.ppaonline.com.au/programs/medication-management-programs/medscheck-and-diabetes-medscheck. Accessed 06 Mar.

  16. 16.

    Turner SF, Cardinal LB, Burton RM. Research design for mixed methods: a triangulation-based framework and roadmap. Organ Res Methods. 2017;20(2):243–67.

    Article  Google Scholar 

  17. 17.

    O’Cathain A, Murphy E, Nicholl J. The quality of mixed methods studies in health services research. J Health Serv Res Policy. 2008;13(2):92–8.

    Article  Google Scholar 

  18. 18.

    Seeniyar R, Wilkinson C. Expenditure and prescriptions twelve months to 30 June 2017. Canberra, Australia: Australian Government; 2017. http://www.pbs.gov.au/statistics/expenditure-prescriptions/2016-2017/expenditure-and-prescriptions-twelve-months-to-30-june-2017.pdf. Accessed 5 Oct 2018.

  19. 19.

    Department of Human Services. HSD search. In: Human services directory. State Government of Victoria, Melbourne, Australia. 2018. http://humanservicesdirectory.vic.gov.au/Home.aspx. Accessed 05 Oct 2018.

  20. 20.

    Australian Bureau of Statistics. Postcode 2012 to remoteness area 2011. Canberra, Australia: Australian Goverment; 2013. https://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/1270.0.55.006July%202011?OpenDocument. Accessed 18 Oct 2018.

  21. 21.

    Sclavos K. MedsCheck and diabetes MedsCheck. Aust Pharm. 2012;31(7):525.

    Google Scholar 

  22. 22.

    Pharmacy Guild of Australia. Full audit of MedsCheck program required. Canberra, Australia: Pharmacy Guild of Australia; 2014. https://www.guild.org.au/news-events/news/2014/03/05/full-audit-of-medscheck-program-required. Accessed 18 Oct 2018.

  23. 23.

    Meyers DC, Durlak JA, Wandersman A. The quality implementation framework: a synthesis of critical steps in the implementation process. Am J Community Psychol. 2012;50(3–4):462–80.

    Article  Google Scholar 

  24. 24.

    Dolovich L, Gagnon A, McAiney CA, Sparrow L, Burns S. Initial pharmacist experience with the Ontario-based MedsCheck program. Can Pharm J (Ott). 2008;141(6):339–45.

    Article  Google Scholar 

  25. 25.

    MacKeigan LD, Ijaz N, Bojarski EA, Dolovich L. Implementation of a reimbursed medication review program: corporate and pharmacy level strategies. Res Social Adm Pharm. 2017;13(5):947–58.

    Article  Google Scholar 

  26. 26.

    Blenkinsopp A, Celino G, Bond C, Inch J. Medicines use reviews: the first year of a new community pharmacy service. Pharm J. 2007;278:218–23.

    Google Scholar 

  27. 27.

    Latif A. Community pharmacy medicines use review: current challenges. Integr Pharm Res Pract. 2017;7:83–92.

    Article  Google Scholar 

  28. 28.

    Weir NM, Newham R, Dunlop E, Bennie M. Factors influencing national implementation of innovations within community pharmacy: a systematic review applying the consolidated framework for implementation research. Implement Sci. 2019;14:21.

    Article  Google Scholar 

  29. 29.

    PricewaterhouseCoopers. Combined review of fifth Community Pharmacy Agreement medication management programmes: Final report. Canberra, Australia; 2015. https://www1.health.gov.au/internet/main/publishing.nsf/Content/6EF022DE87761986CA257EC80013198B/$File/combined-review-5cpa-medication-management-programmes-final-report-and-appendices.pdf.

  30. 30.

    The 6CPA. MedsCheck and Diabetes MedsCheck. In: Medication adherence and medication management programs. The 6CPA, Canberra, Australia. 2015. http://6cpa.com.au/medication-management-programmes/medscheck-diabetes-medscheck/. Accessed 05 Oct 2018.

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Acknowledgements

The authors would like to acknowledge Simon Carroll for his support in the participant recruitment. Furthermore, the authors would like to express their sincere thanks to all community pharmacists who participated in the study, and to the researchers and stakeholders who reviewed the questionnaire before survey commencement.

Funding

The University of Canberra provided funding for the survey’s and interviews’ incentives through the higher degree research student fund. No further funding was provided.

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Correspondence to Mark Naunton.

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Buss, V.H., Shield, A., Kosari, S. et al. Exploring pharmacists’ views on an in-pharmacy medication review program in Australia using a mixed-methods design. Int J Clin Pharm (2020). https://doi.org/10.1007/s11096-020-01102-4

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Keywords

  • Adherence
  • Australia
  • Community pharmacy services
  • Health service evaluation
  • Medication knowledge
  • Medication reconciliation
  • Medication review
  • MedsCheck