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Experiences of a community pharmacy service to support adherence and self-management in chronic heart failure

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Abstract

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.

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Acknowledgments

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.

Funding

NHS Greater Glasgow and Clyde. The principal author’s time was funded by The National Research Scotland Fellowship Scheme.

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Authors and Affiliations

  1. Research and Development, Pharmacy and Prescribing Support Unit, NHS Greater Glasgow and Clyde, Victoria Infirmary, Langside Road, Glasgow, G42 9TT, UK

    Richard Lowrie, Paul Forsyth & Stuart Lochhead Bryce

  2. Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK

    Lina Johansson & Susan McKellar

  3. Create Consultancy Ltd., Glasgow, UK

    Niamh Fitzgerald

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  1. Richard Lowrie
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  2. Lina Johansson
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Correspondence to Richard Lowrie.

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Lowrie, R., Johansson, L., Forsyth, P. et al. Experiences of a community pharmacy service to support adherence and self-management in chronic heart failure. Int J Clin Pharm 36, 154–162 (2014). https://doi.org/10.1007/s11096-013-9889-2

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