Sustainability of Professional Pharmacy Services in Community Pharmacy

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๐—•๐—ฎ๐—ฐ๐—ธ๐—ด๐—ฟ๐—ผ๐˜‚๐—ป๐—ฑ: Businesses have had to evolve through the development of innovations to respond to competitive markets. In the healthcare area, these innovations have been designed with the objective of improving patients' quality of life and safety. Specifically, in Pharmacy, the role of community pharmacists has significantly changed from a product to a patient orientation. As a result, multiple innovations referred to as professional pharmacy services have been designed, evaluated and implemented in practice. Nevertheless, once these innovations have been incorporated into practice, there is a paucity of evidence on how to maintain and make these services sustainable. ๐—ข๐—ฏ๐—ท๐—ฒ๐—ฐ๐˜๐—ถ๐˜ƒ๐—ฒ๐˜€: This thesis covers the exploration, analysis and development of knowledge of the sustainability of professional pharmacy services. This research aims to fill a gap in the literature. The beliefs, perceptions and experiences of key stakeholders were explored to add their views on theories and knowledge acquired from the literature. ๐— ๐—ฒ๐˜๐—ต๐—ผ๐—ฑ๐˜€: Qualitative and quantitative methods were used. This thesis encompassed four phases which included: (1) A literature review to explore definitions of sustainability in health services research and to develop a specific definition for the sustainability of professional pharmacy services. (2) A systematic review to identify the different conceptual approaches and assessment tools for the sustainability of innovations in healthcare. These data were used to develop a framework for the sustainability of professional services in pharmacy. (3) A qualitative study to explore community pharmacists' experiences and perspectives on the sustainability of professional services and to assess the applicability of the developed sustainability framework in practice. (4) A mixed-methods study to identify patients' needs and align them with the professional services provided by community pharmacists in Australia. ๐—ฅ๐—ฒ๐˜€๐˜‚๐—น๐˜๐˜€: Twenty-nine sustainability and twenty-three implementations definitions were identified in the literature review. The concepts retrieved from these definitions allowed the development of a specific definition for the sustainability of professional pharmacy services. One hundred thirty-two studies describing a sustainability conceptual approach or an assessment tool were identified in the systematic review. Factors affecting the sustainability of professional pharmacy services were identified, including funding, government support, adaptation, or program evaluation amongst others. From the results of this review a framework for the sustainability of professional pharmacy services was proposed. Eighteen interviews with community pharmacists were conducted as part of the qualitative study. The applicability of the framework for the sustainability of professional services was explored. The relevance of remuneration, training, government support as factors moderating the sustainability of professional services was reinforced. Additional moderating factors such as service promotion, government recognition or the need for making "patients feel comfortableโ€ were also identified. In the last piece of research, 26 anonymous surveys were conducted with patients and pharmacy owners. Patients' needs (e.g. receiving information about their medication and management of their health condition) and the services most frequently provided by community pharmacists (MedsCheck, Monitoring and Screening services) were identified. These needs and services were aligned and the most suitable services to respond to patients' needs were identified (i.e. Tailored counselling, MedsCheck and Home Medicines Review) ๐—–๐—ผ๐—ป๐—ฐ๐—น๐˜‚๐˜€๐—ถ๐—ผ๐—ป: The theoretical exploration of sustainability has revealed inconsistency on the terms and approaches available in the scientific literature. The resulting definition and proposed framework should be used as a guide to achieve the sustainability of professional services in pharmacy. The identified sustainability factors may serve as a guide for the development of future tools to measure the sustainability of these innovations in practice. Identifying patients' expressed needs should be a priority for community pharmacists who are willing to achieve the sustainability of their professional services.
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