Medicines adherence support in areas of high deprivation in England

摘要

Introduction and aim: Pharmacists provide a range of services in the community to support the use of prescribed medicines, including the delivery and dispensing of medicines into multicompartment compliance aids (MCAs). However, there is little research exploring pharmacists' experiences of providing these services, with existing literature focusing on patient outcomes or costs. This study explores community pharmacists' experiences of providing interventions, products and services that support medicine adherence. Methods: Between September 2016 and August 2018, a small sample of pharmacists with experience in the community sector were recruited from deprived areas in north east England (n=15) and London (n=5). Semi-structured interviews were completed using an interview schedule in these two areas. Thematic analysis was conducted by both authors using the qualitative anlaytical software NVivo (QSR International). Approval was obtained by the ethics approval committee in the Faculty of Medical Sciences, Newcastle University. Results: A total of 20 interviews were conducted with 20 different participants from independent, small-to-medium and large-chain community pharmacies. Three themes were identified that described: 1) a variety of different interventions, products and services to support prescribed medicine use, including delivering medicines, packing medicines into MCAs and completing patient-facing consultations; 2) that participants identified medicines use reviews (MURs) and new medicine service consultations (NMSs) as the most efficacious way to support treatment adherence; and 3) that participants reported that services, such as delivery and MCA dispensing, were often provided pro bono, based on pharmacists' own assessment of clinical need. Most participants highlighted that pro bono services may have to be restricted in the future to support business sustainability, following changes to reimbursement in the 'Community pharmacy contractual framework 2016-2018'. Discussion: Current funding arrangements for community pharmacy services to support medicine use may create barriers to the provision of services to support medicines adherence. These findings should be interpreted with caution as the majority of pharmacists who took part in the study were working in areas of high deprivation; therefore, the findings may not be transferable to areas of low deprivation. Conclusion: Further work is needed to examine how funding structures could be redesigned to support the delivery of services that are currently provided pro bono by community pharmacists.