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An investigation into the awareness, demand and use of community pharmacy services for people with long-term conditions
[Thesis]. Manchester, UK: The University of Manchester; 2019.
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Abstract
The increasing population of patients with long-term conditions (LTCs) poses particular challenges for healthcare organisations due to high levels of morbidity, healthcare costs and workload in general practices. Policymakers have recognised the potential of community pharmacies to meet some of the needs of patients with LTCs and reduce general practitioners' (GPs) workload by implementing novel reimbursement structures for a range of public health and medicines services ("extended services") across the United Kingdom. However, there is evidence that, despite positive outcomes, patient awareness, demand and uptake of these extended services is low. This PhD aimed to explore and identify ways to improve low awareness, demand and use of community pharmacy services which may benefit patients with LTCs. Three studies were conducted to achieve the aim of this programme. Study One systemically reviewed the literature on patient/public, pharmacist and GP perceptions of community pharmacy services and confirmed that awareness, demand and uptake of extended services was low and that integration within primary care remained poor. However, GPs' views were underrepresented and the published evidence did not explore ways to overcome low awareness and uptake of extended community pharmacy services with a view to better integrate community pharmacy services into the patients' primary care pathway. Study Two was a qualitative focus group study which used the 7Ps marketing mix to examine the views of the three main stakeholder groups - patients, community pharmacists and GPs - to identify how community pharmacy services may be better used and integrated within the primary care pathway for people with LTCs. Study Three was informed by the findings of Study Two and involved a cross-sectional survey of patients' views. Using the 7Ps marketing mix highlighted that improving consistency in delivery and quality of services; strategically promoting community pharmacy services; and incentivising joint-working between community pharmacies and GP practice along a patient's primary care pathway could increase patients' and GPs' awareness of and demand for community pharmacy services. Service characteristics such as pharmacy staff's interpersonal skills, good quality consultation rooms and having integrated information systems with GP practices are also essential to encourage patients to use community pharmacies for management of LTCs instead of GP practices. The findings in this research show that community pharmacies have the potential to offer more support for patients with LTCs but further developments are needed to fully integrate community pharmacy services within patient primary care pathways. After conceptualising key factors which could influence better awareness, demand and use of community pharmacy services for patients with LTCs, this thesis sets out a series of recommendations for policymakers and future research.
Keyword(s)
NHS; community pharmacy; general practice; health policy; integration; long-term conditions; patients; primary care