Extending the scope of community pharmacists’ practice to patients requiring urgent care – an evaluation of a training programme using the Theoretical Domains Framework

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Abstract

Redesigned health systems could meet the rising demand for healthcare, with community pharmacy currently an under-used resource for the treatment and management of patients requiring urgent care. This study aimed to investigate whether a training intervention delivered over two days to community pharmacists resulted in behaviour and practice change. Validated measures of psychological motivation and capability factors relevant to understanding behaviour and behaviour change were collected one week before, one week after and two months after training in a non controlled before and after study design. Two targeted behaviours of the intervention were the primary outcome measures: taking a structured history; and applying clinical examination techniques to patients requiring urgent care. Secondary outcomes measured participants’ reported patient management behaviours to investigate possible bridging of gaps in the health system. Training was provided in 14 locations in the UK to 258 community pharmacists, with data collection occurring July 2015 – September 2016. In total, 81 participants completed all three rounds of data collection (31.4%). Findings suggest that one-week post-training significant changes in psychological capability had taken place, and that these were sustained two months later: of the eight domains influencing behaviour and stimulating behaviour change, knowledge, skills, professional role, beliefs about capabilities and goals all increased significantly between T1 and T2, and T1 and T3 (all p<0.0001). At T3 participants were more likely to have taken a structured history than performed a clinical examination, and reported both managing patients themselves and changing referral practices to other healthcare providers. Participants reported workload and the need for liability insurance as structural and contextual barriers to implementation. While findings suggest the potential to transform models of care through training to extend community pharmacists’ practice these barriers to successful implementation of the urgent care service would need to be addressed if this service is rolled out nationally.

Bibliographical metadata

Original languageEnglish
JournalHealth and Social Care in the Community
Early online date29 Jan 2019
DOIs
Publication statusPublished - 2019

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