Objective:
1) To evaluate the participation rate and identify the practical
barriers to implementing a community pharmacist-led medication
review service in francophone Switzerland and, 2) To assess the
effectiveness of external support.
Methods: A qualitative survey was undertaken to identify barriers
to patient inclusion and medication review delivery in daily practice
among all contactable independent pharmacists working in francophone
Switzerland (n=78) who were members of a virtual chain (pharmacieplus),
regardless of their participation in a simultaneous cross-sectional
study. This study analyzed the dissemination of a medication review
service including a prescription and drug utilization review with
access to clinical data, a patient interview and a pharmaceutical
report to the physicians. In addition, we observed an exploratory
and external coaching for pharmacists that we launched seven months
after the beginning of the cross-sectional study.
Results: Poor motivation on the part of pharmacists and difficulties
communicating with physicians and patients were the primary obstacles
identified. Lack of time and lack of self-confidence in administering
the medication review process were the most commonly perceived
practical barriers to the implementation of the new service. The
main facilitators to overcome these issues may be well-planned
workflow organization techniques, strengthened by an adequate
remuneration scheme and a comprehensive and practice-based training
course that includes skill-building in pharmacotherapy and communication.
External support may partially compensate for a weak organizational
framework.
Conclusions: To facilitate the implementation of a medication
review service, a strong local networking with physicians, an
effective workflow management and a practice- and communications-focused
training for pharmacists and their teams seem key elements required.
External support can be useful to help some pharmacists improve
their service management skills. Adequate remuneration seems necessary
to encourage initial investments to provide such a service. Future
research in this area may help improve the process and design
of training programs, as well as the monitoring of implementation
for each new pharmaceutical service.
