Are professional pharmacy services being offered for free in pharmacies? A feasibility study exploring the use of a time motion study in New Zealand

Main Article Content

Keywords

Community Pharmacy Services, Pharmaceutical Services, Patient Care, Remuneration, Professional Practice, Workflow, Pharmacies, Pharmacists, Research Design, Feasibility Studies, Qualitative Research, New Zealand

Abstract

Background: Pharmacists report to be providing patient-focused clinical services for which they receive no remuneration. Limited literature exists about unfunded services leading to difficulties in ascertaining an appropriate study design for such research.


Objective: This study aims to assess the appropriateness of a proposed study design before launching a nationwide study to investigate the provision of unfunded patient care services.


Methods: A multi-methods approach was utilised consisting of (1) continuous time motion study in community pharmacies (2) semi structured patient interviews (3) patient follow up (4) semi structured interviews with pharmacy owners/managers. All observations of unfunded patient care services were recorded, numerically coded and descriptively analysed. Semi structured interviews were audio recorded and transcribed verbatim. A semantic thematic analysis was carried out. Appropriateness of study design was dictated by the ability to characterise services and obtain patient perceptions.


Results: Ten pharmacies took part in the feasibility study, across the city of Dunedin, New Zealand, representing a range of different practice settings and demographics. Ten patients were interviewed and six responded to follow up. Both pharmacy and patient recruitment proved challenging due to concerns around disruption to workflow and patient privacy. A continuous observation time motion study was found to be appropriate as it minimises disruption to workflow with no additional work required from the pharmacy teams.


Conclusions: A continuous observation time motion study proved to be an appropriate method to investigate the provision of unfunded services on a national scale. The findings of the study suggest design changes such as length of observation time, increasing patient recruitment and additional patient questions to enhance the nationwide study.

Abstract 2824 | pdf Downloads 533

References

1. Ministry of Health New Zealand. Pharmacy action plan 2016 to 2020. https://www.health.govt.nz/system/files/documents/publications/pharmacy-action-plan-2016-to-2020.pdf (accessed Nov 5, 2017).
2. Canadian Pharmacists Association. Blueprint for pharmacy: transition in a new era. https://www.pharmacists.ca/cpha-ca/assets/File/pharmacy-in-canada/blueprint/Blueprint%20Transition%20Report_2015_ENG.pdf (accessed Oct 1, 2020).
3. Dunlop JA, Shaw JP. Community pharmacists' perspectives on pharmaceutical care implementation in New Zealand. Pharm World Sci. 2002;24(6):224-230. https://doi.org/10.1023/a:1021526425458
4. Smith AJ, Scahill SL, Harrison J, Carroll T, Medlicott NJ. Service provision in the wake of a new funding model for community pharmacy. BMC Health Serv Res. 2018;18(1):307. https://doi.org/10.1186/s12913-018-3120-z
5. Cruthirds DL, Hughes PJ, Weaver S. Value of pharmacy services to the healthcare system: an interdisciplinary assessment. Int J Pharm Pract. 2013;21(1):38-45. https://doi.org/10.1111/j.2042-7174.2012.00239.x
6. Scahill S, Harrison J, Carswell P, Shaw J. Health care policy and community pharmacy: implications for the New Zealand primary health care sector. N Z Med J. 2010;123(1317):41-51.
7. Kinsey H, Scahill S, Bye L, Harrison J. Funding for change: New Zealand pharmacists' views on, and experiences of, the community pharmacy services agreement. Int J Pharm Pract. 2016;24(6):379-389. https://doi.org/10.1111/ijpp.12266
8. Bernsten C, Andersson K, Gariepy Y, Simoens S. A comparative analysis of remuneration models for pharmaceutical professional services. Health Policy. 2010;95(1):1-9. https://doi.org/10.1016/j.healthpol.2009.11.008
9. Van Mil JWF, De Boer WO, Tromp TFJ. European barriers to the implementation of pharmaceutical care. Int J Pharm Pract. 2001;9(3):163-168.
10. Cook M. DHB modelling sparks fears of funding cuts under new pharmacy contract. https://www.pharmacytoday.co.nz/article/news/dhb-modelling-sparks-fears-funding-cuts-under-new-pharmacy-contract (accessed May 9, 2018).
11. Chilton-Towle J. Pharmacists going extra mile fear future without funding. https://www.pharmacytoday.co.nz/article/news/business/pharmacists-going-extra-mile-fear-future-without-funding (accesed Mar 23, 2018).
12. Zoio N. Pharmacists call for more funding for INR tests. https://www.pharmacytoday.co.nz/article/print-archive/pharmacists-call-more-funding-inr-tests (accessed Nov 10, 2017).
13. Torjesen I. Pharmacy funding cuts: the story so far. https://www.pharmaceutical-journal.com/news-and-analysis/features/pharmacy-funding-cuts-the-story-so-far/20202223.article?firstPass=false (accessed Mar 28, 2018).
14. Abdul Aziz YH, Heydon SJ, Duffull SB, Marra CA. What free services do pharmacists offer? Investigating the provision of unfunded pharmacy services in community pharmacies. Res Social Adm Pharm. 2021;17(3):588-594. https://doi.org/10.1016/j.sapharm.2020.05.007
15. Lopetegui M, Yen PY, Lai A, Jeffries J, Embi P, Payne P. Time motion studies in healthcare: what are we talking about?. J Biomed Inform. 2014;49:292-299. https://doi.org/10.1016/j.jbi.2014.02.017
16. Ampt A, Westbrook J, Creswick N, Mallock N. A comparison of self-reported and observational work sampling techniques for measuring time in nursing tasks. J Health Serv Res Policy. 2007;12(1):18-24. https://doi.org/10.1258/135581907779497576
17. Dreyer NA, Tunis SR, Berger M, Ollendorf D, Mattox P, Gliklich R. Why observational studies should be among the tools used in comparative effectiveness research. Health Aff (Millwood). 2010;29(10):1818-1825. https://doi.org/10.1377/hlthaff.2010.0666
18. Arain M, Campbell MJ, Cooper CL, Lancaster GA. What is a pilot or feasibility study? A review of current practice and editorial policy. BMC Med Res Methodol. 2010;10:67. https://doi.org/10.1186/1471-2288-10-67
19. Doody O, Doody CM. Conducting a pilot study: case study of a novice researcher. Br J Nurs. 2015;24(21):1074-1078. https://doi.org/10.12968/bjon.2015.24.21.1074
20. Bowen DJ, Kreuter M, Spring B, et al. How we design feasibility studies. Am J Prev Med. 2009;36(5):452-457. https://doi.org/10.1016/j.amepre.2009.02.002
21. Cavaye D, Lehnbom EC, Laba TL, El-Boustani E, Joshi R, Webster R. Considering pharmacy workflow in the context of Australian community pharmacy: A pilot time and motion study. Res Social Adm Pharm. 2018;14(12):1157-1162. https://doi.org/10.1016/j.sapharm.2018.01.003
22. Dean B, Barber N. Validity and reliability of observational methods for studying medication administration errors. Am J Health Syst Pharm. 2001;58(1):54-59. https://doi.org/10.1093/ajhp/58.1.54
23. Van de Mortel TF. Faking it: social desirability response bias in self-report research. Aust J Adv Nurs. 2008;25(4):40-48.