Design of an algorithm to support community pharmacy dyspepsia management
- 174 Downloads
Objectives To design a care pathway and referral documentation system to support dyspepsia management in the community pharmacy according to national guidelines. To explore attitudes of community pharmacists and general practitioners (GPs) towards the proposed model of care. Setting Focus group of four community pharmacists from one locality and one-to-one interviews with five GPs in each of their surgeries in different city localities. Method Literature review; design of a care pathway and referral system; qualitative analysis of focus group discussion and one-to-one interviews. Main outcome measure Modified design of documentation system; attitudes and barriers towards an extended role for pharmacists in a community pharmacy based model of individual care of patients with dyspepsia. Results The care pathway and documentation system was modified to make it simple to use and to assure appropriate referral and reporting to GPs. All participants agreed that the SIGN guideline for Dyspepsia and local dyspepsia guidelines provide an opportunity to extend the role of pharmacists to prescribe therapeutic doses of H2 receptor antagonists, test for Helicobacter pylori in the pharmacy and prescribe eradication therapy. Perceived advantages to patients included better convenience and reduced waiting times for H. pylori testing. Current barriers to this model identified were: medico-legal issues, budgetary issues, limited access to patient data, lack of privacy to talk to patients, inadequate time and remuneration, no patient registration, patients describing vague symptoms and patient confidence in pharmacists. Conclusion The proposed model of care and documentation system for community pharmacy based dyspepsia management generated a favourable response and design contributions from community pharmacists and GPs. Barriers were identified which have to be overcome prior to implementation and evaluation of the model.
KeywordsCare pathway Community pharmacy Dyspepsia Extended role Guidelines Partnership working Pharmacists Scotland
The authors would like to thank the community pharmacists and GPs for their participation in the study and Susan McKellar from the University of Strathclyde for help with the focus group and data analysis.
Financial support of the study
No external funding support was associated with this study.
Conflicts of interest
- 1.Scottish Intercollegiate Guidelines Network. Dyspepsia. Guideline number 68. SIGN, Edinburgh. 2003. Available from: http://sign.ac.uk/pdf/sign68.pdf.
- 3.National Institute for Clinical Excellence. Clinical Guideline 17, Dyspepsia: managing adults in primary care. National Institute for Clinical Excellence (NICE); 2004.Google Scholar
- 4.Scottish Executive. The right medicine: a strategy for pharmaceutical care in Scotland. Edinburgh: Scottish Executive; 2002.Google Scholar
- 6.News feature. How the minor ailments service works. Pharm J 2004;272:115–6.Google Scholar
- 7.Vohra S. A community pharmacy minor ailment scheme- effective, rapid and convenient. Pharm J 2006;276:754–6.Google Scholar
- 8.New Community Pharmacy Contract – Minor Ailments Service – Implementation. NHS circular: PCP(P)(2006)9. Scottish Executive; May 2006.Google Scholar
- 9.Lothian Minor Ailments Formulary. Available: http://ljf.scot.nhs.uk/maf/01_a.pdf.
- 10.NHS Education Scotland (NES) Pharmacy. The Minor Ailment Service (MAS) implementation pack. Available: http://nes.scot.nhs.uk/pharmacy/newcontract/minor_ailment_service/.
- 13.The National Health Service (Charges for drugs and compliances) (Scotland) (No.2) Regulations 2007. NHS circular: CEL (2007) 9. Scottish Government; 2007.Google Scholar
- 14.Supplementary prescribing: pharmacists practitioners. A guide for implementation within NHS Scotland. Scottish Executive; 2004.Google Scholar
- 15.Bellingham C. How supplementary prescribing is working for pharmacists in practice? Pharm J 2004;273:2–3.Google Scholar
- 17.Johnson G, McCaig D, Bond C, Cunningham S, Diack H, Watson A, Stewart D. Supplementary prescribing: early experiences of pharmacists in Great Britain. Ann Pharmacother 2006;40:843–50.Google Scholar
- 18.Smalley L. Patients’ experience of pharmacist-led supplementary prescribing in primary care. Pharm J 2006;276:567–9.Google Scholar
- 22.Buckley P, Grime J, Blenkinsopp A. Inter- and intra- professional perspectives on non-medical prescribing in an NHS Trust. Pharm J 2006;277:394–8.Google Scholar
- 25.Bond CM. Guidelines for dyspepsia treatment. Pharm J 1994;252:228–9.Google Scholar
- 29.Ritchie J, Spencer L. Qualitative data analysis for applied policy research. In: Bryman A, Burgess RG, editors. Analysing qualitative data. London: Routledge; 1993. p. 173–194.Google Scholar
- 30.Smith F. Referral of clients by community pharmacists: views of general medical practitioners. Int J Pharm Pract 1996;4:30–5.Google Scholar