To satisfy the pharmaceutical care needs of a growing number of patients seeking healthcare in primary care, it is increasingly important to integrate family doctor teams as providers of such care services, while the way bringing the strength of the teams into full play needs to be further explored.
To understand the needs of pharmaceutical care services in the community of Shanghai, providing a reference for improving the way of integrating community pharmacists into a family doctor team for delivering such services.
This study was conducted from September to December in 2020. Multistage sampling was used to select 349 elderly patients with chronic diseases in the community and 855 main members of family doctor teams〔general practitioners (n=481) , nurses (n=234) , and public health doctors (n=140) 〕 for questionnaire survey. The questionnaire for the patients mainly includes demographics, chronic condition, use of medications, needs and utilization of community-based pharmaceutical care. And the questionnaire for family doctor team members mainly contains demographics, understanding of community-based pharmaceutical care, and pharmaceutical services preferred to be involved in as a provider.
According to the survey results, the prevalence of three or more chronic diseases, and needing to take medications two or more times a day was 35.8% (125/349) , and 87.4% (305/349) , respectively. Among medication management services, "medication re-prescribing and follow-up" was the most needed〔14.9% (52/349) 〕, and "medication follow-up" was the most used〔14.0% (49/349) 〕. Among medication education services, "universal education on medication cautions for chronic conditions" was the most needed〔70.8% (247/349) 〕, and "healthy lifestyle promotion" was the most used〔9.4% (33/349) 〕. Among family doctor team members, 440 (91.5%) general practitioners, 202 (86.3%) nurses and 112 (80.0%) public health doctors expressed that they had an understanding of pharmaceutical care. In terms of the level of trust in pharmacists, the self-reported level of 302 (62.8%) general practitioners, 183 (78.2%) nurses, and 103 (73.6%) public health doctors was high. The number of general practitioners, nurses, and public health doctors wanting to be involved in "assisting physicians in providing medication selection and use services" was 359 (74.6%) , 112 (47.9%) , and 81 (57.8%) , respectively. The number of general practitioners, nurses, and public health doctors wanting to be involved in "providing nurses with guidance on medication use and management" was 190 (39.5%) , 153 (65.4%) and 57 (40.7%) , respectively.
Elderly patients with chronic diseases were in urgent need of medication management services, and more medication education services. However, the strength of pharmaceutical professional workforce in the community was weak, and family doctor team members had limited understanding of community-based pharmaceutical services. To efficiently provide residents with such services, it is suggested to train family doctor team members with relevant trainings by pharmaceutical professionals to improve their understanding level and service capability regarding pharmaceutical services at the individual and team levels.
Most of the elderly are prone to more than two chronic diseases and polypharmacy. Community health institutions are the key to ensuring rational drug use for in this population. Given many problems existing in the delivery of community pharmaceutical services, how to make better use of existing resources to improve the level of community pharmaceutical services remains to be further explored.
To understand the status of community pharmaceutical services implemented in Shanghai, providing a reference for improving community pharmaceutical services.
We conducted a survey in Shanghai with 235 pharmaceutical professionals selected by use of phased sampling from September to December 2020 with a questionnaire named as "Community Pharmacists Questionnaire" developed by us based on the results of previous literature review and on-site visits. In November 2020, we conducted a focus group interview with 82 stakeholders (including one pharmaceutical professional, one general practitioner and one community administrator selected from each community, two or three administrators selected from the health commission of each district) in Shanghai guided by an outline named as "Rational Drug Use for the Elderly" developed by us based on the results of previous literature review and on-site visits. The allocation of community pharmaceutical care resources, implementation and management of community pharmaceutical care involved in the interview were extracted as supplements to the survey results.
Among the 235 community pharmacists surveyed, the prevalence of providing prescription dispensing, prescription review, pharmaceutical drive-thru window services or outpatient consultation and guidance, and prescription comment services was 94.0% (221/235) , 82.6% (194/235) , 64.3% (151/235) , and 51.9% (122/235) , respectively. Among these services, prescription dispensing and prescription review were ranked as the top two in terms of average comprehensive score, indicating that implementing these two services required longer working hours of community pharmacists. In terms of the delivery methods of community pharmaceutical services, community pharmacists mainly used consultation windows〔226 cases (96.2%) 〕, pharmaceutical clinics〔119 cases (50.6%) 〕 and publicity lectures〔109 cases (46.4%) 〕. Only 53 (22.6%) participated in the family doctor team, among whom 22 (41.5%) had the qualification of clinical pharmacist; 47 (88.7%) mainly provided public education on rational drug use, and 45 (84.9%) mainly provided medication guidance and consultation services for patients. In terms of training, 180 cases (76.6%) participated in a training in the past one year, while other 55 (23.4%) cases did not. The number of trainings for most of cases was one or two times〔105 (58.3%) 〕. The way of trainings for most of cases was continuing education〔155 (86.1%) 〕. Both the questionnaire survey and interview results revealed that the main problems existing in the provision of community pharmaceutical services were heavy workload of dispensing/prescription review, lack of clinical knowledge patients' insufficient trust in pharmacists, and lack of performance incentives.
To meet the pharmaceutical needs of elderly patients with multiple chronic conditions, actions need to be taken to reduce the heavy workload of delivering traditional services in pharmacists, strengthen the clinical training of in-service pharmacists, and encourage pharmacists to join the family doctor team. Through providing pharmaceutical consultations and trainings for other family doctor team members by pharmacists, the scope of influence of pharmaceutical services will be expanded, which contributes to the ensuring of rational drug use.
