Developing Integrated Extended Pharmacist Roles and Services for Equitable Access and Outcomes in Primary Healthcare:...

Area of Science:

• Health Services Research
• Pharmaceutical Practice
• Primary Healthcare Policy

Background:

• Pharmacists' roles are evolving from dispensing to patient-focused clinical care, reflecting shifts in health policy.
• This study examines the development and implementation of practice pharmacist roles and services within New Zealand's primary healthcare (PHC) settings.
• It investigates the responses of pharmacists, patients, and other PHC professionals to these evolving roles.

Purpose of the Study:

• To evaluate the development of practice pharmacists' roles and services in New Zealand PHC.
• To understand how these services were implemented and the resulting stakeholder responses.
• To identify factors influencing the integration and utilization of practice pharmacists within PHC teams.

Main Methods:

• A realist evaluation methodology was employed, focusing on context, mechanism, and outcome (CMO) configurations.
• Data were gathered through rapid realist review, key informant interviews, six case studies, and a national survey.
• Programme theories were developed and refined to explain how CMO configurations influence desired outcomes.

Main Results:

• Four programme theories, based on 22 CMO configurations, illustrate factors enabling or hindering the integration of practice pharmacists.
• Enabling factors include a clear need for change, supportive colleagues, appropriate infrastructure, well-defined roles, and patient awareness.
• Barriers identified were disjointed leadership, role uncertainty, and limited patient access; funding influenced all levels.

Conclusions:

• Practice pharmacist services are influenced by multiple contextual levels, necessitating a systems approach for development and implementation.
• Strengthening enabling contexts and mitigating barriers are key to achieving successful integration and equitable outcomes.
• Policy focus is needed on equitable service distribution, sustainable funding models, and the impact of patient copayments on equity.