Scott Cunningham

In the United Kingdom (UK), the vision is to further develop the pharmacy workforce through career development pathways aligning to the Royal Pharmaceutical Society’s post-registration foundation, advanced, and consultant practice curricula, which align with the four pillars of advanced practice recognized across multiple healthcare professionals—clinical practice, leadership and management, education, and research. However, it has been recognized that research capacity, competency, and confidence within the pharmacy profession require development. It has been noted that it is this ‘pillar’ that most frequently impedes successful credentialing at both ‘Core advanced’ and ‘Consultant levels’. A report presenting the findings of a UK-wide call for evidence on clinical academic careers in pharmacy outlines recommendations to embed a research culture in pharmacy careers, develop a clinical academic pathway for pharmacy, and provide a pipeline of pharmacy research leaders. The establishment of such pathways would provide opportunities for building capacity within the profession. The Scottish Pharmacist Clinical Academic Fellowship (SPCAF) programme was created to develop a network of Clinical Academic Pharmacist posts; a collaborative initiative between National Health Service Education for Scotland and the two Pharmacy Higher Education Institutions in Scotland is aimed at developing pharmacists as researchers to advance pharmaceutical care within the National Health Service in Scotland. This commentary presents a summary of an archival review completed as part of a wider research programme that adopted a case study approach with the purpose of evaluating the SPCAF programme cohort 1 (2021–23). The scope is to support others looking to develop similar practice-based research programmes aiming to build research capacity, competence, and confidence in the pharmacy workforce.

Background: The importance of involvement of community pharmacy (CP) teams in antimicrobial stewardship (AMS)-related interventions is justified by the high prevalence of antimicrobial prescribing in primary care. Yet, CP teams are rarely considered as part of AMS activities. Aim: To synthesize the available evidence in relation to the current involvement of community pharmacists in AMS-related interventions involving CP team members. Methods: To ensure rigour, the search followed the recommendations of the PRISMA-ScR and the protocol registered with the Open Science Framework. The search was conducted in MEDLINE, International Pharmaceutical Abstracts and CINAHL, identifying studies published between 1999 and 2023 and in English. Studies reporting AMS-related interventions, including at least one CP team member and conducted in a CP setting were included. Study selection and data extraction were performed by two independent reviewers. Results: Thirty-eight reports were included with pharmacists mainly using patient interviews (n = 26) and point-of-care testing (n = 15) as information sources to support patient assessment. Pharmacist interventions included providing patient counselling (n = 30) and referring to other healthcare professionals (n = 17). The main barrier for intervention implementation was the lack of or inadequate remuneration (n = 10); the easy accessibility of CPs was the predominant facilitator (n = 12). Only three of the included reports were underpinned by implementation theory. Conclusions: The review is significant since it highlights CP interventions in an area where there is not much evidence. It emphasizes the need to remunerate CPs for their involvement in AMS while highlighting the potential for expansion of easily accessible CP services.

Introduction Episodes of alienation and/or anomie in pharmacists have been reported in historical accounts since the 19th century. Alienation and anomie are distinct types of psychological or social ills where people are problematically separated from, or their skills and values are misaligned with, others and their environment. Alienation and/or anomie can be important precursors of many negative work experiences, including job dissatisfaction, burnout and/or intention to leave. Methods and analysis We aim to study alienation and/or anomie in pharmacists from across the globe, reviewing all types of methodological designs, published in peer-reviewed journals, including all primary qualitative, quantitative and/or mixed-method research studies. We will narratively describe any focuses, causes, associated factors and/or consequences of alienation and/or anomie. We will identify all published peer-reviewed research by searching seven electronic databases (MEDLINE, Embase, APA PsychINFO, CINAHL Plus, Cochrane Library, Web of Science Core Collection and Scopus) and Google Scholar in May 2024. Extensive hand and citation-searching will also take place. Two independent reviewers will identify eligible studies, conduct a critical appraisal of the study conduct, extract data and synthesise reported findings by narratively exploring relationships within and between studies. The synthesis will follow a hybrid thematic analysis. Initially, we will deductively structure the findings according to six themes from underpinning alienation and anomie theory: Care, Values, Meaning, Recognition, Autonomy and Shared Responsibility. This structure may thereafter be inductively adapted, by creating new additional themes, if required from the data. A GRADE Confidence in the Evidence from Reviews of the Qualitative research approach will be used to determine a confidence profile of each theme. A thematic map showing the links between themes will also be produced. Ethics and dissemination Ethical permission is not required, as this study uses data from published research. Dissemination will be through publication in peer-reviewed journals and conference presentations. PROSPERO registration number CRD42024536336.

Background: Inappropriate polypharmacy arises through many factors including deficiencies in prescribing processes. Most research has focused on solutions at the clinician/patient levels with less at the organisational level. Aim: To explore key stakeholder identified barriers and facilitators to implementation of an organisational level polypharmacy management framework. Method: Qualitative data were collected within the Ministry of Health in Oman. Key stakeholders were purposively sampled encompassing senior representatives of pharmacy, medicine, and nursing directors; healthcare policymakers; patient safety leaders; and academic leaders. A semi-structured interview schedule was developed informed by a recent scoping review and underpinned by the Consolidated Framework for Implementation Research (CFIR). Interviews, which continued until data saturation, were audio-recorded, transcribed and analysed using the Framework Approach. Results: Thirteen key stakeholders were interviewed, with representation of each target group. Facilitators largely mapped to the CFIR domain of inner setting (i.e., aspects of stakeholder awareness, the electronic health system and national leadership), intervention characteristic (evidence gaps), characteristics of individuals (stakeholders and champions) and process (change strategy). Barriers also largely mapped to the inner setting (policy absence, communication and health professional practice) and outer setting (resource needs). Conclusion: This study has illuminated the facilitators and barriers to the implementation of an organisational level polypharmacy management framework. Further work is required to translate these themes into an actionable plan to implement the framework. Particular attention is required for aspects of the CFIR domain of inner setting (i.e., the internal context within which implementation occurs) as most barriers mapped to this domain.

Background: Independent prescribing (IP) has not been extensively investigated in community pharmacy (CP). Normalization process theory (NPT) constructs help explain how interventions are integrated into practice and include: ‘coherence’ (understanding), ‘cognitive participation’ (what promotes engagement), ‘collective action’ (integration with existing systems), and ‘reflexive monitoring’ (evaluation). Aim: To use NPT to investigate the integration of pharmacist IP in CP. Method: NHS Scotland Pharmacy First Plus (PFP) is a community pharmacy IP service. Questionnaire items were developed using the NPT derived Normalisation MeAsure Development (NoMAD) tool for an online survey of all PFP IP pharmacists. Demographic data were analysed descriptively and scale scores (calculated from item scores for the 4 NPT constructs) were used for inferential analysis. Results: There was a 73% (88/120) response rate. Greater than 90% ‘strongly agreed’/‘agreed’ to NoMAD items relating to most NPT constructs. However, responses to ‘collective action’ items were diverse with more participants answering ‘neither agree nor disagree’ or ‘disagree’. A statistically significant difference in NPT construct scale scores with significant p-values (ranging from p < 0.001 to p = 0.033) was shown on all the NPT constructs for the variable ‘On average, how often do you consult with patients under the PFP service?’. Conclusion: This theory-based work offers perspectives on IP integration within CP. Despite its geographic focus this work offers insights relevant to wider contexts on IP integration. It shows ‘collective action’ focused ‘organisation’ and ‘group process’ challenges with a need for further work on staff training, resource availability and utilisation, working relationships, communication and management.

Background In several countries independent prescribing (IP) has been supported as a practice model but its integration into community pharmacy (CP) has not been extensively investigated. Aim To use Normalization Process Theory to investigate the integration of pharmacist IP in CP. Method In 2020, NHS Scotland launched Pharmacy First Plus (PFP) which uses community pharmacist IP for common clinical conditions. Questionnaire items were developed using the NPT derived Normalisation MeAsure Development (NoMAD) questionnaire tool for a cross-sectional online survey of all PFP CPs. Demographic data were analysed descriptively. Item scores for the 4 NPT constructs were reliability tested using Cronbach’s alpha and scale scores calculated and used for inferential analysis. Results A 73% (88/120) response rate showed that 76% (67/88) consulted with patients for PFP >6 times a week. Thirty-eight percent (33/88) indicated they had 90% ‘strongly agreeing’ or ‘agreeing’ in items relating to the NPT constructs ‘coherence’, ‘cognitive participation’ and ‘reflexive monitoring’. Responses to ‘collective action’ items showed diversity with more answering ‘neither agree nor disagree’ or ‘disagree’. Conclusion This theory-based work offers a perspective on IP integration within CP. Despite its geographic focus it offers insights relevant to wider contexts. It shows ‘collective action’ focussed ‘organisation’ and ‘group process’ challenges with a need for further work on staff training, resource availability and utilisation, working relationships, communication and management.