Article Text

Download PDFPDF

Qualitative meta-synthesis of barriers and facilitators that influence the implementation of community pharmacy services: perspectives of patients, nurses and general medical practitioners
  1. Lutfun N Hossain1,
  2. Fernando Fernandez-Llimos2,
  3. Tim Luckett,
  4. Joanna C Moullin3,
  5. Desire Durks1,
  6. Lucia Franco-Trigo1,
  7. Shalom I Benrimoj1,
  8. Daniel Sabater-Hernández1,4
  1. 1 Graduate School of Health, University of Technology, Sydney, New South Wales, Australia
  2. 2 Department of Social Pharmacy, Faculty of Pharmacy, Research Institute for Medicines, University of Lisbon, Lisboa, Portugal
  3. 3 Department of Psychiatry, University of California, San Diego, California, USA
  4. 4 Academic Centre in Pharmaceutical Care, University of Granada, Granada, Spain
  1. Correspondence to Dr Daniel Sabater-Hernández; Daniel.SabaterHernandez{at}


Objectives The integration of community pharmacy services (CPSs) into primary care practice can be enhanced by assessing (and further addressing) the elements that enable (ie, facilitators) or hinder (ie, barriers) the implementation of such CPSs. These elements have been widely researched from the perspective of pharmacists but not from the perspectives of other stakeholders who can interact with and influence the implementation of CPSs. The aim of this study was to synthesise the literature on patients’, general practitioners’ (GPs) and nurses’ perspectives of CPSs to identify barriers and facilitators to their implementation in Australia.

Methods A meta-synthesis of qualitative studies was performed. A systematic search in PubMed, Scopus and Informit was conducted to identify studies that explored patients’, GPs’ or nurses’ views about CPSs in Australia. Thematic synthesis was performed to identify elements influencing CPS implementation, which were further classified using an ecological approach.

Results Twenty-nine articles were included in the review, addressing 63 elements influencing CPS implementation. Elements were identified as a barrier, facilitator or both and were related to four ecological levels: individual patient (n=14), interpersonal (n=24), organisational (n=16) and community and healthcare system (n=9). It was found that patients, nurses and GPs identified elements reported in previous pharmacist-informed studies, such as pharmacist’s training/education or financial remuneration, but also new elements, such as patients’ capability to follow service's procedures, the relationships between GP and pharmacy professional bodies or the availability of multidisciplinary training/education.

Conclusions Patients, GPs and nurses can describe a large number of elements influencing CPS implementation. These elements can be combined with previous findings in pharmacists-informed studies to produce a comprehensive framework to assess barriers and facilitators to CPS implementation. This framework can be used by pharmacy service planners and policy makers to improve the analysis of the contexts in which CPSs are implemented.

  • Community pharmacy services
  • health service research
  • qualitative meta-synthesis
  • barriers
  • facilitators
  • determinants of practice

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

View Full Text

Statistics from


  • 75th International Pharmaceutical Federation(FIP) World Congress of Pharmacy and Pharmaceutical Sciences; 29 September-3October, 2015; Dusseldorf, Germany

  • Contributors Conception or design of the work: LNH, FF-L, TL and DS-H. Data collection: LNH, DD and LF-T. Data analysis and interpretation: LNH, JCM, CB and DS-H. Drafting the article: LNH, FF-L, TL and DS-H. Critical revision of the article: LNH, JCM, FF-L, TL and DS-H. Final approval of the version to be published: all authors.

  • Funding LNH was awarded a University of Technology Sydney (UTS) President’s 424 Scholarship and a UTS Chancellors Research Scholarship. This work is part of a larger UTS Chancellor’s Postdoctoral Research Fellowship awarded to Dr DSH (UTS ID number: 2013001605).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles