Table 3

Elements that can hinder (ie, barrier) or enable (ie, facilitator) the implementation of CPSs as identified by patients, general practitioners and nurses

Effect on implementation and source of information (ie, stakeholder)
Barrier*Facilitator†
Elements at the individual patient level
1. Patients’ real or perceived need for healthcare (according to patients’ individual concerns, understanding or perception of their health problems).Pt18 40 49 51 53; GP17 Pt18 33 35 36 38 43 47 49 51; N41; GP17
2. Patients’ awareness of the availability of CPSPt33 40 47; GP20 40
3. Patient personal desire or preference for CPSsPt38 47 49 51
4. Patients’ understanding, perceptions and expectations of their own role in the CPSPt36 49 70 Pt17 36 49
5. Patients’ understanding, perceptions and expectations of the role of community pharmacists in healthcarePt17 18 35 36 38 46 49; N41; GP20 Pt35 38 45 46 49 67 70
6. Patients’ understanding, perceptions and expectations of the role of the GP associated to the CPSPt35 36 40 47 49 51 69 70
7. Patients’ understanding, perceptions and expectations of collaboration between healthcare professionalsPt49 Pt49
8. Patients’ availability, time to participate in CPSsPt33 44 Pt44 49
9. Patients’ previous/background experiences with CPSs and multidisciplinary carePt38 40 46 49 Pt40 45 46 49 51 69
10. Patient abilities; that is, to follow the procedures of the CPS or to self-manage their health problemsPt44 49; GP36 42 50 Pt44 47 67
11. Patients’ satisfaction with the delivered CPSs and multidisciplinary carePt36 44–46 51; N41
12. Patients’ motivation towards CPSsPt51 Pt44 51 67
13. Patients’ level of emotional intelligence; that is, ability to cope with negative experiences.Pt44 Pt44
14. Patients’ language, communication and cultural issuesPt47 52; GP20
Elements at interpersonal level
a. Individual healthcare professionals (sublevel)
a.1. Community pharmacist
15. Knowledge, expertise, clinical and non-clinical skills (eg, cultural competency) to adequately provide CPSsPt46; GP34 42 Pt18*, 20, 38, 40, 41*, 42, 44, 48; GP37 50
16. Communication skills, including the capacity to speak other languagesPt47 69; N68 Pt18 33 35 38 47 67 69 70
17. Humanistic attributes (eg, being respectful, caring, non-judgemental, friendly, empathetic, supportive and approachable)Pt44 Pt33 35 36 38 39 44–46 49 51
18. Willingness, interest and motivation to provide CPSs and/or participate in multidisciplinary collaborationN33 41 49 67; GP40 Pt35
a.2. Other community pharmacy staff members (eg, pharmacy assistants)
19. Technical knowledge (eg, about a product)Pt38 46 Pt38
20. Communication skillsPt46 Pt38
21. Humanistic attributesPt38
22. Ability to work professionally (eg, uphold patient confidentiality)Pt39 46
23. Experience working in the pharmacyPt38 46 Pt38
a.3. GP
24. Understanding, perceptions and expectations of their individual role with regard CPSsGP42 50
25. Understanding, perceptions and expectations of pharmacist’s capabilities and role in healthcareGP34 36 42 48 50 GP17 34 36 37 43 50
26. Awareness of the availability of CPSGP20
27. Willingness, interest, motivation to collaborate with CPSsGP20 GP20 50
a.4. Nurse
28. Understanding, perceptions and expectations of their individual role within, or in regards to, CPSsN19
29. Knowledge and skills to adequately participate in the delivery of CPSN19 N19*
30. Attitude towards other healthcare professionals and their rolesN19
31. Willingness, interest and motivation to collaborate with CPSsN19 N19
b. Relationships (or interactions) between individuals (sublevel)
32. Influence of friends and family on patients utilising CPSs (ie, they may provide support, affect patient’s adherence or patient’s enthusiasm with CPSs)Pt38 44 47 Pt17*, 35*, 41
33. Previous relationship between the patient and the pharmacist and its nature (eg, trusting relationship)Pt18; GP20 Pt18 33 36 38 44–46 51; GP42
34. Collaborative relationships between the pharmacist and other healthcare providers (eg, GPs) and their naturePt43; N41; GP34 40 42 43 48 68 Pt35 49; N19 41; GP17*, 20, 52-54, 57
35. Communication channels and modes between pharmacists and other healthcare providers (eg, GPs)N19 68; GP36 42 50 53 Pt17 18 35; N41; GP17 42 48 50
36. Existence of referral mechanisms between healthcare professionals, including also those between pharmacy support staff and pharmacists (ie, care coordination and transition)Pt46; GP36 42; N,41 Pt38 45; GP17 20 36 37 40 42 50; N41
37. Consistency in the information provided by the pharmacist with regards to the GP’s recommendationsGP42 43 48 68 GP42 43
38. Availability of multidisciplinary education, training and meetings for pharmacists and GPs that enhance integrated, collaborative carePt52*, 56*; N41; GP17 34 42 48
Elements at the organisational level
a. Community pharmacy setting (sublevel)
39. Accessibility of the pharmacy setting (eg, convenient location, colocation, no appointments required and opening hours)Pt17 69; N41 Pt17, 33, 35, 37, 38, 40, 41, 56*, 57; N41; GP47*, 52*, 53
40. Structural characteristics of the pharmacy setting, that is, size, provision of counselling rooms, use of visual space for posters and child-friendly areaPt39 Pt40, 41, 43*
41. Privacy of the setting, including the availability of a private consultation area and limited involvement of multiple staff members who would be aware of the patients’ personal mattersPt18 38 39 46 49 69; GP20; N68 Pt39 44 45
42. Availability of suitable material resources to support the service (eg, educational material for patients, medical devices, patient data management system and so on)Pt38 46 52
43. Sufficient qualified staff to perform CPSPt52; GP20 40 43 Pt47
44. Organisation of the pharmacist’s workload and time to deliver CPSsPt38 47 49 69; N41; GP33 40 Pt38 43
45. Organisational commitment to implement a CPSPt33 38; N41
46. Promotion of the CPS to facilitate its uptakePt33*, 35*, 47; GP20
b. CPS
47. Extent to which the CPS meets and is tailored to fit individual patient’s needs or fills existing gaps in healthcare practice (this enhances the value of the service for patients and healthcare professionals)Pt18 35 36 40 46 49 51; GP42 50 Pt18 33 35 38 40 45–47 49 51 69; N40; GP20 37 40 42 43 48 50 53
48. Quality of the CPS (eg, validity, accuracy of the materials and tools used, CPSs provided in a timely manner, provision of both verbal and written information, professional advice and education and so on)Pt51; GP40 43; N19 Pt18 38 44 45; GP20
49. Complexity of the CPS for use by healthcare professionalsGP20; N19 41
50. Extent to which CPSs provide ongoing support, follow-up and feedback to patientsGP42 Pt18 33 39 40 44–46
51. Flexibility to use different communication channels (eg, telephone and website) to interact with patients and healthcare providersPt38, 40, 43*
52. Consistency in the community pharmacist delivering the CPSPt,38 45 51 N19*
53. Involvement of other healthcare providers in delivering the CPSPt38; N19*; GP20*
54. Costs and duration of the CPS consultation for the patientPt43 49; N41 Pt43 45; GP17 20; N51*,
Elements at the community and health system level
55. General consumer education about healthcare; promotion of CPS by the mediaPt43; GP43 Pt43 47; GP47*, 57
56. Collaboration, influences, conflicts between GP and pharmacist professional bodiesGP34*
57. Organisation of GPs’ workload and time to collaborate with CPSsGP20 40 42 50 53
58. Complexity of system-level administrative processes (eg, tedious paperwork) associated to the delivery of CPS; that is, complying with the requirements of the department of healthGP17 20 40 43 48
59. Availability of an electronic system for sharing informationPt18 49 Pt17*, 57; N19*; GP17, 20*, 36*, 50, 52*, 53
60. Presence of agreed healthcare protocols, regulations, rules and policies to facilitate the delivery of CPSsPt52; N41 Pt52; GP20*, 52, 53
61. Limits on the healthcare budget; that is, funding allocated to support CPS deliveryGP17 40 43 50 Pt44, 56*; GP17 42 43
62. Availability of financial incentives for service provision and inter-professional collaborationPt56*; N51*
63. Organisation of the healthcare systemPt49; GP43

  • *Barrier: the element was mentioned to act as a BARRIER or hinder to the implementation of CPSs.

  • †Facilitator: the element was mentioned to act as a FACILITATOR or enabler to the implementation of CPSs.

  • (*) This element was reported as a potential strategy to overcome a barrier (ie, facilitator).

  • CPSs, community pharmacy services; GP, general practitioner; N, nurse; Pt, patient.