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 CPS | Pt33 40 47; GP20 40 | |
3. Patient personal desire or preference for CPSs | Pt38 47 49 51 | |
4. Patients’ understanding, perceptions and expectations of their own role in the CPS | Pt36 49 70 | Pt17 36 49 |
5. Patients’ understanding, perceptions and expectations of the role of community pharmacists in healthcare | Pt17 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 CPS | Pt35 36 40 47 49 51 69 70 | |
7. Patients’ understanding, perceptions and expectations of collaboration between healthcare professionals | Pt49 | Pt49 |
8. Patients’ availability, time to participate in CPSs | Pt33 44 | Pt44 49 |
9. Patients’ previous/background experiences with CPSs and multidisciplinary care | Pt38 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 problems | Pt44 49; GP36 42 50 | Pt44 47 67 |
11. Patients’ satisfaction with the delivered CPSs and multidisciplinary care | Pt36 44–46 51; N41 | |
12. Patients’ motivation towards CPSs | Pt51 | 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 issues | Pt47 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 CPSs | Pt46; GP34 42 | Pt18*, 20, 38, 40, 41*, 42, 44, 48; GP37 50 |
16. Communication skills, including the capacity to speak other languages | Pt47 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 collaboration | N33 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 skills | Pt46 | Pt38 |
21. Humanistic attributes | Pt38 | |
22. Ability to work professionally (eg, uphold patient confidentiality) | Pt39 46 | |
23. Experience working in the pharmacy | Pt38 46 | Pt38 |
a.3. GP | ||
24. Understanding, perceptions and expectations of their individual role with regard CPSs | GP42 50 | |
25. Understanding, perceptions and expectations of pharmacist’s capabilities and role in healthcare | GP34 36 42 48 50 | GP17 34 36 37 43 50 |
26. Awareness of the availability of CPS | GP20 | |
27. Willingness, interest, motivation to collaborate with CPSs | GP20 | GP20 50 |
a.4. Nurse | ||
28. Understanding, perceptions and expectations of their individual role within, or in regards to, CPSs | N19 | |
29. Knowledge and skills to adequately participate in the delivery of CPS | N19 | N19* |
30. Attitude towards other healthcare professionals and their roles | N19 | |
31. Willingness, interest and motivation to collaborate with CPSs | N19 | 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 nature | Pt43; 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 recommendations | GP42 43 48 68 | GP42 43 |
38. Availability of multidisciplinary education, training and meetings for pharmacists and GPs that enhance integrated, collaborative care | Pt52*, 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 area | Pt39 | 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 matters | Pt18 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 CPS | Pt52; GP20 40 43 | Pt47 |
44. Organisation of the pharmacist’s workload and time to deliver CPSs | Pt38 47 49 69; N41; GP33 40 | Pt38 43 |
45. Organisational commitment to implement a CPS | Pt33 38; N41 | |
46. Promotion of the CPS to facilitate its uptake | Pt33*, 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 professionals | GP20; N19 41 | |
50. Extent to which CPSs provide ongoing support, follow-up and feedback to patients | GP42 | Pt18 33 39 40 44–46 |
51. Flexibility to use different communication channels (eg, telephone and website) to interact with patients and healthcare providers | Pt38, 40, 43* | |
52. Consistency in the community pharmacist delivering the CPS | Pt,38 45 51 N19* | |
53. Involvement of other healthcare providers in delivering the CPS | Pt38; N19*; GP20* | |
54. Costs and duration of the CPS consultation for the patient | Pt43 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 media | Pt43; GP43 | Pt43 47; GP47*, 57 |
56. Collaboration, influences, conflicts between GP and pharmacist professional bodies | GP34* | |
57. Organisation of GPs’ workload and time to collaborate with CPSs | GP20 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 health | GP17 20 40 43 48 | |
59. Availability of an electronic system for sharing information | Pt18 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 CPSs | Pt52; N41 | Pt52; GP20*, 52, 53 |
61. Limits on the healthcare budget; that is, funding allocated to support CPS delivery | GP17 40 43 50 | Pt44, 56*; GP17 42 43 |
62. Availability of financial incentives for service provision and inter-professional collaboration | Pt56*; N51* | |
63. Organisation of the healthcare system | Pt49; 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.