Community Pharmaceutical Services Implemented in Shanghai

Background Most of the elderly are prone to more than two chronic diseases and polypharmacy. Community health institutions are the key to ensuring rational drug use for in this population. Given many problems existing in the delivery of community pharmaceutical services, how to make better use of existing resources to improve the level of community pharmaceutical services remains to be further explored. Objective To understand the status of community pharmaceutical services implemented in Shanghai, providing a reference for improving community pharmaceutical services. Methods We conducted a survey in Shanghai with 235 pharmaceutical professionals selected by use of phased sampling from September to December 2020 with a questionnaire named as "Community Pharmacists Questionnaire" developed by us based on the results of previous literature review and on-site visits. In November 2020, we conducted a focus group interview with 82 stakeholders (including one pharmaceutical professional, one general practitioner and one community administrator selected from each community, two or three administrators selected from the health commission of each district) in Shanghai guided by an outline named as "Rational Drug Use for the Elderly" developed by us based on the results of previous literature review and on-site visits. The allocation of community pharmaceutical care resources, implementation and management of community pharmaceutical care involved in the interview were extracted as supplements to the survey results. Results Among the 235 community pharmacists surveyed, the prevalence of providing prescription dispensing, prescription review, pharmaceutical drive-thru window services or outpatient consultation and guidance, and prescription comment services was 94.0% (221/235) , 82.6% (194/235) , 64.3% (151/235) , and 51.9% (122/235) , respectively. Among these services, prescription dispensing and prescription review were ranked as the top two in terms of average comprehensive score, indicating that implementing these two services required longer working hours of community pharmacists. In terms of the delivery methods of community pharmaceutical services, community pharmacists mainly used consultation windows〔226 cases (96.2%) 〕, pharmaceutical clinics〔119 cases (50.6%) 〕 and publicity lectures〔109 cases (46.4%) 〕. Only 53 (22.6%) participated in the family doctor team, among whom 22 (41.5%) had the qualification of clinical pharmacist; 47 (88.7%) mainly provided public education on rational drug use, and 45 (84.9%) mainly provided medication guidance and consultation services for patients. In terms of training, 180 cases (76.6%) participated in a training in the past one year, while other 55 (23.4%) cases did not. The number of trainings for most of cases was one or two times〔105 (58.3%) 〕. The way of trainings for most of cases was continuing education〔155 (86.1%) 〕. Both the questionnaire survey and interview results revealed that the main problems existing in the provision of community pharmaceutical services were heavy workload of dispensing/prescription review, lack of clinical knowledge patients' insufficient trust in pharmacists, and lack of performance incentives. Conclusion To meet the pharmaceutical needs of elderly patients with multiple chronic conditions, actions need to be taken to reduce the heavy workload of delivering traditional services in pharmacists, strengthen the clinical training of in-service pharmacists, and encourage pharmacists to join the family doctor team. Through providing pharmaceutical consultations and trainings for other family doctor team members by pharmacists, the scope of influence of pharmaceutical services will be expanded, which contributes to the ensuring of rational drug use.