Supplementary material

Experiences of a community pharmacy service to support adherence and self-management in chronic heart failure

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Abstract……………………………………………………………………………………….…2

Table 2………………….…………………………………………………………………….….3

Table 3………………….…………………………………………………………………….….4

Abstract

Background:Heart Failure (HF) is common, disabling and deadly. Patients with HF often have poor self-care and medicines non-adherence, which contributes to poor outcomes. Community pharmacy based cognitive services have the potential to help, but we do not know how patients view community-pharmacist-led services for patients with HF.

Objective: We aimed to explore and portray in detail, the perspectives of patients receiving, and pharmacists delivering an enhanced, pay for performance community pharmacy HF service.

Setting:Community pharmacies and community-based patients in Greater Glasgow and Clyde, Scotland.

Method:Focus groups with pharmacists andsemi-structured interviews with individual patients by telephone.Cross sectional thematic analysis of qualitative data used Normalization Process Theory to understand and describe patient’s reports.

Main Outcome: An understanding and an explanation of the experiences of receiving and delivering an enhanced HF service.

Results: Pharmacists voiced their confidence in delivering the service and highlighted valued aspects including the structured consultation and repeated contacts with patients enabling the opportunity to improve self care and medicines adherence.Discussing co-morbidities other than HF was difficult and persuading patients to modify behaviour was challenging. Patients were comfortable discussing symptoms and medicines with pharmacists; they identified pharmacists as fulfilling roles that were needed but not currently addressed. Patients reported the service helped them to enact HF medicines and HF self care management strategies.

Conclusion: Both patients receiving and pharmacists delivering a cognitive HF service felt that it addressed a shortfall in current care. There may be a clearly defined role for pharmacists in supporting patients to address the burden of understanding and managing their condition and treatment, leading to better self management and medicines adherence.

This study may inform the development of strategies or policies to improve the process of care for patients with HFand has implications for the development of other extended role services.

Impact of findings on practice

  • Patients with HF and other chronic illnesses struggle to cope with their medicines and manage their conditions
  • Governments across the world, and patients, are increasingly looking to pharmacists and other health professionals, for alternative models of care to improve self care and medicines management
  • Few qualitative data underpin service developments by community pharmacists aiming to help patients with HF.
  • Patients and pharmacists confirmed the need for a service to focus on medicines adherence and self care
  • Policy makers considering the introduction of such a service may be reassured by patients’ and pharmacists’ reports of evidence of acceptability and benefit from qualitative evidence

Keywords:

Community pharmacy; heart failure; adherence; self-care; patient views; Scotland.

Table 2.Pharmacist group interview schedule

  1. In terms of the heart failure service you’re offering in the pharmacy, can you suggest ways in which you think it’s working well?
  2. Can you suggest aspects that don’t work so well, and how the service could be improved?
  3. What about talking to patients about symptoms? Do you do that?
[follow-up question - do you feel comfortable talking about symptoms?]
  1. What are the main areas that patients themselves want to discuss?
  2. Are there areas that patients seem to avoid discussing?
  3. Can you indicate what advantages you feel patients may be getting from the service?

Table 3.Patient telephone interviews†

1 / Do you feel that talking to the pharmacist in the community pharmacy made any difference to how much you know about your heart failure?
2 / Do you feel that talking to the pharmacist in the pharmacy made any difference to how much you know about your heart failure medicines?
3 / Has talking to the pharmacist made any difference to your routine for taking your heart failure medicines?
4 / Has talking to the pharmacist made any difference to how much you know about the symptoms of heart failure?
5 / Has talking to the pharmacist made any difference to how much you know about the symptoms to watch out for in the future that could suggest your heart isn’t working quite as well?
6 / Has talking to the pharmacist made any difference to the likelihood of you telling the doctor or nurse if you notice those symptoms?
7 / Are there any questions about your heart failure that nobody else has answered?
8 / Overall, what do you think about the service provided by the pharmacist?
†Questions 5 and 7 were introduced after the first 18 telephone interviews had been carried out.

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