ABSTRACT
Healthcare decision-makers are constantly challenged by growing healthcare needs in tandem with rising healthcare costs. Disinvesting in technologies and practices that are "low in value" is one strategy to re-allocate limited resources to the most effective, safe and cost-effective technologies. We put forward a health technology reassessment framework and examined the opportunities and challenges on technology disinvestment in Singapore and deliberated on possible solutions. We coordinated and supported a disinvestment programme in 2 hospitals, 1 specialist centre and 9 primary care institutions in the public healthcare sector. The key processes were identifying, prioritising and assessing low-value health technologies and practices, disseminating and implementing disinvestment recommendations, and post-implementation evaluation. Through case studies, we explored the barriers and enablers to the success of the programme. One of the barriers to disinvestment included difficulty in demonstrating a lack of benefit of in-use technologies from published studies. Differing viewpoint and priority might preclude a healthcare leader's support in such initiatives and that posed an unsurmountable hurdle. On the other hand, engaging the stakeholder throughout the evidence review process and striking a balance between rigour and timeliness of review were likely to assure success. Lastly, monitoring the impact on resources and patient outcomes can be diverse and methods need to be developed. Understanding barriers and enablers in health technology disinvestment can translate into improved opportunities for eliminating and minimising resource wastage.
ABSTRACT
<p><b>INTRODUCTION</b>We appraised the roles and responsibilities assigned to community pharmacists internationally and in Singapore.</p><p><b>MATERIALS AND METHODS</b>A systematic search of international peer-reviewed literature was undertaken using Medline. Grey literature was identified through generic search engines. The search period was from 1 January 1991 to 30 July 2009. The search criteria were English language manuscripts and search terms "community pharmacist", "community pharmacy", "disease management" and "roles" as a major heading. Boolean operators were used to combine the search terms. Identified abstracts were independently reviewed and the findings were presented as a narrative summary.</p><p><b>RESULTS</b>Overall, we reviewed 115 articles on an abstract level and retrieved 45 of those as full text articles for background information review and inclusion into the evidence report. Of the articles included in the review, 32% were from United Kingdom (UK). Literature highlights the multi-faceted role of the community pharmacist in disease management. Community pharmacists were involved in the management of asthma, arthritis, cardiovascular diseases, diabetes, depression, hypertension, osteoporosis and palliative care either alone or in the disease management team. Evidence of effectiveness for community pharmacy/ community pharmacist interventions exists for lipid, diabetes, and hypertension management and for preventive services such as weight management, osteoporosis prevention and fl u immunisation services. Majority of the community pharmacists in Singapore play the traditional role of dispensing. Attempts by the private community pharmacies to provide some professional services were not successful due to lack of funding. Factors found to impede the growth of community pharmacists are insufficient integration of community pharmacist input into healthcare pathways, poor relationship among pharmacists and physicians, lack of access to patient information, time constraints and inadequate compensation.</p><p><b>CONCLUSION</b>Evidence from observational studies points out the wide range of roles played by the community pharmacist and provides insights into their integration into chronic disease management programmes and health promotion.</p>