Community Pharmacists’ Expanding Roles In Supporting Patients Before And During COVID-19: An Exploratory Qualitative Study (preprint)

Background: Timely access and attachment to a primary healthcare provider is essential for population health outcomes. Patients without a family physician or nurse practitioner (“unattached”) or who cannot access their provider when needed may seek care from a community pharmacist. Community pharmacists are highly accessible in Canada and have a broad scope of practice. During the coronavirus disease 2019 (COVID-19) pandemic, community pharmacists took on additional roles. However, little is known about how community pharmacists managed the needs of unattached versus attached patients before and during the COVID-19 pandemic.Aim: To explore Nova Scotian community pharmacists’ roles in caring for patients before and during the COVID-19 pandemic and identifying barriers and facilitators to optimizing patient access.Method: Semi-structured interviews with community pharmacists across the province of Nova Scotia (Canada) were conducted. Data were analyzed using framework analysis.Results: Eleven community pharmacists were interviewed. Five key themes were noted: 1) rising pressure on pharmacists to meet unique health needs; 2) what pharmacists have to offer; 3) positioning pharmacists in the system; 4) pharmacist wellbeing; and 5) recommendations for practice post-pandemic.Conclusion: Before and during the pandemic, community pharmacists played a significant and increasing role in providing care to patients, especially unattached patients. With the growing number of unattached patients, it is vital community pharmacists are supported to provide additional services to care for the health needs of patients.

COVID-19 – An Opportunity to Improve Access to Primary Care Through Organizational Innovations? (preprint)

Background: COVID-19 catalyzed a rapid and substantial reorganization of primary care, accelerating the spread of existing strategies and fostering a proliferation of innovations. Access to primary care is an essential component of a health care system, particularly during a pandemic. We describe organizational innovations aiming to improve access to primary care and related contextual changes, during the first year of the COVID-19 pandemic in two Canadian provinces, Quebec and Nova Scotia. Methods: We conducted a multiple case studies, based on 63 semi-structured interviews (n=33 in Quebec, n=30 in Nova Scotia) conducted between October 2020 and May 2021 and a review of related internal documents from both jurisdictions. We recruited a diverse range of provincial and regional stakeholders (e.g., policymakers, decision-makers, family physicians, nurses) involved in reorganizing primary care during COVID-19 using purposeful sampling (e.g., based on role, region). Interviews were transcribed verbatim and thematic analysis was conducted in NVivo12. Emerging results were discussed by team members to identify salient themes and organized into logic models. Results: We identified and analyzed six organizational innovations. Four of these - centralized public online booking systems, centralized access centers for unattached patients, and interim primary care clinics for unattached patients and community connector to health and social services for older adults – pre-dated COVID-19 but were accelerated by the pandemic context. The remaining two innovations were created to specifically address pandemic-related needs: COVID-19 hotlines and COVID dedicated primary healthcare clinics. Innovation spread and proliferation was influenced by several factors such as a strengthened sense of community amongst providers, decreased patient demand at the beginning of the first wave, renewed policy and provider interest in population-wide access (versus attachment of patients only), suspended performance targets (e.g., continuity ≥80%) in Quebec, in modality of care delivery, modified fee codes, and greater regional flexibility to implement tailored innovations. Conclusion: COVID-19 accelerated the uptake and creation of organizational innovations to potentially improve access to primary healthcare, removing, at least temporarily, certain longstanding barriers. Many stakeholders believed this reorganization would have positive impacts on access to primary care after COVID-19. Further studies should analyze the effectiveness and sustainability of innovations adapted, developed, and implemented during the COVID-19 pandemic.