Pharmacists' roles in assisted reproductive technology.

Background: The global issue of infertility has prompted an increased reliance on Assisted Reproductive Technology (ART) for conception. In Australia, patients have previously accessed ART medications through specialist clinics, however recently due to modifications in ART medication subsidisation, community pharmacists now dispense and counsel patients on ART medications. Patients residing in rural and remote locations face challenges in accessing fertility clinics, which are primarily located in metropolitan and large regional cities. Objective: To investigate the perceived role, experience, confidence, and training requirements that pharmacists have in relation to providing ART medications and counselling to patients. Methods: Purposive sampling related to location of practice, pharmacist experience with ART and self-classification as an ART specialist was used to recruit 19 Australian pharmacists from rural, remote, large regional, and metropolitan areas, who participated in semi-structured interviews based on the Consolidated Framework for Implementation Research (CFIR). Interview transcriptions were transcribed, imported into NVivo, analysed using thematic analysis and mapped to CFIR domains and constructs. Results: Of the nineteen pharmacists interviewed, six were from rural and remote areas and thirteen were from metropolitan or large regional areas. Eight participants perceived themselves as specialist pharmacists in ART, all of which were in metropolitan or large regional locations. Three CFIR domains were identified as relevant for this study, which were further developed, with data mapped to eleven constructs under those domains. Emergent themes were identified that contributed to the pharmacist role including patient needs, external policies, fertility clinics, pharmacist experience and training, procuring ART, and the personal attributes of participants. Some constructs and themes differed between participants dependent on self-reported specialisation status and geographical location (e.g., self-efficacy), whereas others were consistent (e.g., knowledge and belief about the intervention). Pharmacists considered their role not to be limited to the supply and counselling of medication, but to also involve a support role for patients undergoing an emotionally difficult and sensitive journey, without guaranteed success. Conclusion: This study reveals the diverse role of Australian pharmacists in ART, influenced by location, experience, and confidence. Pharmacists have an important role to play in reducing barriers to ART access by offering fertility education, addressing concerns, providing medications and counselling, and monitoring patient well-being, improving outcomes for this cohort of patients particularly in rural and remote areas.

Bridging Allied Health Professional Roles to Improve Patient Outcomes in Rural and Remote Australia: A Descriptive Qualitative Study.

Purpose: Australia's rural and remote populations experience inequality of access to healthcare, with demand exceeding capacity for delivery of health services, often due to a maldistribution of the health workforce. A strategy which may overcome barriers to accessing adequate healthcare includes implementation of interdisciplinary collaborative teams, identified as a successful method of healthcare delivery. This study thus aimed to explore interdisciplinary allied health collaborative practice in a rural community. Methods: Role theory, as a philosophical perspective, was used to explore role perceptions and the potential for interdisciplinary collaboration between pharmacists and allied health professionals including dieticians/public health nutritionists, speech pathologists, occupational therapists, and physiotherapists, by conducting 29 interviews in a rural community. All interviews were transcribed verbatim, coded, and categorised into emerging themes. Results: Five constructs of role theory were used to describe the data: role identity, role overload, role sufficiency, role conflict, and role ambiguity. Participants identified as rural generalists and health promoters, who work within innovative and adaptive healthcare settings. Role overload was reported as considerable due to high demand for services and a lack of resources in rural and remote regions, resulting in poor role sufficiency. Overall, there was a low level of role conflict, and participants were highly in favor of interprofessional collaboration; however, uncertainty of the pharmacist's role (role ambiguity) was a major barrier identified. Health professionals with more years in practice provided few examples of how they would utilise a pharmacist in their practice, although these gave valuable insight into the potential integration of a pharmacist into an interdisciplinary health team, with allied health professionals. Conclusion: This study has applied role theory providing a greater understanding of the enablers and barriers of pharmacists working within interdisciplinary allied health teams and highlighting opportunities to bridge interprofessional roles to improve patient outcomes, especially in rural and remote communities.

Expanded practice for rural community pharmacy: what are we waiting for?

OBJECTIVE: To synthesise stakeholder (consumer, pharmacist and health professional) perspectives of expanded pharmacy practice in rural and remote community pharmacy. METHODS: Comparison of perspectives of stakeholder groups identified by four studies has highlighted the expected outcomes and anticipated barriers to expanded pharmacy practice. Aligning the studies has identified priority areas of health for which pharmacists may be able to provide expanded service delivery. KEY FINDINGS: Expanded pharmacy services are supported by consumers, pharmacists and health professionals and are expected to improve health outcomes for rural and remote populations. Barriers will need to be overcome for expanded services to be sustainable in the future. CONCLUSION: The pharmacy profession will need to undertake a paradigm shift to professional practice and work towards this should begin to reduce the health inequality for rural populations.

The Rural Pharmacy Practice Landscape: Challenges and Motivators.

BACKGROUND: Health outcome delivery for rural and remote Australian communities is challenged by the maldistribution of the pharmacy workforce. High staff turnover rates, reduced pharmacist numbers, and reliance on temporary staff have placed great strain on both state health services and rural community pharmacies. However, recent changes to the demographic profile of the rural pharmacist including a lower average age and increased time spent in rural practice highlights a more positive future for the delivery of better health outcomes for rural communities. The aim of this study was to investigate the factors that motivate and challenge pharmacists' choice to practice rurally. METHODS: Rural pharmacists were invited to participate in semi-structured interviews using purposive non-probability sampling. Twelve pharmacists were interviewed with early-, middle- and late-career pharmacists represented. Participants described their experiences of working and living in rural and remote locations. Three themes emerged: workforce, practice environment and social factors, which were examined to determine the underlying challenges and motivators impacting rural and remote pharmacy practice. RESULTS: Lack of staff presented a workforce challenge, while motivators included potential for expanded scope of practice and working as part of a multidisciplinary team. While social isolation has often been presented as a challenge, an emerging theme highlighted that this may no longer be true, and that notions of "rural and remote communities as socially isolated was a stigma that needed to be stopped". CONCLUSION: This study highlights that despite the challenges rural pharmacists face, there is a shift happening that could deliver better health outcomes for isolated communities. However, for this to gain momentum, it is important to examine both the challenges and motivators of rural pharmacy practice to provide a platform for the development and implementation of appropriate frameworks and programs to better support the rural pharmacy workforce.

Rural pharmacy workforce: Influence of curriculum and clinical placement on pharmacists' choice of rural practice.

OBJECTIVE: This two-phase study aimed to explore the influence of a university rural curriculum and clinical placements on pharmacists' choice to practise in a rural or remote area. DESIGN: A sequential mixed-methods approach involved the design of both a questionnaire and semistructured in-depth interviews to collect quantitative and qualitative data. SETTING: Regional, rural and remote practice areas according to the Pharmacy Access/Remoteness Index of Australia classifications. PARTICIPANTS: Ninety-two pharmacists from varied areas of practice, working in rural and remote locations across Australia, participated in the study. MAIN OUTCOME MEASURES: University curriculum and clinical placements during the degree and their influence on the current rural workforce. RESULTS: In the survey sample, two-thirds of the current rural pharmacy workforce's choice of practice location was significantly influenced by positive rural placement experiences. Rural practice was, however, not included in the curriculum for 50% of the rural workforce in the sample, although graduates from regional universities experienced up to 80% more exposure to rural curricula. In this sample, rural origin was also not found to be a significant determinant of rural practice, while rural lifestyle, family commitments, remuneration, career opportunities and other contractual agreements have had a greater influence than university education. CONCLUSION: Although the positive influence of rural placements has been identified, there is still a way to go in terms of the development of a meaningful rural curriculum. This highlights that universities have a role to play in addressing this issue to produce graduates who are better prepared for the opportunities and challenges of rural pharmacy practice.

Scoping the impact of curriculum and placement on the rural pharmacy workforce.

OBJECTIVE: The objective of this review was to scope the impact of university rural curriculum and rural clinical placements on students' intentions to practise rurally and rural pharmacists' choice of rural practice. DESIGN: The scoping review used Arskey and O'Malley's methodological framework, searching the following databases: MEDLINE, CINAHL, Informit and Scopus. This scoping review followed PRISMA for article reporting. SETTING: Studies were selected from those conducted in Australia, USA, Canada and Africa. PARTICIPANTS: Pharmacy undergraduate students, interns, registered and academic pharmacists were included. MAIN OUTCOME MEASURE: The pharmacy curriculum at universities and placements undertaken, specifically in rural and remote settings, were evaluated to determine their influence on intention to practise as a rural pharmacist. RESULTS: The search strategy generated 294 records, 31 of which were included in the scoping review. Key findings were mapped to two domains, which broadly included the impact of rural placements and curriculum on intention to practise rurally. Some universities have attempted to introduce a rural curriculum, but reported resources as a barrier and the lack of resulting evidence of students' intention to practise rurally. Although results indicate rural placements have had a positive influence on students' intention to work rurally, this intention has been measured immediately after exposure to rural practice and might not reflect future intentions. CONCLUSION: This review highlights significant gaps in the impact particularly of a rural curriculum and rural clinical placements in relation to the current rural pharmacist workforce. A greater understanding of this topic may guide recommendations for future strategies to address rural pharmacy workforce maldistribution.