Lowrie Richard, Johansson Lina, Forsyth Paul, Bryce Stuart Lochhead, McKellar Susan, Fitzgerald Niamh
Research and Development, Pharmacy and Prescribing Support Unit, NHS Greater Glasgow and Clyde, Victoria Infirmary, Langside Road, Glasgow, G42 9TT, UK,
Int J Clin Pharm. 2014 Feb;36(1):154-62. doi: 10.1007/s11096-013-9889-2. Epub 2013 Nov 30.
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.
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.
Community pharmacies and community-based patients in Greater Glasgow and Clyde, Scotland.
Focus groups with pharmacists and semi-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.
Experiences of receiving and delivering an enhanced HF service.
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.
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 HF and has implications for the development of other extended role services.
心力衰竭（HF）常见、致残且致命。心力衰竭患者往往自我护理能力差且不坚持服药，这导致了不良后果。基于社区药房的认知服务有帮助的潜力，但我们不知道患者如何看待由社区药剂师主导的针对心力衰竭患者的服务。
我们旨在详细探索和描述接受强化的、按绩效付费的社区药房心力衰竭服务的患者以及提供该服务的药剂师的观点。
苏格兰大格拉斯哥和克莱德地区的社区药房及社区患者。
与药剂师进行焦点小组讨论，并通过电话对个体患者进行半结构化访谈。使用规范化过程理论对定性数据进行横断面主题分析，以理解和描述患者的报告。
接受和提供强化心力衰竭服务的体验。
药剂师表达了他们对提供该服务的信心，并强调了有价值的方面，包括结构化咨询以及与患者的反复接触，这使得有机会改善自我护理和药物依从性。讨论除心力衰竭之外的合并症很困难，说服患者改变行为具有挑战性。患者与药剂师讨论症状和药物时感到自在；他们认为药剂师发挥了所需但目前未得到满足的作用。患者报告该服务帮助他们实施心力衰竭药物治疗和心力衰竭自我护理管理策略。
接受认知性心力衰竭服务的患者和提供该服务的药剂师都认为它弥补了当前护理中的不足。药剂师在支持患者应对理解和管理自身病情及治疗负担方面可能有明确的作用，从而实现更好的自我管理和药物依从性。本研究可能为改善心力衰竭患者护理过程的策略或政策制定提供信息，并对其他扩展角色服务的发展具有启示意义。
