Hann Mark, Schafheutle Ellen I, Bradley Fay, Elvey Rebecca, Wagner Andrew, Halsall Devina, Hassell Karen, Jacobs Sally
Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK.
Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK.
BMJ Open. 2017 Oct 10;7(10):e017843. doi: 10.1136/bmjopen-2017-017843.
This study aimed to identify the organisational and extraorganisational factors associated with existing variation in the volume of services delivered by community pharmacies.
Linear and ordered logistic regression of linked national data from secondary sources-community pharmacy activity, socioeconomic and health need datasets-and primary data from a questionnaire survey of community pharmacies in nine diverse geographical areas in England.
Annual dispensing volume; annual volume of medicines use reviews (MURs).
National dataset (n=10 454 pharmacies): greater dispensing volume was significantly associated with pharmacy ownership type (large chains>independents>supermarkets), greater deprivation, higher local prevalence of cardiovascular disease and depression, older people (aged >75 years) and infants (aged 0-4 years) but lower prevalence of mental health conditions. Greater volume of MURs was significantly associated with pharmacy ownership type (large chains/supermarkets>>independents), greater dispensing volume, and lower disease prevalence.Survey dataset (n=285 pharmacies; response=34.6%): greater dispensing volume was significantly associated with staffing, skill-mix, organisational culture, years open and greater deprivation. Greater MUR volume was significantly associated with pharmacy ownership type (large chains/supermarkets>>independents), greater dispensing volume, weekly opening hours and lower asthma prevalence.
Organisational and extraorganisational factors were found to impact differently on dispensing volume and MUR activity, the latter being driven more by corporate ownership than population need. While levels of staffing and skill-mix were associated with dispensing volume, they did not influence MUR activity. Despite recent changes to the contractual framework, the existing fee-for-service reimbursement may therefore not be the most appropriate for the delivery of cognitive (rather than supply) services, still appearing to incentivise quantity over the quality (in terms of appropriate targeting) of services delivered. Future research should focus on the development of quality measures that could be incorporated into community pharmacy reimbursement mechanisms.
本研究旨在确定与社区药房提供服务量的现有差异相关的组织因素和组织外因素。
对来自二级来源的关联国家数据（社区药房活动、社会经济和健康需求数据集）以及来自对英格兰九个不同地理区域的社区药房进行问卷调查的原始数据进行线性和有序逻辑回归分析。
年配药量；年度药物使用评估（MURs）量。
国家数据集（n = 10454家药房）：配药量增加与药房所有权类型（大型连锁药店>独立药店>超市）、更高的贫困程度、当地心血管疾病和抑郁症的更高患病率、老年人（75岁以上）和婴儿（0 - 4岁）显著相关，但心理健康状况的患病率较低。MURs量增加与药房所有权类型（大型连锁药店/超市>>独立药店）、更高的配药量和更低的疾病患病率显著相关。调查数据集（n = 285家药房；回复率 = 34.6%）：配药量增加与人员配备、技能组合、组织文化、开业年限和更高的贫困程度显著相关。MUR量增加与药房所有权类型（大型连锁药店/超市>>独立药店）、更高的配药量、每周营业时间和更低的哮喘患病率显著相关。
发现组织因素和组织外因素对配药量和MUR活动的影响不同，后者更多地由企业所有权驱动而非人口需求。虽然人员配备水平和技能组合与配药量相关，但它们并未影响MUR活动。尽管最近合同框架有所变化，但现有的按服务收费报销可能并非最适合提供认知（而非供应）服务，似乎仍在激励服务数量而非服务质量（就适当的目标定位而言）。未来的研究应侧重于制定可纳入社区药房报销机制的质量指标。
