What are pharmacists perceptions of their existing PMR systems?

Background

Healthcare access and delivery faces significant global and local challenges. Funding restraints in healthcare practices means that there is now even more need to ensure technology is available to better integrate services, to allow swifter delivery clinical care and pharmacy for patients in community. Technology has great potential to improve medicines safety; the use of existing Pharmacy Management Records (PMR) technology in routine use does allow better care and prompt management of patients in community. However, the evidence-base for this technology has been insubstantial. Examples of technologies advocated for use in relation to medication management include electronic prescribing systems, automated dispensing technology, patient bar-coded verification, and electronic transmission of prescriptions. Where further integration of pharmacy services through technology is now required to enhance safety and the delivery of care to patients. In addition, there is a need for technology to enhance multi-disciplinary working, efficiency, and quality.

Aims and Objectives
This research focused on exploring and identifying what current PMR systems are being used in community pharmacy practice, and seeked to understand what advances are to be made to meet the needs of ‘today’s community pharmacists and their requirements to ensure more stream-line services. This research used mixed methodology to collect data and form baseline analysis of the real issues surrounding existing us of PMR technology.

Introduction
Community pharmacy services are continuously facing issues in the delivery of more efficient practice. It was suggested that smarter technology could be used to empower the pharmacist and allow them to provide better patient care. There is a push for using swifter technology to bridge knowledge gaps in healthcare. The major piece of technology used to support pharmacists in delivering pharmaceutical care is the Patient Medication Record (PMR) system, which is now widely used to manage patient care. Therefore, this study aims to explore the perceptions of pharmacists and the community pharmacy team on current PMR systems and identify key improvements that need to be implemented to support the community pharmacist in providing better quality care.

Despite the potential benefits of novel technology in community pharmacy, it cannot be introduced overnight. Community pharmacy and their teams will need support to maximize their potential, and appropriate training must be provided to all staff. Learning itself is a highly individual process, so no one formula will be suited to every individual, and individual preferences will influence uptake. It is also important to accommodate the needs of all staff in practice, as demographic features such as age, gender and voluntariness to use technology, this will differ.

Literature
With the anticipation of a more clinical role for community pharmacists approaching, technological support is becoming increasingly paramount. It is evident that community pharmacists’ clinical knowledge is being utilised by numerous patient centred services and the role is expanding within the primary care sector. However, as community pharmacies are paid by the number of items dispensed and recent changes resulting in a decrease in funding by 7.5% since 2016, the strain on pharmacists to undertake these new clinical roles is overwhelming. Although the pharmacy profession is revolutionising, the community pharmacy environment is not, as it still concentrates on the dispense and supply process.

Ongoing Concerns
There are many areas of health to any one individual patient and this care ranges between primary and secondary care. Pharmacists have a unique role to play to improve health outcomes (or Patient Reported Outcome Measures - PROMS) and care is optimized more effectively through use of PMR. More research and development is required to tailor technology to better pharmacy practice in the UK. It is also critical that PMR technology is assessed on the impact of medication safety to create an evidence base for their use, rather than presuming that quality and error will accumulate.

PMR systems are not integrated with General Practice (GP) or other healthcare professionals’ records, which seems to be a major limitation as literature shows that primary care providers need to coordinate their initiatives to provide better local healthcare. Community pharmacists with access to drug information and laboratory information systems reported increased productivity and better quality of care. Research informs existing PMRs can be daunting and unfamiliar. Introducing up-to-date technology to community pharmacy will provide numerous benefits that include relieving the current reliance on paper and enable the pharmacist to fulfil a more clinical role in the community setting. Uptake of technology is also reduced because of PMR inefficiencies.

Methodology
Qualitative: This study involved two focus groups to explore and understand existing issues surrounding PMR technology and establish how they could be improved to aid the role of the community pharmacist. Eleven (11) participants were recruited. The inclusion criteria entailed pharmacists and the wider community pharmacy team such as dispensers and technicians who use PMR systems in community pharmacy daily. The research team used thematic analysis to derive themes from focus groups. Quantitative: The Invatech research team also developed a survey that was implemented nationally across 600 community pharmacies in the UK. The survey asked several questions including 1) role in community pharmacy, 2) current challenges, 3) existing PMR, 4) would they recommend their PMR to a colleague or friend, 5) technology used in community pharmacy, 6) No. of staffs employed using PMR, 7) No. of staffs employed who need to access PMR at any one time, 7) influences on uptake of technology and 8) Contract lengths.

Results
Qualitative: This covers the perceived downsides of PMR systems that were mentioned. Eight out of eleven participants pointed out various limitations. Participants spoke about the difficulty of using the different systems due to issues such as variations in shortcuts or even password barriers. "You could make the system easier because when you’ve got all different systems and you’re hopping from place to place, it’s quite difficult”; “One tablet daily - one place it’s so you have to then be able to know what the codes are for everything”; “Its password protected most of the things”; “It’s not uniform at all”; Five participants mentioned that when their PMR systems breakdown, it is very frustrating as it causes major delays and there is nothing they can do. This has even led to pharmacists having to handwrite labels.; “You can get into a situation where you’re struggling to do anything”; “We had to handwrite labels because there’s literally nothing we can do”; “Soul Destroying”

To resolve issues like this, the participants have said it will consume even more time trying to get hold of system providers to deal with it and so they try to solve the issues themselves. They made it clear that the support provided from system providers is insufficient and does not meet their needs.“The time it takes to ring up people to fix um and then getting through to the right person on the other end of the phone”; “You have to get to the right person on the phone to unlock the scripts stuck in the systems”;

Furthermore, five participants stated that their repeat dispensing is managed separately and not interlinked to their PMR systems. The idea of separate systems and some having to manage their repeats manually was perceived as an issue. “We use a completely separate system to track when you are using repeats”; “A lot of that repeat ordering stuff is done manually, they don’t do any of that electronically it’s all done on paper so they will be able to print off a repeat electronically but other than that, everything else you’re relying constantly on people to put things in the right place so if all of that is done electronically, that’s a big thing”; “So, you generate a repeat order, but you just won’t get it back, so we’ve gone back to using the old system instead of using the online system”; “It can just go wrong once, and you lose like eight repeats. We go back to the old school way”.

Results

Quantitative: From the survey implemented, 206 responses were received. The findings were as follows: 1) the Net Promoter Score (NPS) (which relates to how likely are community pharmacists to promote their current PMR) was -63. 2) 61% of community pharmacists wanted no contract, 3) 81% would only uptake technology if it grew business, 4) 81% would uptake technology if it saved time in an activity or pharmacy process, 5) 61% would uptake technology if it integrated with existing workflow and PMR, 6) 91% would uptake technology if it was user-friendly, 7) 54% inform that the biggest challenge is managing dispensing volumes, 8) 65% inform speed of use is still a frustrating concern.

Pharmacy and Investment in Technology
Technology has great potential to improve the safety of medicines administration; its ability to hold large amounts of information, to support decisions, and to repeatedly do the same act, gives the potential to meet both service providers and users. There is presently no single source of information about improving medicines safety and technology in the UK. There may well also be additional evidence as audits from individual practices, but unless this is made publicly available – the evidence and any lessons learned are not made universal which then negatively impedes on pharmacy practice. Whilst technology advances are being made, this also means community pharmacists need to invest more in novel technology to free up time to deliver more effective clinical healthcare services for the communities they serve. Research is still needed to strengthen the evidence-base and impact of technology in pharmacy practice. Building on research credence, Invatech is now developing technology by assessing understanding real pharmacy concerns and limitations. It is only through understanding real needs, pharmacists can enhance patient services in pharmacy practice

Summary
Current PMRs on the market are not recommended by community pharmacists. There are significant lessons to be learnt by PMR providers in creating systems that are fit for purpose in today's pharmacy setting. Pharmacists are facing challenges in operating businesses and technology is needed to support their objectives. The research carried out has highlighted the need for user-friendly systems that are functional. In addition, the research has highlighted frustrations in the commercial approach adopted by system providers, such as contract length periods and the freedom to purchase their own hardware. 

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