Supplementary material
Experiences of a community pharmacy service to support adherence and selfmanagement in chronic heart failure
Page
Abstract……………………………………………………………………………………….…2
Table 2………………….…………………………………………………………………….….3
Table 3………………….…………………………………………………………………….….4
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Abstract
Background: 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.
Objective: 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.
Setting: Community pharmacies and community-based patients in Greater Glasgow and
Clyde, Scotland.
Method: 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.
Main Outcome: An understanding and an explanation of the experiences of receiving and
delivering an enhanced HF service.
Results: 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 comorbidities 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.
Conclusion: 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.
Impact of findings on practice
 Patients with HF and other chronic illnesses struggle to cope with their medicines
and manage their conditions
 Governments across the world, and patients, are increasingly looking to pharmacists
and other health professionals, for alternative models of care to improve self care
and medicines management
 Few qualitative data underpin service developments by community pharmacists
aiming to help patients with HF.
 Patients and pharmacists confirmed the need for a service to focus on medicines
adherence and self care
 Policy makers considering the introduction of such a service may be reassured by
patients’ and pharmacists’ reports of evidence of acceptability and benefit from
qualitative evidence
Keywords:
Community pharmacy; heart failure; adherence; self-care; patient views; Scotland.
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Table 2. Pharmacist group interview schedule
1. In terms of the heart failure service you’re offering in the pharmacy, can you suggest
ways in which you think it’s working well?
2. Can you suggest aspects that don’t work so well, and how the service could be
improved?
3. What about talking to patients about symptoms? Do you do that?
[follow-up question - do you feel comfortable talking about symptoms?]
4. What are the main areas that patients themselves want to discuss?
5. Are there areas that patients seem to avoid discussing?
6. Can you indicate what advantages you feel patients may be getting from the
service?
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Table 3. Patient telephone interviews†
1
Do you feel that talking to the pharmacist in the community pharmacy made any
difference to how much you know about your heart failure?
2
Do you feel that talking to the pharmacist in the pharmacy made any difference to
how much you know about your heart failure medicines?
3
Has talking to the pharmacist made any difference to your routine for taking your
heart failure medicines?
4
Has talking to the pharmacist made any difference to how much you know about
the symptoms of heart failure?
5
Has talking to the pharmacist made any difference to how much you know about
the symptoms to watch out for in the future that could suggest your heart isn’t
working quite as well?
6
Has talking to the pharmacist made any difference to the likelihood of you telling
the doctor or nurse if you notice those symptoms?
7
Are there any questions about your heart failure that nobody else has answered?
8
Overall, what do you think about the service provided by the pharmacist?
†
Questions 5 and 7 were introduced after the first 18 telephone interviews had been carried
out.
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