From “retailers” to health care providers: Transforming the role of community pharmacists in chronic disease management

May combine two claims.

Research evaluating the impact of collaborative medication reviews indicates that such services improve prescribing, and have the potential to reduce health service use and medication costs for patients with multiple chronic conditions.

“Research evaluating the impact of collaborative medication reviews indicates that such services improve prescribing, and have the potential to reduce health service use and medication costs for patients with multiple chronic conditions [18,19].”

• cites [18] 18. Lenaghan E, Holland R, Brooks A. Home-based medication review in a high risk elderly population in primary care-the POLYMED ran- domised controlled trial. Age and Ageing 2007;36(3):292-7. sourceNot checked — no full text of the source
• cites [19] 19. Roughead EE, Barratt JD, Ramsay E, Pratt N, Ryan P, Peck R, et al. The effectiveness of collaborative medicine reviews in delaying time to next hospitalization for patients with heart failure in the practice setting: results of a cohort study. Circulation: Heart Failure 2009;2(5):424-8. sourcePartly supported

  The Discussion reports that collaborative home medication reviews were associated with a 45% lower rate of heart-failure hospitalization in the study population, supporting the potential to reduce health-service use. The paper describes identifying medication-related problems, but does not report improved prescribing or reduced medication costs. Its findings concern older patients with heart failure, not patients with multiple chronic conditions generally. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

Canadian pharmacists are increasingly able to renew, adjust or substitute physicians' prescriptions, although the scope of pharmacist practice varies according to province.

“Canadian pharmacists are also increasingly able to renew, adjust or substitute physicians' prescriptions, although again the scope of pharmacist practice varies according to province [12].”

• cites [12] 12. Tannenbaum C, Tsuyuki RT. The expanding scope of pharmacists' practice: implications for physicians. Canadian Medical Association Journal 2013;185(14):1228-32. sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Many Canadian universities offer training in interdisciplinary care to nursing, medical, and pharmacy students.

“Many Canadian universities offer training in interdisciplinary care to nursing, medical, and pharmacy students [10].”

• cites [10] 10. Tannebaum C, Tsuyuki RT. The expanding role of pharmacists' practice: implications for physicians. Canadian Medical Association Journal 2013;185(14):1228-332. sourcePartly supported

  The Next steps section says many universities bring pharmacy and medical students together for interdisciplinary-care training. It identifies only two universities—the Université de Montréal and the University of Alberta—where nursing students also participate, so it does not establish that many Canadian universities offer training to all three groups. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Since 2005, community pharmacists in England have been providing professional services in three tiers: essential, advanced, and enhanced.

“Since 2005, community pharmacists in England have been providing professional services in three tiers: essential, advanced, and enhanced [14].”

• cites [14] 14. Richardson E, Pollock AM. Community pharmacy: moving from dispensing to diagnosis and treatment. British Medical Journal 2010:340. sourceNot checked — no full text of the source

May combine two claims.

The level of reimbursement for patient-centered services offered in community pharmacists in Canada varies greatly across provinces, in part because the 10 provincial regulatory bodies have different legislative and professional standards.

“The level of reimbursement for patient-centered services offered in community pharmacists in Canada varies greatly across provinces, in part because the 10 provincial regulatory bodies have different legislative and professional standards [13,34].”

• cites [13] 13. Law MR, Ma T, Fisher J, Sketris IS. Independent pharmacist prescrib- ing in Canada. Canadian Pharmacists Journal/Revue des Pharmaciens du Canada 2012;145(1):17-24. sourceNot checked — no full text of the source
• cites [34] 34. Sketris IS. Extending prescribing privileges in Canada. Canadian Phar- maceutical Journal 2009;142(1):17. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

In the US, limited progress is occurring towards engaging community pharmacists in tasks aimed at chronic disease prevention.

“In the US, limited progress is occurring towards engaging community pharmacists in tasks aimed at chronic disease prevention.”

May combine two claims.

Three Canadian provinces have recently authorized community pharmacists to order and interpret laboratory tests, with similar legislation under way in three other provinces.

“Three Canadian provinces have recently authorized community pharmacists to order and interpret laboratory tests, with similar legislation under way in three other provinces [11].”

• cites [11] 11. Canadian Pharmacist Association. Pharmacists' medical manage- ment services. Environmental scan of activities across Canada. Ottawa: Canadian Pharmacists Association; 2013.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S4 (based).

Historically, remuneration in community pharmacy settings has been primarily based on retailing and dispensing functions in all countries considered.

“Historically, remuneration in community pharmacy settings has been primarily based on retailing and dispensing functions in all countries considered.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In England, the introduction of the three-tier pharmacy contract changed the existing remuneration mechanisms for community pharmacists.

“In England, the introduction of the three-tier pharmacy contract changed the existing remuneration mechanisms for community pharmacists.”

Classified as probably not a substantial claim.

The roles of community pharmacists are evolving in the six countries selected.

“The roles of community pharmacists are evolving in the six countries selected and this article presents a picture of the situation as of early 2015.”

Classified as probably not a substantial claim.

While reforms vary in focus and scope, they are similar in their aim to benefit from pharmacists as primary health care professionals.

“While these reforms vary in their focus and scope, they are similar in their aim to benefit from pharmacists as primary health care professionals.”

May combine two claims.

The Australian government introduced new compensation mechanisms for community pharmacists conducting medication reviews in 1997 in residential care and in 2001 for all community patients.

“The Australian government introduced new compensation mechanisms for community pharmacists conducting medication reviews in 1997 in residential care and in 2001 for all community patients [16].”

• cites [16] 16. Rigby D. Collaboration between doctors and pharmacists in the com- munity. Australian Prescriber 2010;33(6):191-3. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Recent reform efforts in some of the country cases have gradually introduced new payment mechanisms to encourage the adoption of patient-centered services in community pharmacist settings.

“Although limited, recent reform efforts in some of our country cases have gradually introduced new payment mechanisms to encourage the adoption of patient-centered services in community pharmacist settings.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In 2012, reforms in England and Scotland allowed pharmacists to also prescribe certain controlled drugs.

“In 2012, reforms in both countries allowed pharmacists to also prescribe certain controlled drugs.”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

Australian community pharmacists have the authority to perform emergency prescribing and continued dispensing and to provide additional services, including medication use reviews.

“Community pharmacists also have the authority to perform emergency prescribing and continued dispensing and to provide additional services, including medication use reviews.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Dispensing and retailing remain the core functions of the pharmacy profession.

“Dispensing and retailing remain the core functions of the pharmacy profession, and the selected countries have made great strides in equipping community pharmacists with tasks aimed at ensuring the effective, safe, and efficient use of medicines (Table 1).”

May combine two claims.

The Dutch preference policy had unintended consequences and considerably limited the number and scope of patient-centered services offered by community pharmacists because these services had to be financed out of the pharmacy's retailing-related income.

“Despite its well-intentioned objectives, this policy had unintended consequences and considerably limited the number and scope of patientcentered services offered by community pharmacists as these services had to be financed out of the pharmacy's retailing-related income.”

May combine two claims.

Two pilot studies in Australia demonstrated that community pharmacists can play an important role in managing some chronic conditions, as long as there is a strong coordination system in place between the healthcare professionals involved.

“Two pilot studies assessing the potential for the involvement of community pharmacists in chronic disease control programs demonstrated the important role that community pharmacists can play in managing some conditions, as long as there is a strong coordination system in place between the healthcare professionals involved [30].”

• cites [30] 30. Urbis. Evaluation of the asthma pilot program. Urbis: Canberra; 2010.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Existing evidence from systematic reviews suggests that MTM-like practices reduce medication-related problems, improve adherence, and achieve better clinical outcomes.

“Existing evidence from systematic reviews suggests that such practices reduce medication-related problems, improve adherence, and achieve better clinical outcomes [24].”

• cites [24] 24. Chisholm-Burns M, Lee JK, Spivey C, Slack M, Herrier R, Hall-Lipsy E, et al. US pharmacists' effects as team members on patient care: sys- tematic review and meta-analyses. Medical Care 2010;48:923-33. sourceNot checked — no full text of the source

May combine two claims.

Although recent Dutch legislation aimed at giving pharmacists access to laboratory test results and indications for prescribing has been approved in parliament, pharmacist access to data is not yet widely implemented, mostly due to a lack of adequate training and necessary information technologies.

“Although these changes have been approved in parliament, and there are increasing numbers of pharmacists and general practitioners that cooperate closely, pharmacist access to data is not yet widely implemented, mostly due to a lack of adequate training and necessary information technologies.”

May combine two claims.

Barriers to further progress in Canada range from practical considerations (lack of time, funding, and workforce) to limited patient awareness and inadequate training of pharmacists.

“Barriers to further progress range from practical considerations (lack of time, funding, and workforce) to limited patient awareness and inadequate training of pharmacists [29].”

• cites [29] 29. Hartnell NR, MacKinnon NJ, Sketris IS, Gass D. The roles of commu- nity pharmacists in managing patients with diabetes: perceptions of health care professionals in Nova Scotia. Canadian Pharmacists Journal 2005;138(6):46-53. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Many community pharmacies in the US now provide vaccinations and this is reimbursed by health insurers.

“Many community pharmacies now provide vaccinations and this is reimbursed by health insurers.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

In Canada, the limited development of electronic medical records could be a barrier to the integration of community pharmacists.

“In Canada, the limited development of electronic medical records could be a barrier to the integration of community pharmacists.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Several universities in the US offer training courses in interprofessional education.

“There are already several universities in the US offering training courses in interprofessional education [36].”

• cites [36] 36. American College of Clinical Pharmacy. Interprofessional edu- cation (IPE) in action. http://www.aacp.org/resources/education/ Documents/IPEC-in-action.pdf. ; 2011 [cited 22.10.13].Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Although quality improvement efforts are prominent on the political agenda in the US, progress thus far remains limited.

“Although quality improvement efforts are prominent on the political agenda in the US, progress thus far remains limited.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In the Netherlands, community pharmacists and primary care physicians have been cooperating through Pharmacotherapy Quality Circles.

“In the Netherlands, community pharmacists and primary care physicians have been cooperating through Pharmacotherapy Quality Circles.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

In the Netherlands, interdisciplinary education is limited to one week during the curriculum and is sometimes only optional.

“In the Netherlands interdisciplinary education is limited to one week during the curriculum, and is sometimes only optional.”

Probably not a substantial claim: may not pass S4 (based).

Pharmacist remuneration in most settings is primarily based on dispensing.

“Pharmacist remuneration in most settings is primarily based on dispensing.”

Probably not a substantial claim: may not pass S4 (based).

Currently, in the US, pharmacist remuneration is primarily based on retailing functions, which are determined by payers, pharmacy benefit managers, or health plans.

“Currently, in the US, pharmacist remuneration is primarily based on retailing functions, which are determined by payers, pharmacy benefit managers, or health plans.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The Netherlands introduced a set of 42 indicators to measure the quality of care provided by community pharmacists in 2008.

“The Netherlands introduced a set of 42 indicators to measure the quality of care provided by community pharmacists in 2008.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Similar developments in interprofessional education are occurring in the US, where there is a greater emphasis on training health professionals in interdisciplinary collaborative teams.

“Similar developments are occurring in the US, where there is a greater emphasis on training health professionals in interdisciplinary collaborative teams [35].”

• cites [35] 35. American College of Clinical Pharmacy. ACCP white paper-interprofessional education: principles and application. A framework for clinical pharmacy. http://www.accp.com/docs/ positions/whitePapers/InterProfEduc.pdf. ; 2009 [cited 22.10.13].Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Australia has made progress in integrating community pharmacists within the primary care system.

“Australia has made progress on a number of different fronts, and specifically in the area of integrating community pharmacists within the primary care system.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

The National Quality Forum recently developed pharmacy-specific quality indicators, primarily used by health plans, aimed at monitoring the safety of prescription drug therapy, promoting generic drug use, and improving adherence.

“The National Quality Forum recently developed pharmacy-specific quality indicators, primarily used by health plans, aimed at monitoring the safety of prescription drug therapy, promoting generic drug use, and improving adherence.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

With the exception of the US and the Netherlands, community pharmacists are often not playing a key role in the recent policy evolution of accountable care.

“Paradoxically, with the exception of the US and the Netherlands, community pharmacists are often not playing a key role in the recent policy evolution of accountable care.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In Canada, facilitators of integration include flexible regulatory frameworks, emerging alternative financing and reimbursement approaches, and the publication of the national interprofessional competency framework in 2014.

“In Canada, facilitators include flexible regulatory frameworks, emerging alternative financing and reimbursement approaches as well as the publication of the national interprofessional competency framework in 2014.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Postgraduate training courses in the US include community pharmacy residencies focused on advancing skills in collaborative patient care.

“Postgraduate training courses in the US include community pharmacy residencies focused on advancing skills in collaborative patient care.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Canada has been at the forefront of interprofessional education.

“Although developments remain limited, Canada has been at the forefront of interprofessional education.”

Probably not a substantial claim: may not pass S3 (load-bearing).

England recognizes different levels of pharmacy services-essential, advanced, and enhanced-accompanied by respective sets of tasks and required skills.

“England recognizes different levels of pharmacy services, accompanied by respective sets of tasks and required skills: essential, advanced, and enhanced.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

In the Netherlands, choice and competition across service providers pose a barrier to effective integration of pharmacists into primary care and are responsible for discontinuing care.

“In the Netherlands, choice and competition across service providers pose a barrier to effective integration of pharmacists into primary care and are responsible for discontinuing care.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

England and Scotland have been at the forefront of defining different tiers of community pharmacist roles in terms of effective, safe, and efficient use of medicines and prevention and management of chronic conditions.

“Notably, England and Scotland have been at the forefront of defining different “tiers” of community pharmacist roles in terms of both (1) effective, safe, and efficient use of medicines and (2) prevention and management of chronic conditions.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The Pharmacy Quality Alliance is actively pursuing the development and adoption of metrics of community pharmacy services for use in quality improvement, benchmarking, and pay-for-performance benchmarks.

“The Pharmacy Quality Alliance is actively pursuing the development and adoption of metrics of community pharmacy services for use in quality improvement, benchmarking, and pay-for-performance benchmarks [37].”

• cites [37] 37. Ross LA. Quality improvement in health care: opportunities and responsibilities for pharmacists. Annals of Pharmacotherapy 2013;47(9):1206-9. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Despite slow progress, a number of policy developments are underway in the Netherlands and policymakers are actively engaged in developing legislation to expand the roles of community pharmacists.

“Despite slow progress on the implementation front, a number of policy developments are currently underway in the Netherlands and policymakers are actively engaged in developing legislation to expand the roles of community pharmacists.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Policymakers in England and Scotland have aligned new community pharmacist responsibilities with specific remuneration systems.

“Policymakers in England and Scotland have also aligned these new responsibilities with specific remuneration systems.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In Australia, the National Health Policy encourages the integration of community pharmacists through payment for referral by primary care physicians for Home Medicines Reviews, review and reporting by pharmacist to primary care physicians, or payment for collaboration with others as part of the Pharmacy Practice Incentives.

“In Australia, the National Health Policy encourages the integration of community pharmacists through for instance payment for referral by the primary care physicians for Home Medicines Reviews; or review and reporting by pharmacist to primary care physicians; or payment for “collaboration with others” as part of the Pharmacy Practice Incentives.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

In the Netherlands, enabling patients' health information to be electronically transferred to and from community pharmacies is a national priority.

“In the Netherlands, enabling patients' health information to be electronically transferred to and from community pharmacies is a national priority, allowing community pharmacists and primary care physicians to increasingly consult each other.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Since 2011, the Pharmacy Practice Incentive Program has been providing incentives on a fee-for-service basis for the delivery of patient-centered services in five core areas: diabetes, respiratory disease, cardiovascular disease, mental health conditions and health promotion.

“Since 2011, the Pharmacy Practice Incentive Program has been providing incentives on a fee-for-service basis for the delivery of patient-centered services in five core areas: diabetes, respiratory disease, cardiovascular disease, mental health conditions and health promotion.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Canada and the US have pioneered multidisciplinary pharmacy education.

“Canada and the US have pioneered multidisciplinary pharmacy education-an essential component to ensure that future health care professionals view community pharmacists as members of integrated care teams.”

May combine two claims.

The Dutch indicators were introduced nationally in 2008 and were designed to provide pharmacist-reported data on the structure, process and outcome of care at the level of a community pharmacy.

“Introduced nationally in 2008, the indicators were designed to provide pharmacist-reported data on the structure, process and outcome of care at the level of a community pharmacy [38].”

• cites [38] 38. De Bie J, Kijlstra NB, Daemen BJ, Bouvy ML. The development of qual- ity indicators for community pharmacy care. British Medical Journal Quality and Safety 2011;20(8):666-71. sourceNot checked — no full text of the source

May combine two claims.

The total length of formal training for pharmacists is typically five to six years, with an additional two or three years required to specialize or obtain an advanced degree.

“Although educational requirements vary by country, the total length of formal training is typically five to six years, with an additional two or three years required to specialize or obtain an advanced degree [4].”

• cites [4] 4. Global Knowledge Exchange Network. An overview of edu- cation and training requirements for global healthcare professionals-pharmacist. http://www.gken.org/Docs/Workforce/ Pharmacy Education FINAL 102609.pdf. ; 2009 [cited 23.07.12].Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Chronic conditions are the largest cause of death and disability in the world.

“Chronic conditions are the largest cause of death and disability in the world [1].”

• cites [1] 1. Yach D, Hawkes C, Gould C, Hofman KJ. The global burden of chronic diseases: overcoming impediments to prevention and control. Jour- nal of the American Medical Association 2004;291(21):2616-22. sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

Community pharmacists are under-utilized as public health professionals.

“Despite their considerable training, community pharmacists are the only health professionals who are not primarily rewarded for delivering health care and hence are under-utilized as public health professionals.”

• AssumptionRests on an assumption: Community pharmacists are the only health professionals who are not primarily rewarded for delivering health care.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In the United States, there are approximately 110,000 practicing community pharmacists as compared to roughly 250,000 primary care physicians.

“In the United States (US), there are approximately 110,000 practicing community pharmacists [2] as compared to roughly 250,000 primary care physicians [3].”

• cites [2] 2. Department of Health and Human Services-Health Resources and Services Administration-Bureau of Health Professions. The ade- quacy of pharmacist supply: 2004 to 2030. http://bhpr.hrsa.gov/ healthworkforce/reports/pharmsupply20042030.pdf ; 2008 [cited 24.10.13].Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [3] 3. Agency for Healthcare Research and Quality. The number of practicing primary care physicians in the united states: primary care workforce facts and stats No. 1 Rockville. http://www.ahrq.gov/ research/findings/factsheets/primary/pcwork1/index.html. ; 2011 [cited 24.10.13].Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S2 (checkable).

Pharmacists are well suited to assume an expanded role in the healthcare system.

“Pharmacists are well suited to assume an expanded role in the healthcare system.”

Probably not a substantial claim: may not pass S2 (checkable).

One promising financing model would involve the funding of community pharmacists to be part of the primary care system.

“One promising financing model would involve the funding of community pharmacists to be part of the primary care system [42].”

• cites [42] 42. Canadian Academy of Health Sciences. Transforming care for Canadi- ans with chronic health conditions. Put people first, expect the best, manage for results. Ottawa: Canadian Academy of Health Sciences; 2010.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Integration of community pharmacists into primary care faces obstacles: lack of established collaboration among providers; inadequate compensation models that fail to reward the delivery of patient-centered services in the pharmacy setting; and lack of a shared vision for different levels of pharmacist services.

“Integration of community pharmacists into primary care faces the following obstacles: lack of established collaboration among providers; inadequate compensation models that fail to reward the delivery of patient-centered services in the pharmacy setting; and lack of a shared vision for different levels of pharmacist services.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

Multidisciplinary pharmacy education is an essential component to ensure that future health care professionals view community pharmacists as members of integrated care teams.

“Canada and the US have pioneered multidisciplinary pharmacy education-an essential component to ensure that future health care professionals view community pharmacists as members of integrated care teams.”

Classified as probably not a substantial claim. May combine two claims.

Community pharmacists are underutilized professionals: they have the skills and position in the healthcare system to engage further in the provision of care for people with multiple chronic diseases.

“Community pharmacists are underutilized professionals: they have the skills and position in the healthcare system to engage further in the provision of care for people with multiple chronic diseases.”