Abstract
BACKGROUND: Health workforce planning is especially important in a setting of political, social, and economic uncertainty. Portuguese community pharmacists are experiencing such conditions as well as increasing patient empowerment, shortage of primary care physicians, and primary health care reforms. This study aims to design three future scenarios for Portuguese community pharmacists, recognizing the changing environment as an opportunity to develop the role that community pharmacists may play in the Portuguese health system.
METHODS: The community pharmacist scenario design followed a three-stage approach. The first stage comprised thinking of relevant questions to be addressed and definition of the scenarios horizon. The second stage comprised two face-to-face, scenario-building workshops, for which 10 experts from practice and academic settings were invited. Academic and professional experience was the main selection criteria. The first workshop was meant for context analysis and design of draft scenarios, while the second was aimed at scenario analysis and validation. The final scenarios were built merging workshops' information with data collected from scientific literature followed by team consensus. The final stage involved scenario development carried by the authors alone, developing the narratives behind each scenario.
RESULTS: Analysis allowed the identification of critical factors expected to have particular influence in 2020 for Portuguese community pharmacists, leading to two critical uncertainties: the "Legislative environment" and "Ability to innovate and develop services". Three final scenarios were built, namely "Pharmacy-Mall", "e-Pharmacist", and "Reorganize or Die". These scenarios provide possible trends for market needs, pharmacist workforce numbers, and expected qualifications to be developed by future professionals.
CONCLUSIONS: In all scenarios it is clear that the future advance of Portuguese community pharmacists will depend on pharmaceutical services provision beyond medicine dispensing. This innovative professional role will require the acquisition or development of competencies in the fields of management, leadership, marketing, information technologies, teamwork abilities, and behavioural and communication skills. To accomplish a sustainable evolution, legislative changes and adequate financial incentives will be beneficial. The scenario development proves to be valuable as a strategic planning tool, not only for understanding future community pharmacist needs in a complex and uncertain environment, but also for other health care professionals.
| Original language | English |
|---|---|
| Pages (from-to) | 58 |
| Number of pages | 1 |
| Journal | Human Resources for Health |
| Volume | 12 |
| DOIs | |
| Publication status | Published - 2014 |
Funding
Portuguese community pharmacists have followed the global trend for an extended practice. Community pharmacists in Portugal serve the public in independent shops, the community pharmacies. The installation of community pharmacies is regulated by the government, establishing the minimum distance between pharmacies and number of inhabitants serviced. The number of pharmacies, now close to 2,900 in total, has increased 9.5% since the turn of the century, with an average of 24 new pharmacies per year [14]. From 2007 onwards, changes in legislation allowed for non-pharmacist ownership, a decrease in the population base from 4,000 to 3,500 inhabitants per pharmacy per county, and a shorter distance between pharmacies from 500 m to 350 m. This political measure had impact in that year, with a rapid increase of pharmacies, but quickly stabilized. Pharmacies have a National Health Service (NHS) contract for dispensing medicines, establishing prescription medicines’ profit margins and co-payments. Apart from dispensing, none of the new services is supported by NHS remuneration. To cope with this, pharmacies may offer services such as smoking cessation, minor ailment schemes, and adherence support services, all of which are supported by the patient’s direct payments [15]. During the early 21st century, Portuguese pharmacies have implemented pharmaceutical care programs for hypertension and diabetes with the help of professional organizations such as the National Association of Pharmacies (ANF), a pharmacy owner’s organization. The program for diabetes was financially supported by the NHS from 2006 to 2009. At the time, a maximum of 400 pharmacies were doing patient follow-up, with an average of three patients per pharmacy [16]. After the cancelation of NHS financial support of these programs, most pharmacies terminated the provision of the service and stopped with patient follow-up. Since then, many pharmacies have broadened their services to other services provided by different professionals such as nutritionists, podologists, or nurses in an attempt to have more revenue to face the present financial constraints.
| Funders | Funder number |
|---|---|
| Fundação para a Ciência e Tecnologia | PTDC/CCI-CIN/122690/2010 |