An in-depth examination of funded and unfunded cognitive pharmaceutical services

BACKGROUND: A substantial expansion in the scope of practice of community pharmacists has become evident over the years, with increased government remuneration pledged to support cognitive pharmaceutical services (CPS) delivery as part of the Australian Community Pharmacy Agreements. Exploring experiences in providing funded and unfunded CPS within the existing work environment will enable better understanding of community pharmacists' roles and responsibilities in delivering CPS. OBJECTIVE: To explore pharmacists' roles, responsibilities, experiences, and perceived impact associated with delivering CPS. METHODS: Qualitative semi-structured interviews (n = 25) were conducted with practising community pharmacists in Australia who were engaged in delivering CPS during the time when the Sixth Community Pharmacy Agreement (6CPA) was in effect. Verbatim transcripts were thematically analysed (inductive analysis). RESULTS: All participants reported an expansion of services being provided in community pharmacies. Pharmacists offered a broad range of CPS within the community pharmacy setting, via 6CPA-funded and non-6CPA or unfunded initiatives. Almost all participants reported that their pharmacy provided 6CPA-funded initiatives such as dose administration aids, clinical interventions, MedsChecks/Diabetes MedsChecks, and Home Medicines Reviews. User-pay services being offered included pharmacist-led flu vaccinations, opioid substitution therapy, sleep apnoea services, and absence from work certificates, among other services. However, profit margins on user-pay services were minimal. CPS provision was seen to have positive impacts at patient and health care system levels. Pharmacists felt they enabled timely and convenient access to health care for patients in the community pharmacy setting, and facilitated quality use of medicines, which in turn had positive impact on the community pharmacy business. CONCLUSIONS: A prominent shift in the provision of CPS was evident. Professional services provision has become the status quo for the practice of the profession, indicative of a likely shift in the work value of community pharmacists. Pharmacists should be further recognised professionally and financially for their contributions as health care professionals within the broader health care system.