A scenario-planning approach to human resources for health: the case of community pharmacists in Portugal

Human Resources for Health

Luís Velez Lapão²  Afonso Cavaco¹  João Gregório² 

[1] Department of Social Pharmacy, School of Pharmacy, The Faculty of Mathematics and Natural Sciences, University of Oslo, Farmasibygningen, Sem Sælands vei 3, 0371 Oslo, Norway;WHO Collaborating Centre for Health Workforce Policy and Planning, International Public Health and Biostatistics Unit, Instituto de Higiene e Medicina Tropical, Rua da Junqueira n°100, 1349-008 Lisbon, Portugal

关键词: Portugal;    Scenario planning;    Pharmaceutical services;    Human resources for health;    Community pharmacists;   

Others  :  1139286
DOI  :  10.1186/1478-4491-12-58

 received in 2014-03-31, accepted in 2014-09-29,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 Gregório et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Campbell J, Dussault G, Buchan J, Pozo-Martin F, Arias MG, Leone C, Siyam A, Cometto G: A universal truth: no health without a workforce. In Forum Report, Third Global Forum on Human Resources for Health, Recife, Brazil. Geneva: Global Health Workforce Alliance and World Health Organization; 2013.
• [2]Dussault G: Gestão dos Recursos Humanos e Qualidade dos Serviços de Saúde. Educ Med Salud 1994, 28(4):478-489.
• [3]Dussault G, Ferrinho P: A health workforce strategy for Portugal. Cah Sociol Demogr Med 2007, 47(3):235-240.
• [4]Wagner EH: Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract 1998, 1(1):2-4.
• [5]McAlister FA, Lawson FM, Teo KK, Armstrong PW: A systematic review of randomized trials of disease management programs in heart failure. Am J Med 2001, 110(5):378-384.
• [6]Cranor CW, Bunting BA, Christensen DB: The Asheville Project: long-term clinical and economic outcomes of a community pharmacy diabetes care program. J Am Pharm Assoc (Wash) 2003, 43(2):173-184.
• [7]Willis A, Rivers P, Gray LJ, Davies M, Khunti K: The effectiveness of screening for diabetes and cardiovascular disease risk factors in a community pharmacy setting. PLoS One 2014, 9(4):e91157.
• [8]Chisholm-Burns MA, Graff Zivin JS, Lee JK, Spivey CA, Slack M, Herrier RN, Hall-Lipsy E, Abraham I, Palmer J: Economic effects of pharmacists on health outcomes in the United States: a systematic review. Am J Health Syst Pharm 2010, 67(19):1624-1634.
• [9]Duarte A, Nunes F, Martins L: Social Responsibility of the Pharmacy Sector in Portugal. Lisbon: GEST-IN/ISCTE; 2007.
• [10]Maddux MS, Dong BJ, Miller WA, Nelson KM, Raebel MA, Raehl CL, Smith WE: A vision of pharmacy’s future roles, responsibilities, and manpower needs in the United States: American College of Clinical Pharmacy. Pharmacotherapy 2000, 20(8):991-1020.
• [11]Zellmer WA: Pharmacy’s future: transformation, diffusion, and imagination. Am J Health Syst Pharm 2010, 67(14):1199-1204.
• [12]Hepler C, Strand L: Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm 1990, 47(3):533-543.
• [13]Roberts AS, Benrimoj SI, Chen TF, Williams KA, Hopp TR, Aslani P: Understanding practice change in community pharmacy: a qualitative study in Australia. Res Social Adm Pharm 2005, 1(4):546-564.
• [14]PORDATA: Health sector statistical data, 2000–2009. Pordata - Base de dados Portugal contemporâneo 2011. [http://www.pordata.pt/Portugal/Pessoal+de+saude+medicos++dentistas++odontologistas++enfermeiros+e+farmaceuticos-144 webcite]. Accessed 02/02/2011
• [15]Costa S, Santos C, Silveira J: Community pharmacy services in Portugal. Ann Pharmacother 2006, 40(12):2228-2234.
• [16]INFARMED: Farmácias com farmacêuticos tecnicamente habilitados a efectuar o seguimento dos doentes nos moldes previstos no Nível II de intervenção do Protocolo de Colaboração da Diabetes Mellitus e Número de doentes por farmácia. Lisbon; 2009. [http://www.infarmed.pt/portal/page/portal/INFARMED/DISPOSITIVOS_MEDICOS/PROGRAMA_CONTROLO_DIABETES_MELLITUS/FARMACIAS_ABRANGIDAS_PELO_PROTOCOLO/FARMACIAS_NIVEL_II/2009/Lista2_200910.pdf webcite]. Accessed 26/06/2011
• [17]OF: Statistical Data, November 2009. Lisbon: Ordem dos Farmacêuticos; 2009. [http://www.ordemfarmaceuticos.pt/scid//ofWebInst_09/defaultCategoryViewOne.asp?categoryId=1914 webcite]. Accessed 15/05/2011
• [18]OF: The Young Pharmacists - Characterization of Portuguese Pharmacists. Lisbon: Ordem dos Farmacêuticos; 2012. [http://www.ordemfarmaceuticos.pt/xFiles/scContentDeployer_pt/docs/Doc6318.pdf webcite]. Accessed 22/02/2013
• [19]INFARMED: Medicine Statistics 2004. Lisbon: Instituto Nacional da Farmácia e do Medicamento; 2006.
• [20]INFARMED: Medicine Statistics 2009. Lisbon: Instituto Nacional da Farmácia e do Medicamento; 2010.
• [21]MCTES: Access to Higher Education - Index of Courses. Lisbon; 2011. [http://www.dges.mec.pt/guias/indcurso.asp?curso=9494 webcite]. Accessed 29/05/2011
• [22]ANF: Pharmacy in Portugal. Associação Nacional de Farmácias; 2010. [http://www.anf.pt/index.php?option=com_content&task=blogcategory&id=107&Itemid=107 webcite]. Accessed 15/05/2011
• [23]Rodrigues A, Marques FB, Ferreira PL, Raposo V: Estudo do Sector das Farmácias em Portugal. Coimbra: Centro de Estudos e Investigação em Saúde da Universidade de Coimbra; 2007.
• [24]OF: Employability of the Young Pharmacists. Lisbon: Ordem dos Farmacêuticos; 2012. [http://www.ordemfarmaceuticos.pt/xFiles/scContentDeployer_pt/docs/Doc6443.pdf webcite]. Accessed 22/02/2013
• [25]Ginter PM, Duncan WJ, Capper SA: Strategic planning for public health practice using macroenvironmental analysis. Public Health Rep 1991, 106(2):134-141.
• [26]Poz MRD, Gupta N, Quain E, Soucat ALB, WHO: Manual Para a Monitorização e Avaliação Dos Recursos Humanos de Saúde: Com Aplicação Dedicada aos Países de Rendimento Baixo e Médio. Geneva: World Health Organization; 2009.
• [27]WSHA: Governing Board Orientation Manual - Strategic Planning. Washington: Washington State Hospital Association; 2011. [http://www.wsha.org/files/62/gov_board_manual_strategic_planning.pdf webcite]. Accessed 07/05/2011
• [28]Kuhn KA, Giuse DA, Lapao L, Wurst SH: Expanding the scope of health information systems - from hospitals to regional networks, to national infrastructures, and beyond. Methods Inf Med 2007, 46(4):500-502.
• [29]Azhar S, Hassali MA, Ibrahim MI, Ahmad M, Masood I, Shafie AA: The role of pharmacists in developing countries: the current scenario in Pakistan. Hum Resour Health 2009, 7:54. BioMed Central Full Text
• [30]Mintzberg H: The fall and rise of strategic planning. Harv Bus Rev 1994, 107-114.
• [31]Postma TJBM, Liebl F: How to improve scenario analysis as a strategic management tool? Technol Forecast Social Change 2005, 72(2):161-173.
• [32]Yoe C: Scenario-Based Planning and Decision-Making: Guidelines for Use in the U.S. Army Corps of Engineers Planning Studies and Literature Review. Alexandria, VF: Institute for Water Resources; 2005.
• [33]Long M, Ridout L, Bagnulo J, Braddock D, Chen T, Gissing P, Lennon B, Sansom L, Shah C: Pharmacy Workforce Planning Study. Barton: Pharmacy Guild of Australia; 2010.
• [34]Patterson DG, Skillman SM, Hart LG: Washington State’s Pharmacist Workforce Through 2020: Influential Factors and Available Data. Seattle: WWAMI Center for Health Workforce Studies; 2004.
• [35]Low J: Pharmacist oversupply-myth or mission? J Pharm Prac Res 2010, 40(4):262.
• [36]Leufkens H, Hekster Y, Hudson S: Scenario analysis of the future of clinical pharmacy. Pharm World Sci 1997, 19(4):182-185.
• [37]Norgaard LS, Colberg L, Niemann MR: The role of the Danish community pharmacist: perceptions and future scenarios. Pharm World Sci 2001, 23(4):159-164.
• [38]Godet M: The art of scenarios and strategic planning: tools and pitfalls. Technol Forecast Social Change 2000, 65:3-22.
• [39]Schoemaker PJH: Multiple scenario development: its conceptual and behavioral foundation. Strat Manag J 1993, 14(3):193-213.
• [40]Schoemaker PJH: Scenario planning: a tool for strategic thinking. Sloan Manage Rev 1995, 36(2):25-40.
• [41]Schoemaker PJH: Twenty common pitfalls in scenario planning. In Learning from the Future. Edited by Fahey L, Randall RM. Chichester: John Wiley & Sons, Ltd; 1998:422-431.
• [42]Pomerol JC: Scenario development and practical decision making under uncertainty. Decis Supp Syst 2001, 31(2):197-204.
• [43]Bishop P, Hines A, Collins T: The current state of scenario development: an overview of techniques. Foresight 2007, 9(1):5.
• [44]Clark J: Five futures for academic medicine: the ICRAM scenarios. BMJ 2005, 331(7508):101-104.
• [45]Lapão LV, Thore S: Prioritizing R&D Projects in the Face of Technological and Market Uncertainty: Scenario Planning in the Telecommunication Business. In 12th International Conference on Forecasting. Edinburgh; 1998.
• [46]Heijden K: Scenarios: The Art of Strategic Conversation. 2nd edition. Chichester: John Wiley & Sons, Ltd.; 1996.
• [47]Almarsdottir AB, Morgall JM, Bjornsdottir I: A question of emphasis: efficiency or equality in the provision of pharmaceuticals. Int J Health Plann Manage 2000, 15(2):149-161.
• [48]Lluch M, Kanavos P: Impact of regulation of community pharmacies on efficiency, access and equity: evidence from the UK and Spain. Health Policy 2010, 95(2–3):245-254.
• [49]Lluch M: Are regulations of community pharmacies in Europe questioning our pro-competitive policies? Eurohealth 2009, 15(4):3.
• [50]Dussault G, Franceschini MC: Not enough there, too many here: understanding geographical imbalances in the distribution of the health workforce. Human Resour Health 2006, 4:12. BioMed Central Full Text
• [51]Hawthorne N, Anderson C: The global pharmacy workforce: a systematic review of the literature. Hum Resour Health 2009, 7:48. BioMed Central Full Text
• [52]Ferguson J, Ashcroft D, Hassell K: Qualitative insights into job satisfaction and dissatisfaction with management among community and hospital pharmacists. Res Social Adm Pharm 2011, 7(3):306-316.
• [53]Resnik DB, Ranelli PL, Resnik SP: The conflict between ethics and business in community pharmacy: what about patient counseling? J Bus Ethics 2000, 28(2):179-186.
• [54]Petropoulou SG, Bekakos MP, Gravvanis GA: E-prescribing - Telepharmacy. In 7th Hellenic European Conference on Computers. Athens; 2005.
• [55]Sellors C, Sellors J, Levine M, Chan D, Dolovich L, Howard M: Computer networking to enhance pharmacist-physician communication: a pilot demonstration project in community settings. Can Pharmacist J 2004, 137(8):26-30.
• [56]Green BB, Cook AJ, Ralston JD, Fishman PA, Catz SL, Carlson J, Carrell D, Tyll L, Larson EB, Thompson RS: Effectiveness of home blood pressure monitoring, Web communication, and pharmacist care on hypertension control: a randomized controlled trial. JAMA 2008, 299(24):2857-2867.
• [57]Roughead L, Semple S, Vitry A: The value of pharmacist professional services in the community setting: a systematic review of the literature 1990–2002. In Quality Use of Medicines and Pharmacy Research Centre. Adelaide: University of South Australia, School of Pharmaceutical, Molecular and Biomedical Sciences; 2002.
• [58]Berenguer B, La Casa C, de la Matta MJ, Martin-Calero MJ: Pharmaceutical care: past, present and future. Curr Pharm Des 2004, 10(31):3931-3946.
• [59]McDonough RP, Harthan AA, McLeese KE, Doucette WR: Retrospective financial analysis of medication therapy management services from the pharmacy’s perspective. J Am Pharm Assoc (2003) 2010, 50(1):62-66.
• [60]Westerlund T, Marklund B: Assessment of the clinical and economic outcomes of pharmacy interventions in drug-related problems. J Clin Pharm Ther 2009, 34(3):319-327.
• [61]Wiedenmayer K, Summers RS, Mackie CA, Gous AGS, Everard M: Developing Pharmacy Practice - A Focus on Patient Care. Geneva: World Health Organization and International Pharmaceutical Federation; 2006.
• [62]Benrimoj S: Educating pharmacists to provide new Pharmacy Services. In European Association of Faculties of Pharmacy Annual Congress - New Roles for Pharmacy and Pharmacists in Europe: A Challenge for Education in Pharmacy. Lisbon: Ordem dos Farmacêuticos; 2011.
• [63]Fernandez-Llimos F: Desenvolvimento de conceitos em “Cuidados Farmacêuticos”. In IV Congresso Ibero-Americano de Ciências Farmacêuticas. Lisbon: Ordem dos Farmacêuticos; 2011.
• [64]Jungnickel PW, Kelley KW, Hammer DP, Haines ST, Marlowe KF: Addressing competencies for the future in the professional curriculum. Am J Pharm Educ 2009, 73(8):156.
• [65]Fox N, Ward K, O’Rourke A: The birth of the e-clinic: continuity or transformation in the UK governance of pharmaceutical consumption? Soc Sci Med 2005, 61(7):1474-1484.
• [66]Katz SJ, Moyer CA: The emerging role of online communication between patients and their providers. J Gen Intern Med 2004, 19:978-983.
• [67]Lam AY, Rose D: Telepharmacy services in an urban community health clinic system. J Am Pharm Assoc (2003) 2009, 49(5):652-659.
• [68]Lamb M: Improving Patient Compliance in Clinical Trials - Smart Packages or Smart Design?. 2010. [https://www.yumpu.com/en/document/view/7773301/improving-patient-compliance-in-clinical-trials-almac webcite]. Accessed 30/05/2011
• [69]Vervloet M, Van Dijk L, Santen-Reestman J, Van Vlijmen B, Van Wingerden P, Bouvy ML, De Bakker DH: SMS reminders improve adherence to oral medication in type 2 diabetes patients who are real time electronically monitored. Int J Med Inform 2012, 81(9):594-604.
• [70]Collins B, Borders TF, Tebrink K, Xu KT: Utilization of prescription medications and ancillary pharmacy services among rural elders in west Texas: distance barriers and implications for telepharmacy. J Health Hum Serv Adm 2007, 30(1):75-97.
• [71]Lapão LV, Gregório J, Cavaco A, da Silva MM, Lovis C: Implementing eHealth services for enhanced pharmaceutical care provision: opportunities and challenges. Adv Information Syst Technol 2013, 206:433-443.
• [72]Van der Kam WJ, Meyboom de Jong B, Tromp TF, Moorman PW, Van der Lei J: Effects of electronic communication between the GP and the pharmacist: the quality of medication data on admission and after discharge. Fam Pract 2001, 18(6):605-609.
• [73]Bradley F, Elvey R, Ashcroft DM, Hassell K, Kendall J, Sibbald B, Noyce P: The challenge of integrating community pharmacists into the primary health care team: a case study of local pharmaceutical services (LPS) pilots and interprofessional collaboration. J Interprof Care 2008, 22(4):387-398.
• [74]O’Connor M, Pugh J, Jiwa M, Hughes J, Fisher C: The palliative care interdisciplinary team: where is the community pharmacist? J Palliat Med 2011, 14(1):7-11.
• [75]Edmunds J, Calnan MW: The reprofessionalisation of community pharmacy? An exploration of attitudes to extended roles for community pharmacists amongst pharmacists and General Practioners in the United Kingdom. Soc Sci Med 2001, 53(7):943-955.
• [76]Paulino E, Guerreiro MP, Cantrill JA, Martins AP, Costa FA, Benrimoj SIC: Community pharmacists’ and physicians’ inter-professional work: insights from qualitative studies with multiple stakeholders. Rev Port Clin Geral 2010, 26:590-606.
• [77]Buchan J, Temido M, Fronteira I, Lapao L, Dussault G: Nurses in advanced roles: a review of acceptability in Portugal. Rev Lat Am Enfermagem 2013, 21:38-46.
• [78]Leese B: New opportunities for nurses and other healthcare professionals? A review of the potential impact of the new GMS contract on the primary care workforce. J Health Organ Manag 2006, 20(6):525-536.