The pharmacy as a primary care provider

Frontiers in Public Health

Public Health

Nachiket Mor¹  Dyuti Sen²  Rubayat Khan³  Sarah Zaheen³  Priya Naik⁴  Nayonika Basu⁴ 

[1] Banyan Academy of Leadership in Mental Health, Chennai, India;India Fellow, Independent Researcher, New Delhi, India;Jeeon Foundation, Dhaka, Bangladesh;Samhita Social Ventures, Mumbai, India;

关键词: primary care;    health systems;    informal providers;    task shifting;    community resource;   

DOI  :  10.3389/fpubh.2023.1221439

 received in 2023-05-12, accepted in 2023-08-03,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionPrimary care is an essential component of any health system, but building high-quality primary care has proven to be a challenge for most developing countries. Among the multiplicity of providers in South Asia, one of the most ubiquitous channels through which not only medicines are obtained but also primary care advice is sought is the neighborhood pharmacy. There are widespread availability of pharmacies in South Asia. There is also good evidence that working with pharmacies in this way is a globally accepted idea, and there are several examples of countries, such as France and Nigeria, that have integrated pharmacies into their primary care systems and entrusted them with significant responsibilities.MethodsIn this paper, we explore the potential of this channel as a formal primary care provider, with a particular focus on the South Asian context, by examining how pharmacies perform against the seven Starfield attributes of (i) first contact care, (ii) continuity of care, (iii) comprehensiveness, (iv) coordination, (v) family centredness, (vi) cultural competency, and (vii) community orientation. In the paper, we use data on pharmacies from four pharmacy-related interventions, one from Bangladesh and three from India, to carry out our analysis using the Qualitative Comparative Analysis (QCA) framework.ResultsWe find that even in the South Asian context, pharmacies provide several components of good primary care. As expected, they demonstrate a strong orientation toward the community in which they are located and are able to provide first-contact care. However, we find no direct evidence that they are able to offer continuity of care or bring to bear family-centredness and cultural competency when dealing with their patients. It is encouraging, however, that while there is no formal evidence of this in any of the interventions, multiple anecdotal examples suggest that pharmacists do indeed do much of this, but perhaps in an informal and inconsistent manner.DiscussionThe evidence from these studies provides support for the view that pharmacies have many of the inherent characteristics needed to become an effective primary care channel and already play an important role in providing access to health information and care. However, it is also clear from the research that without additional training and access to tools, pharmacies will not have the competency or knowledge necessary to provide these services or even act as an effective gateway to other healthcare providers. To fully unlock this opportunity, therefore, any organization that wishes to engage with them will need to have the vision and patience to work with this network for an extended period of time and not merely aspire for incremental improvements but have a strategy in place that fundamentally changes the capabilities and the roles that pharmacies can play.

【 授权许可】

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Copyright © 2023 Mor, Sen, Zaheen, Khan, Naik and Basu.