Current Situation of Pharmacy Services in Community Health Centers and the Functioning of Pharmacists in Family Doctor Teams in Shanghai

BackgroundCurrently, polypharmacy is common among residents at high risk of unsafe medication practices, partly due to a lack of medication reconciliation and comprehensive medication management. Pharmacy services, facilitated by community health centers with regional advantages, align with their functional orientation. However, a significant gap persists between the supply of pharmacy services in community health centers and public demand.ObjectiveTo assess the current state of pharmacy services and the integration of pharmacists into family doctor teams in Shanghai, as well as to identify the challenges faced by community pharmacists, with the goal of providing recommendations for their development.MethodsA combination of qualitative and quantitative approach was adopted. In December 2020, a stratified sampling method was employed to survey 307 on-duty pharmacists with licensed pharmacist qualifications from 29 community health centers, including 6 in the central urban areas, 8 in the inner and outer suburban areas, and 15 in the outer suburban areas. The contents of the questionnaire covered basic information about the pharmacists, the development of pharmacy services, and the participation of community pharmacists in the family doctor team. Concurrently, a convenience sampling method was used to invite 29 key stakeholders, including 11 head of pharmacies, 6 family doctors, 12 community health center directors or health commission managers from central urban areas, inner and outer suburban areas, and outer suburban areas, for semi-structured focus interviews on pharmacy service demands, resources allocation, and service processes.ResultsThe quantitative results indicated that the most community pharmacists attended 1-2 times of training programs [139 (45.3%)], with continuing education as the main form of training [252 (82.1%)]. The most common pharmacy service activities were prescription dispensing [284 (92.5%)], prescription review [253 (82.4%)], and pharmacy window advice or outpatient consultation guidance [196 (63.8%)]. The services consuming the most pharmacist hours were prescription dispensing [280 (91.2%)], prescription review [244 (79.5%)], and prescription feedback [145 (47.2%)]. Only 78 (25.4%) participants joined family doctor teams. Qualitative results revealed a high demand for pharmacy services among older patients, alongside weak awareness of rational drug use. Challenges included shortage of pharmacist workforce, need for enhanced professional quality, incomplete community pharmacy drug lists, and need for more applying information technology. Furthermore, community pharmacists are often undervalued, with services focusing narrowly on dispensing, insufficient targeted training on rational drug use, and limited functioning within family doctor teams.ConclusionCurrently, the resources allocation and supply capacity of pharmacy services are inadequate to meet resident demands, and the pharmacy service process requires improvement and optimization. The impact of pharmacists who have joined family doctor teams is limited. Therefore, it is necessary to enhance incentive mechanism, clarify service content and improve the service model.