A qualitative study exploring the opportunities and challenges of providing digital community pharmacy services for older people in England
Authors: Gong H , Jacobs S , Willis S 
Published: April 2024

Abstract

Introduction
Digital healthcare can be an innovative, cost-effective solution for the growing healthcare needs of an ageing population, enhancing service accessibility.[1] Older individuals tend to rely more on community pharmacy services, supported by research indicating positive health outcomes.[2] However, scant evidence exists regarding the impact of digital community pharmacy services on this demographic, emphasising the need for crucial investigations into their effectiveness.

Aim
Identify challenges and opportunities in delivering digital pharmacy services for older population in community pharmacies in England, from perspectives of policymakers and pharmacy service providers.

Methods
Between November 2022 and May 2023, online/telephone interviews were conducted with stakeholders including policymakers/commissioners and pharmacy service providers. Recruitment involved purposive and convenience sampling, with commissioners sourced through networks and pharmacy providers via gatekeepers in industry associations. Topics covered the current state of digital pharmacy services in England, implementation opportunities and challenges, and suggestions for enhancement. Audio-recorded interviews were transcribed verbatim and analysed using both inductive and deductive thematic approaches, assisted by NVivo 12 Plus. Themes comprised challenges and solutions in digital pharmacy service delivery and factors influencing user acceptance. Deductive analysis shaped the coding framework based on Davis’s Technology Acceptance Model (TAM).

Results
Twelve interviews (three policy makers/commissioners [PM], four senior managers of community pharmacy [SM], five front-line community pharmacists [CP]) were completed. One of the interviewees was a female and all others were male. Their length of relevant employment in the field of community pharmacy ranged from three to seventeen years. The key findings indicated challenges in implementing digital pharmacy services to older populations may be due to unclear health policies and limited financial support for digital reforms to community pharmacy: “as a pharmacy we’ll take care of that, but we need to know that there will be funding for that before we go and do it all. I think there’s amazing things that can be done, but at local, small level, like a little community pharmacy, they just can’t afford to do the development” [SM1], and “so the majority of independent pharmacies, … they have paper prescriptions, so they’re not as technology based. I believe one, that’s because it’s money, so it’s funding. They get less funding” [CP4]. Interviewees highlighted that community pharmacists facing high workloads and time constraints, often prioritise other responsibilities over adopting new technologies: “unfortunately, there are a fair few demands on pharmacy team’s time at the moment, so where does promoting a digital priority fit on that long list of priorities and probably quite low down” [PM3]. They also expressed a need for additional technical training to effectively navigate digital pharmacy services.

Conclusion
This study provides insights into challenges in implementing digital pharmacy services for older people through diverse stakeholder perspectives, offering practical considerations for policy decisions, service design, and implementation strategies. Nevertheless, this study observes a deficient emphasis on deploying digital pharmacy services for older people. It is orientated towards a broader demographic, while those with specific medical conditions may receive pharmacy services more precisely. The applicability of this study may be limited, requiring region-specific research. Further research would be focusing on those over 50 in Greater Manchester aligns with the local community’s emphasis on ageing-related research, technology, and innovative ideas supported by academic institutions.

References
1. Currie M, Philip LJ, Roberts A. Attitudes towards the use and acceptance of eHealth technologies: a case study of older adults living with chronic pain and implications for rural healthcare. BMC health services research. 2015 Dec;15(1):1-2.
2. Bernsten C, Björkman I, Caramona M et al. Improving the well-being of elderly patients via community pharmacy-based provision of pharmaceutical care: a multicentre study in seven European countries. Drugs & aging. 2001 Jan;18:63-77.