title: Experiences of a community pharmacy service to support adherence and self-management in chronic heart failure.
abstract: BACKGROUND
  Heart failure (HF) is common, disabling and deadly. Patients with HF often have poor self-care and medicines non-adherence, which contributes to poor outcomes. Community pharmacy based cognitive services have the potential to help, but we do not know how patients view community-pharmacist-led services for patients with HF.
  
  
  OBJECTIVE
  We aimed to explore and portray in detail, the perspectives of patients receiving, and pharmacists delivering an enhanced, pay for performance community pharmacy HF service.
  
  
  METHODS
  Community pharmacies and community-based patients in Greater Glasgow and Clyde, Scotland.
  
  
  METHODS
  Focus groups with pharmacists and semi-structured interviews with individual patients by telephone. Cross sectional thematic analysis of qualitative data used Normalization Process Theory to understand and describe patient's reports.
  
  
  METHODS
  Experiences of receiving and delivering an enhanced HF service.
  
  
  RESULTS
  Pharmacists voiced their confidence in delivering the service and highlighted valued aspects including the structured consultation and repeated contacts with patients enabling the opportunity to improve self care and medicines adherence. Discussing co-morbidities other than HF was difficult and persuading patients to modify behaviour was challenging. Patients were comfortable discussing symptoms and medicines with pharmacists; they identified pharmacists as fulfilling roles that were needed but not currently addressed. Patients reported the service helped them to enact HF medicines and HF self care management strategies.
  
  
  CONCLUSIONS
  Both patients receiving and pharmacists delivering a cognitive HF service felt that it addressed a shortfall in current care. There may be a clearly defined role for pharmacists in supporting patients to address the burden of understanding and managing their condition and treatment, leading to better self management and medicines adherence. This study may inform the development of strategies or policies to improve the process of care for patients with HF and has implications for the development of other extended role services.
authors.affiliation: Research and Development, Pharmacy and Prescribing Support Unit, NHS Greater Glasgow and Clyde, Victoria Infirmary, Langside Road, Glasgow, G42 9TT, UK, Richard.Lowrie@ggc.scot.nhs.uk.
authors.forename: Richard
authors.initials: R
authors.lastname: Lowrie
authors.forename: Lina
authors.initials: L
authors.lastname: Johansson
authors.forename: Paul
authors.initials: P
authors.lastname: Forsyth
authors.forename: Stuart Lochhead
authors.initials: SL
authors.lastname: Bryce
authors.forename: Susan
authors.initials: S
authors.lastname: McKellar
authors.forename: Niamh
authors.initials: N
authors.lastname: Fitzgerald
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D002908:Chronic Disease / Q000628:therapy; D003157:Community Pharmacy Services; D005260:Female; D017144:Focus Groups; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D010595:Pharmacists / Q000523:psychology / Q000706:statistics & numerical data; D012606:Scotland; D012648:Self Care / Q000379:methods* / Q000523:psychology / Q000706:statistics & numerical data