Complying with Legal Professional and Organisational Requirements in Pharmacy

Community pharmacy services are easily accessible health services that provide advice on self-treatment, safe and effective use of medications, health promotion and reliable health resources [1]. There is a wide variety of service names and classifications, such as traditional and advanced pharmacy services. In post-socialist countries where the implementation of pharmaceutical supply services is weak or uneven, the provision and advice of non-prescription and prescription medicines, drug composition and health promotion could be considered basic or traditional services. In the extended services group, it is possible to integrate chronic disease management, including medication utilization verification; the new drug service; Early detection and detection; Vaccination; Smoking cessation; and point-of-care tests to measure blood pressure, cholesterol and glucose, among others [2,3]. Internationally, the provision of comprehensive pharmacy services is not always regulated or the scope of community pharmacy activities is limited to the provision of traditional pharmacy services [4]. However, in health care systems that focus on primary health care, the role of community pharmacists in advising and monitoring the patient`s drug treatment is becoming increasingly important. In addition, community pharmacists play a greater role in health promotion and prevention, patient education, chronic disease management and immunization, thereby improving access to primary health services [5]. Poor communication of safety information (contraindications, side effects and interactions) to patients has already been reported in previous studies in Estonia [38,39] and was also confirmed in the CPSQG-based self-assessment. This is not a problem when accessing reliable and up-to-date information on medicines, as pharmacists in Estonia can use the official database for the identification of drug interactions and adverse drug reactions (Inxbase). The Estonian health insurance company also provides pharmacists with free access to the database and an operation to evaluate the interactions between over-the-counter medicines and dietary supplements [40]. However, most pharmacies do not seem to be able to use this tool, and when they do, it is still not known how often this source is used, what sections and for what reasons. In order to provide a high-quality, patient-centred pharmacy service, pharmacists should have access to the same databases and to the same extent as other healthcare professionals.

Use of various tools to support service delivery, e.g. assess stock (2014-16 Tamhane p = 0.006; 2014-19 Tamhane p = 0.017; 2016-19 Tamhane p < 0.001), monitor drug expiry date (F = 4.561, p = 0.033), avoid errors in drug supply, examine potential drug interactions and adverse reactions that have decreased during the study period. At the same time, pharmacists did not have direct external channels to get quick information about drug shortages that increased during academic years (2014-16 Tukey p = 0.033). If the product was not available in the pharmacy`s inventory, it was tedious to find it from drug wholesalers, and the willingness of pharmacists to investigate to resolve the situation decreased significantly (2014-16 Tamhane p = 0.033; 2014-19 Tamhane p = 0.005). In 2014 (N = 478 pharmacies), 2016 (N = 493) and 2019 (N = 494), three cross-sectional electronic surveys were conducted in community pharmacies in Estonia to track the receipt and application of the GQSC. He was asked to complete only one survey per pharmacy. To ensure a high-quality service, among other things, a competent and competent pharmacy manager and a sufficient number of professionals are needed. About half of the pharmacies that participated in the self-assessment in all academic years reported that they had systematically implemented all the activities necessary for effective management, including a supportive and motivating work environment. All employees followed consistent customer service principles, regular customer and employee feedback was obtained on service delivery, and an existing system for disseminating important information was put into operation. However, about 2/3 of respondents reported a shortage of specialized staff in their pharmacy and this problem increased during the university years (2014-19 Tamhane p = 0.003). Despite the lack of specialized staff and less flexible human resource management, participation in the continuing professional development of pharmacists has become more systematic over the years and pharmacists` interest in acquiring knowledge has increased (Figure 5).

Information on extensive pharmacy services (patient health indicators) has always been documented in about 1/5 pharmacies during all academic years. Participation in health and environmental campaigns outside pharmacies has decreased significantly (2014-16 Tamhane p < 0.001; 2014-19 Tamhane p < 0.001). Fourth, pharmacy practice can also be affected by organizational and environmental problems [62]. Management skills and existing management skills play a vital role in shaping an organization`s culture. Only half of the pharmacies participating in this study had implemented all the activities described in the GQSC for effective, efficient, inclusive and motivating management. Lack of strong leadership prevents pharmacies from achieving their goals and changing day-to-day practices by adapting service delivery to patients [63]. Despite the intrinsic motivation of professionals to find ways to improve the quality of pharmacy practice, several other factors may have influenced the operation of community pharmacies to delay the desired improvement in the quality of service. The proposed standards apply to all pharmacists and pharmacy technicians and replace the current standards of conduct, ethics and performance (see table: "Comparison of Proposed and Existing Standards"). The QQSC was used as a self-assessment tool for community pharmacists to assess the quality of service. In this study, aggregate data from 2014, 2016 and 2019 were used to determine the implementation of the guidelines in practice. The self-assessment tool included indicators with a response scale of two points (1 yes/0 no) or four points (0 never/1 occasionally/2 mainly/3 always).

The characteristics of the pharmacy, such as geographical location and type of pharmacy (main pharmacy or branch), were also recorded. The Standards for Pharmacy Professionals describe how to ensure safe and effective care. They are a statement about what people expect from pharmacy professionals and also reflect what pharmacy professionals have told us they expect from themselves and their colleagues. In order to offer extensive services of high quality, additional training is required. In about one third of pharmacies, pharmacy staff providing extensive services had received appropriate training; however, participation in continuing training decreased significantly in the last year of the survey (F = 10.876, P < 0.001). An eForm platform (www.eformular.com, accessed February 10, 2021) was used for data collection and initial analysis. The data was then imported into a statistical package for Social Sciences (SPSS®), v. 27. The results of different survey years were compared to the one-way ANOVA test and to multiple post-hoc comparisons after checking the homogeneity of the variance sample with the Levene test. The data were tested for normality using the Kolmogorov-Smirnov test, and an alpha value of less than 0.05 was received for all variables. The statistical significance level was set at p < 0.05.

The Results section presents only statistically significant results. If only two years of studies were available, the results are presented with Anova`s F-value and p-value. However, if data were available for three reference years, the p-values of the post-hoc comparisons shall be used. The full analysis of the three years of study (i.e., average values for different years of study and p-value) can be found in Appendix A. The CPSQG was distributed to all community pharmacies in Estonia in 2014, 2016 and 2021. An electronic version of the guidelines was also available from professional associations and on the website of the National Medicines Agency. In 2012-2019, several seminars were organized to present the guideline in order to raise awareness of the GCQSP and to use the implementation of the guidelines [23]. The first concepts were compiled from various international GPP guidelines, in particular the framework conditions of the United Kingdom, the United States and Australia [18,19,20].