Clinical pharmacy services in a South African private hospital group, and the factors hindering their progress.

Abstract

Clinical pharmacy and the provision of patient-focused pharmaceutical care services is a hospital pharmacist’s role that is slowly developing in South African private hospitals. The clinical pharmacist, as a valuable member of the health care team, has been shown to improve patient clinical outcomes. However, a number of factors hinder the progression of clinical pharmacy services in these hospitals. To promote the implementation of clinical pharmacy services in South African private hospitals by identifying those factors perceived by South African hospital pharmacists as barriers. This observational mixed methods research study was conducted between September 2015 and February 2016, across 52 private hospitals within the same purposively selected private hospital group. Pharmacy managers were recruited for semi-structured interviews during the first qualitative phase. The second quantitative phase consisted of the distribution of a survey questionnaire to 243 hospital pharmacists and pharmacy managers. The overall response rate was poor, with only 15.9% and 30.4% recorded for the qualitative and quantitative phases, respectively. The median percentage of time that hospital pharmacists spend providing a clinical service at ward level was only 17.5%, and 76.1% of respondents stated that availability of time was negatively impacting clinical pharmacy progression. All survey respondents agreed that further formal education and training was required to progress clinical pharmacy. Hospital management support in clinical pharmacy progression was emphasised by 83.6% of the respondents. The lack of a recognised clinical pharmacist specialist registration category was identified by 70.8% of respondents as having a negative impact on clinical pharmacy progression. The perceived structural and behavioural barriers to clinical pharmacy service progression were identified as being educational requirements, human resource allocation and the need for hospital and governmental support. The FIP Basel Statements on the Future of Hospital Pharmacy require local adaptation in order to be used as a tool to monitor clinical pharmacy practice in hospitals in South Africa, but should be promoted to further expose the identified barriers and initiate corrective action. The perceived barriers and steps for remedial action to educational needs, human resource allocation and hospital and governmental support are provided. Addressing these barriers will further promote and strengthen the role of the clinical pharmacist in South African private hospitals.