A cross-sectional evaluation of community pharmacists’ perceptions of intermediate care and medicines management across the healthcare interface
A cross-sectional evaluation of community pharmacists' perceptions of intermediate care and medicines management across the healthcare interface
Anna Millar 0 1
Carmel Hughes 0 1
Maria Devlin 0 1
Crist´ın Ryan 0 1
0 School of Pharmacy, Royal College of Surgeons in Ireland , 111 St. Stephens Green, Dublin 2 , Ireland
1 School of Pharmacy, Queen's University Belfast , 97 Lisburn Road, Belfast BT9 7BL , UK
Background Despite the importance placed on the concept of the multidisciplinary team in relation to intermediate care (IC), little is known about community pharmacists' (CPs) involvement. Objective To determine CPs' awareness of and involvement with IC services, perceptions of the transfer of patients' medication information between healthcare settings and views of the development of a CP-IC service. Setting Community pharmacies in Northern Ireland. Methods A postal questionnaire, informed by previous qualitative work was developed and piloted. Main outcome measure CPs' awareness of and involvement with IC. Results The response rate was 35.3 % (190/539). Under half (47.4 %) of CPs 'agreed/strongly agreed' that they understood the term 'intermediate care'. Three quarters of respondents were either not involved or unsure if they were involved with providing services to IC. A small minority (1.2 %) of CPs reported that they received communication regarding medication changes made in hospital or IC settings 'all of the time'. Only 9.5 and 0.5 % of respondents 'strongly agreed' that communication from hospital and IC, respectively, was sufficiently detailed. In total, 155 (81.6 %) CPs indicated that they would like to have greater involvement with IC services. 'Current workload' was ranked as the most important barrier to service development. Conclusion It was revealed that CPs had little awareness of, or involvement with, IC. Communication of information relating to patients' medicines between settings was perceived as insufficient, especially between IC and community pharmacy settings. CPs demonstrated willingness to be involved with IC and services aimed at bridging the communication gap between healthcare settings.
Community pharmacy; Healthcare interface; Intermediate care; Medicines management; Questionnaire; United Kingdom
Impacts on practice
• Intermediate care is an evolving healthcare setting that
provides an alternative to hospital for older adults, yet
community pharmacists have little awareness of, or
involvement with such services.
• Community pharmacists could have a role to play in
providing medicines management services to patients
in intermediate care, which may improve the currently
suboptimal communication of information relating to
patients’ medications between hospital, intermediate
care, and primary care settings.
Intermediate care (IC) is a care setting that has evolved in
response to the ageing population, the increasing pressure
faced by acute healthcare services and the resulting need
for alternatives to hospital-based care. Whilst various
terminologies are used to describe similar care settings
globally , IC is broadly defined in the United Kingdom
(UK) as ‘a range of integrated services to prevent
unnecessary hospital admission, promote faster recovery from
illness, support timely discharge and maximise
independent living’ . Despite the importance placed on the
concept of the multidisciplinary team in IC, previous work
has highlighted how the pharmacy profession has not been
integrated into this care setting [1, 3, 4]. This lack of
pharmacy involvement is concerning, given that various
aspects of medicines management within the IC setting
may be suboptimal .
The majority of patients in IC facilities are admitted
directly from hospital, and over 70 % of patients return
home following discharge from IC . Once home, it can
be assumed that the ongoing medicines management of
these individuals will be provided by their primary
healthcare professionals, including general practitioners
(GPs) and community pharmacists (CPs). Patients’
medication regimens are often the subject of change following a
period of care in hospital or an IC facility. Sixty percent of
patients experience five or more changes to their medicines
between admission to and discharge from hospital . It is
therefore imperative that information relating to patients’
current medications is communicated effectively to their
primary healthcare professionals to ensure continuity of
In Northern Ireland (NI), previous qualitative work
with CPs has suggested that they have a limited awareness
of, and involvement with, IC . Furthermore, it was
revealed that CPs frequently experienced challenges
relating to the communication of information at the
various healthcare interfaces. CPs described often being ‘left
out of the loop’, not only in relation to IC, but also the
communication of patients’ medication information at the
points of transfer between secondary care, IC and primary
care. In an attempt to obtain up-to-date information
relating to patients’ medications, CPs described how the
responsibility fell to them to ‘chase things up.’ Finally,
this study’s findings also suggested that CPs could ‘close
the loop’ by bridging the gap between healthcare settings,
through increased involvement in IC and services targeted
at both IC and communication across the healthcare
Ineffective communication relating to patients’
medications between healthcare settings may adversely affect
patient care [7, 8]. Efforts aimed at improving
communication may therefore minimise the potential for
medication-related harm. CPs are ideally placed to potentially
improve patient-related outcomes by facilitating seamless
care when patients are transitioning through the healthcare
Aim of the study
The aim of the present study was to further explore and
quantify the issues that emerged through the previous
qualitative investigation in order to gain a more complete
understanding of CPs’ awareness of and involvement in IC facilities
in NI and their experiences of the transfer of information at the
various existing healthcare interfaces. Additionally, this study
aimed to determine CPs’ views of the development of a
community pharmacy-IC medicines management service,
including their perceived level of confidence in their ability to
conduct tasks that may be part of such a service.
Ethical approval was obtained from the School of
Pharmacy Ethics Committee, Queen’s University Belfast.
This cross-sectional study consisted of an anonymous,
selfadministered, postal questionnaire. The questionnaire was
informed by the findings of previous qualitative work
conducted in the area  and consisted of four sections
(Fig. 1). Questions were largely formatted as either
fixedresponse options or five-point Likert scales. Two
openended questions were also included, asking respondents to
share their views of communication across the healthcare
interface and the development of a community
pharmacyIC service. The questionnaire was piloted with six
pharmacists, to assess face and content validity .
Community pharmacies were identified through the
Pharmaceutical Society of Northern Ireland (PSNI), the regulatory
and professional body for pharmacists in NI. The PSNI
provide a searchable register of pharmacists and pharmacy
premises on their website, however, pharmacists are not linked to
the pharmacy within which they practise, nor are their contact
details provided. For this reason, the questionnaire was sent by
post to every community pharmacy premises in NI (n = 539),
addressed to ‘the pharmacist in charge’. Questionnaires were
posted on two occasions, 3 weeks apart, between January and
February 2015. On the first occasion, each pharmacy was sent
a pack containing: a letter of invitation, a token incentive
(coffee sachet and biscuit), the questionnaire, and a pre-paid
return envelope. Informed consent for participation in the
study was assumed on receipt of the completed questionnaire.
Responses were entered into SPSS Version 20.0 (SPSS
Inc., Chicago, IL, USA) for analysis. Missing responses
were coded as such and omitted from the analysis. A
random sample of 10 % of the questionnaires in the electronic
database was compared against the paper questionnaires to
assess the accuracy of data entry. An error rate of 0.28 %
was revealed, and deemed acceptable. Descriptive analyses
were conducted to describe the demographics of
respondents. Responses to Likert items were analysed by
calculating the percentage agreement or disagreement to each
statement. Wilcoxon signed-ranked tests were used to
explore differences in scores for identical statements
relating to different settings (i.e. IC vs. hospital). Scores
were calculated based upon the CPs’ responses on a scale
of 1–5, where a lower score indicated a greater agreement
with a statement and vice versa. Respondents who
answered ‘don’t know’ were excluded from this analysis.
Differences were considered significant if p \ 0.05.
To determine their perceived level of confidence in their
ability (i.e. self-efficacy) to contribute to a IC service,
respondents were asked to rate their level of confidence in
their ability to provide various aspects of a hypothetical IC
service, in line with Bandura’s Social Cognitive Theory
. The response format for each of these items was a
10-point self-efficacy scale, where 1 indicated ‘cannot do
at all’ and 10 indicated ‘highly certain can do’ .
Responses to open-ended questions were entered into
Microsoft Word (2010) and analysed for emergent
themes. Verbatim quotations were used to illustrate
identified themes. All respondents were assigned a unique
identifier to ensure anonymity.
Response rate and demographics
in Table 1. Data from the PSNI relating to all registered
pharmacists in NI was obtained to allow for a demographic
comparison with the study participants. The information
available related to pharmacists working in all sectors, and
not solely CPs, who comprised 59 % of those pharmacists
registered with the PSNI in 2014.
Less than half (90; 47.4 %) of CPs either ‘agreed’ or
‘strongly agreed’ that they understood what was meant by
the term ‘intermediate care’, and fewer (70; 36.8 %)
‘agreed’ or ‘strongly agreed’ that they were aware of the
IC facilities in their area. Despite these findings, 152
(80.0 %) CPs ‘agreed’ or ‘strongly agreed’ that CPs
(generally) should have greater involvement with IC
services. A similar number (155; 81.6 %) ‘agreed’ or
‘strongly agreed’ that they (personally) would like to be
more involved with IC services (Table 2).
The majority of CPs (142; 74.7 %) were either not
providing any services to IC facilities, or were unsure if
they were providing services. Of the 46 (24.2 %) CPs who
reported that they provided services to IC facilities, the
most frequently provided service was the dispensing of
medication to patients who would regularly use their
pharmacy and were subsequently admitted to IC (41;
Communication across the healthcare interface
A total of 190 completed questionnaires were returned,
corresponding to a response rate of 35.3 %. The
demographic details pertaining to the respondents are provided
CPs were asked to indicate who would typically inform
them when a patient who regularly used their pharmacy
was admitted to IC or hospital. Figure 2 shows the
Table 1 Demographic profile
of study respondents (n = 190)
compared to all pharmacists
registered with the PSNI
(n = 2003)
a Data unavailable from the Pharmaceutical Society of Northern Ireland
Table 2 CPs’ agreement with statements regarding awareness of and involvement with intermediate care
I understand what is meant by the term ‘intermediate care’
I am aware of the intermediate care facilities in my local area
I think community pharmacists should have greater involvement with
intermediate care facilities/services
I would like to have greater involvement with intermediate care facilities/
SA strongly agree, A agree, NAD neither agree nor disagree, D disagree, SD strongly disagree, M missing
categories of informants and the proportion of CPs who
indicated that these individuals would typically notify them
of a patient’s admission.
Approximately one-third of respondents reported that
they were ‘never informed’ when a patient who used their
pharmacy was admitted to either hospital or IC. CPs
described ‘other’ informants as including ‘home-help’,
nursing home staff and pharmacy delivery drivers.
CPs were asked, in general, how frequently they would
be informed of changes made to patients’ medicines at
discharge from hospital and IC. Seventy-five (39.5 %) CPs
indicated that changes in the dose or frequency of
medicines were communicated from hospital ‘most of the
time’. Similarly, 70 (36.8 %) and 63 (33.2 %) respondents
reported that new medicines and stopped medicines,
respectively, were communicated ‘most of the time’. On
average, 36.5 % of CPs reported that changes to patients’
medication regimens (of any type) made in hospital were
communicated ‘most of the time’. Considering changes
made in the IC setting, the corresponding value was less
than half that relating to hospitals (17.4 %). Combining
both hospital and IC, only 1.2 % of CPs reported that they
Fig. 2 Main informants for the CP when a patient who used their
pharmacy was admitted to hospital or an IC facility. Key: GP general
practitioner, IC Intermediate care
11 (5.8) 79 (41.6) 34 (17.9) 53 (27.9) 12 (6.3) 1 (0.5)
9 (4.7) 61 (32.1) 28 (14.7) 78 (41.1) 12 (6.3) 2 (1.1)
64 (33.7) 88 (46.3) 29 (15.3) 8 (4.2) 0 (0.0) 1 (0.5)
63 (33.2) 92 (48.4) 26 (13.7)
0 (0.0) 1 (0.5)
received communication regarding medication changes
made ‘all of the time’.
CPs were also asked the methods by which patients’
medication information was transferred to them at
discharge from hospital or IC, in those instances when
information was indeed communicated. Respondents could
select more than one option. A telephone call was the most
frequently reported, as 156 (82.1 %) and 54 (28.4 %) CPs
indicated that they received communication via this
method from both hospital and IC, respectively. Email was
the least popular as only 17 (8.9 %) and one (0.5 %)
CP(s) indicated that they receive communications via this
method from hospital and IC, respectively.
CPs were asked to indicate their views on additional
aspects of communication across the healthcare interface.
One hundred and six (55.7 %) respondents ‘agreed’ or
‘strongly agreed’ that communication between GP
surgeries and their community pharmacy was good. However,
only 26 (13.7 %) ‘agreed’ or ‘strongly agreed’ that
communication between IC facilities and their community
pharmacy was good. Less than one in ten (9.5 %) CPs
‘strongly agreed’ with the statement: ‘At patient discharge,
the level of detail provided in medication communication
information from hospital is sufficient for my needs as a
community pharmacist.’ For IC, this figure fell to 0.5 %
For both hospital and IC settings, the vast majority of
CPs indicated that they often had to contact a GP to obtain
information relating to patients’ medication after
discharge. Only 19 (10.0 %) respondents ‘strongly agreed’
that information contained in discharge summaries from
hospitals was clearly presented. Only four (2.1 %) and one
(0.5 %) respondents ‘strongly agreed’ that information
from hospitals and IC, respectively, was communicated to
them in a timely manner. The vast majority (144; 75.8 %
and 152; 80.0 %) either ‘strongly agreed’ or ‘agreed’ that
they would like to receive more information relating to
patients’ medications at discharge from hospital and IC,
Excluding those who answered ‘don’t know’, a total of
150 (78.9 %) respondents’ views were compared in
Table 3 CPs’ agreement with statements regarding communication between community pharmacy and various healthcare interfaces
test (two tailed)
Z = -7.02, p \ 0.001
Z = -1.57, p = 0.116
Z = 6.29, p \ 0.01
Z = -4.96, p \ 0.001
Z = -4.52, p \ 0.001
Z = -2.53, p \ 0.05
Z = -2.24, p \ 0.05
SA strongly agree, A agree, NAD neither agree nor disagree, D disagree, SD strongly disagree, DK don’t know, M missing, IQR interquartile
range, GP general practitioner, IC intermediate care, CP community pharmacist
relation to the statements: ‘Overall I think the
communication between IC facilities and my community pharmacy
is good’, and ‘Overall, I think the communication between
hospitals and my community pharmacy is good’.
Significantly more CPs were in agreement with the statement in
relation to hospitals (median score 2.5; interquartile range
2.0–3.0) compared with IC facilities (median score 3.0;
interquartile range 3.0–4.0), z = -6.67, p \ 0.001.
Respondents were asked if they had any further
comments on communication across the healthcare interface.
Three themes emerged from the data: ‘left out of the loop’,
‘chasing things up’ and ‘closing the loop’. Figure 3
highlights these themes with supporting quotations from
Community pharmacy: intermediate care service
When asked about their confidence in conducting specific
tasks with patients and/or staff in IC facilities, CPs were
generally highly confident in their ability to conduct all
those suggested, as evident from the mean self-efficacy
scores for each item (Table 4), with the possible score
range being 1-10, where 1 indicated ‘cannot do at all’ and
10 indicated ‘highly certain can do’ .
CPs were then provided with a list of potential
barriers to the development of an IC service and asked to
rate each in order of importance to them. ‘Current
workload’ was rated by the majority (58; 40.0 %) of
Fig. 3 CPs’ views of
communication between the
various healthcare interfaces
"Left out of the loop"
• “..we don’t have much dealings with intermediate care facilities.” (R157)
“Communications from hospitals is still poor but has improved significantly in the
last few years. Hospitals differ in their quality of communication and better
communication between different levels of care is essential.” (R110)
“When communication takes place it is generally of high quality. Too many
patients fall through the gaps with no...information being provided.” (R51)
“Sometimes hospitals will phone us, sometimes not. Sometimes the GP gets in
touch, sometimes not. Sometimes the patient will inform us, then we have to go
on a time-consuming 'information hunt' to the GP.” (R177)
"Chasing things up"
“There are too many medication errors due to lack of communication...it happens
regularly that I am not informed of medication changes and the patient does not
recieve the change until I chase up missing scripts.” (R22)
“Usually hospital dispenses one week of medication- not always, therefore I have
to spend half a day chasing the discharge letter and new script from the GP
“Biggest problem occurs with patients who recieve mediboxes. If we're not
informed patient in hospital we don't know not to make it up. Quite often elderly
patients have limited local family support, so left entirely to us to organise scripts
[prescriptions] on discharge... the hospital expect us to do this within a a few
hours which is impossible..” (R88)
"Closing the loop"
“I think it is a very important step moving forward that community pharmacies
have access to patient medication files...It enables a more competent and full
service to the patient.” (R98)
“It is vital that pharmacists are included in this communication. We can prevent
errors with medication prescribed from GP surgery from discharge letters...and
provide info [sic] to patient on medication changes.” (R36)
“There needs to be better organisation between healthcare settings... there is not
enough information or contact between healthcare settings to allow good and
'joined up' patient care.”(R6)
respondents as the most important barrier. Despite
comviewed themselves as being ideally placed to being
ments suggesting that such a service would be
concepinvolved with IC services and/or services that would
tually viable, CPs reported that several barriers would
facilitate patients’ transitions across the healthcare
need to be addressed prior to the implementation of such
services. Reimbursement of services and the additional
staff needed in order to provide such services were
highlighted frequently by respondents. Nevertheless,
comments received from respondents indicated that CPs
Community pharmacy is ideally placed to deal with
issues in intermediate care and should have an
important role to play. (R55)
Table 4 CPs’ self-efficacy scores for a range of IC service tasks
Counseling IC patients on their medicines
Providing education to IC staff
Reconciling IC patients’ medicines
Providing prescribing advice/make
recommendations to prescribers on
appropriateness of IC patients’ medicines
[CPs] are extremely competent in providing advice
rather than just dispensing. We have a fountain of
knowledge yet rarely get to use it. (R73)
[CPs] are ideally placed to follow up on discharge
medication reviews and prevent readmission due to
medication errors. (R170)
The study highlighted a low awareness of and involvement
with IC services amongst CPs in NI. This finding is
unsurprising given the confusion surrounding the
terminology used to describe IC . Despite its presence within
the UK for over a decade, IC does not relate to a single
healthcare service or setting . However, a majority of
CPs reported willingness for the profession to have greater
involvement with IC.
The questionnaire generated a response rate of 35.3 %.
Whilst not optimal, this response rate is typical of postal
questionnaires administered to the sample population
[14–17] and the demographic profile of the respondents
was not dissimilar to that provided by the PSNI.
The dispensing of medicines to patients in IC accounted
for the majority of ‘services’ provided by CPs to IC facilities.
In recent times, pharmacists have adopted a variety of
enhanced roles, including prescribing, which reflect their
expertise surrounding medicines. Whilst not widely
implemented in IC, pharmacist prescribing has become an
increasingly commonplace practice in both primary and
secondary care settings [18, 19]. Notably, it has been shown
that patients generally regard pharmacist prescribing as an
acceptable alternative to medical prescribing [20, 21]. This
study suggests that CPs are keen to expand their professional
boundaries, however, it remains the case that the majority of
those who have acquired prescribing qualifications are
currently not using them, perhaps due to a lack of opportunities
or lack of access to clinical information in the community
pharmacy setting necessary to facilitate a prescribing role.
CPs viewed communication across the various
healthcare interfaces to be deficient. This finding reiterates that
reported in the previous qualitative study , where it was
described how CPs were not routinely informed when
patients were admitted into hospital or IC. This issue is not
unique to NI . Irrespective of the setting, only a
minority of CPs reported that they were informed of
changes to patients’ medication regimens ‘all of the time’
at discharge. This poses a risk to patients as
communication breakdown is a leading cause of adverse events at
transitions of care . Furthermore, this study provided
additional evidence of CPs ‘chasing things up’ with GPs as
a means of accessing information. This ad-hoc method is
both inefficient and potentially hazardous. In recognition of
this, there have been calls for pharmacists to have access to
patients’ records . Additionally, electronic
communication of discharge letters has been shown to facilitate the
timely transfer of information between settings [8, 25].
Both the content and level of detail contained in
communications regarding patients’ medicines was found to be
important to CPs. A study by Munday et al.  also
reported that the majority of CPs considered it necessary to
be informed of the reasons underpinning medication
changes, yet few received such information. Urban et al.
 also reported that the provision of information to
community pharmacies from hospitals regarding
medication was inconsistent and lacking in quality. By routinely
providing such level of detail, via a discharge summary,
CPs will be able to ascertain whether apparent changes
made to medicines are intentional, therefore negating the
need to ‘chase things up’.
CPs considered themselves ideally placed and capable
of providing services to IC patients and/or staff, as
evidenced by the high levels of reported self-efficacy. More
than 10 years ago, the Royal Pharmaceutical Society of
Great Britain outlined how pharmacists could contribute to
IC services . Whilst there remains a lack of
involvement from the community pharmacy sector of the
profession, there have been emerging examples of innovative
models of clinical pharmacist-led care pathways under
development in England  and NI . This study
suggests that the most pertinent barrier to CP involvement
is the existing workload that CPs currently face. Further
research should therefore aim to determine whether CP–IC
services are feasible and have the ability to improve patient
outcomes by facilitating seamless care across the
Strengths and limitations
This study has provided quantitative evidence which
further supports the findings of the previous qualitative
research [3, 4]. Whilst effortswere taken to optimise the
response rate, the low response rate achieved may limit the
generalisability of the findings. A poor awareness of IC
among CPs may itself have hindered the response rate. The
potential for differences in the respondent sample should
be acknowledged when interpreting the data, as should the
possibility of social desirability bias.
This study supports the findings of the previous qualitative
work whereby CPs in NI demonstrated a lack of awareness
of IC and the majority had no involvement with local IC
services. In the study described here, the communication of
information relating to patients’ medications between
healthcare settings was reported to be suboptimal both in
quantity and quality, particularly in relation to
communication between IC settings and community pharmacies.
CPs would like to have greater involvement with IC
services and services aimed at bridging the communication
gap between the healthcare interfaces. However, important
barriers exist that would need to be addressed prior to the
development of any service.
Acknowledgments The authors wish to thank all the pharmacists
who participated in the study.
Funding This work was supported by the Department for
Employment and Learning (DEL) Northern Ireland. No other sources of
funding were used to assist in the preparation of this study.
Open Access This article is distributed under the terms of the
Creative Commons Attribution 4.0 International License (http://crea
tivecommons.org/licenses/by/4.0/), which permits unrestricted use,
distribution, and reproduction in any medium, provided you give
appropriate credit to the original author(s) and the source, provide a
link to the Creative Commons license, and indicate if changes were
1. Millar A , Hughes C , Passmore AP , Ryan C. Intermediate care: the role of medicines management . Drugs Aging . 2014 ; 31 : 21 - 31 .
2. Department of Health. Intermediate care-halfway home-updated guidance for the NHS and local authorities . 2009 . http://ww. webarchive.nationalarchives.gov.uk/20130107105354, http://www. dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/ @pg/documents/digitalasset/dh_103154.pdf. Accessed 26 May 2016 .
3. Millar A , Hughes C , Ryan C. '' It's very complicated'': a qualitative study of medicines management in intermediate care facilities in Northern Ireland . BMC Health Serv Res . 2015 ; 15 : 216 .
4. Millar A , Hughes C , Ryan C. A qualitative study of community pharmacists' awareness of and involvement with intermediate care facilities in Northern Ireland . Eur J Pers Cent Healthc . 2016 ; 4 ( 1 ): 53 - 60 .
5. NHS Benchmarking Network . National audit of intermediate care: Summary report . 2015 . http://www.nhsbenchmarking.nhs. uk/CubeCore/.uploads/NAIC/Reports/NAICReport2015FINALA4 printableversion.pdf. Accessed 26 May 2016 .
6. Grimmsmann T , Schwabe U , Himmel W. The influence of hospitalisation on drug prescription in primary care-a large-scale follow-up study . Eur J Clin Pharmacol . 2007 ; 63 ( 8 ): 783 - 90 .
7. Coleman E. Falling through the cracks: challenges and opportunities for improving transitional care for persons with continuous complex care needs . J Am Geriatr Soc . 2003 ; 51 ( 4 ): 549 - 55 .
8. Kripalani S , Lefevre F , Phillips CO , Williams MV , Basaviah P , Baker DW . Deficits in communication and information transfer between hospital-based and primary care physicians-implications for patient safety and continuity of care . J Am Med Assoc . 2007 ; 297 ( 8 ): 831 - 41 .
9. Bolas H , Brookes K , Scott M , McElnay J. Evaluation of a hospital-based community liaison pharmacy service in Northern Ireland . Pharm World Sci . 2004 ; 26 ( 2 ): 114 - 20 .
10. Smith F. Health services research methods in pharmacy: survey research: (2) survey instruments, reliability and validity . Int J Pharm Pract . 1997 ; 5 ( 4 ): 216 - 26 .
11. Bandura A. Social cognitive theory of self-regulation . Organ Behav Hum Decis . 1991 ; 50 ( 2 ): 248 - 87 .
12. Bandura A. Guide for constructing self-efficacy scales . In: Pajares F, Urdan T , editors. Self-efficacy beliefs of adolescents. Greenwich, CT: Information Age Publishing ; 2006 . p. 307 - 37 .
13. Melis R , Parker S , Van Eijken M. What is intermediate care? An international consensus on what constitutes intermediate care is needed . Br Med J . 2004 ; 329 : 360 - 1 .
14. Barry HE , Parsons C , Passmore AP , Hughes CM . Community pharmacists and people with dementia: a cross-sectional survey exploring experiences, attitudes, and knowledge of pain and its management . Int J Geriatr Psychiatry . 2013 ; 28 ( 10 ): 1077 - 85 .
15. Hanna LA , Hughes CM . Pharmacists' attitudes towards an evidence-based approach for over-the-counter medication . Int J Clin Pharm . 2012 ; 34 ( 1 ): 63 - 71 .
16. McCann L , Hughes C , Adair CG , Carwell C. Assessing job satisfaction and stress among pharmacists in Northern Ireland . Pharm World Sci . 2009 ; 31 ( 2 ): 188 - 94 .
17. McCaw B , McGlade K , McElnay J. The impact of the internet on the practice of general practitioners and community pharmacists in Northern Ireland . Inf Prim Care . 2008 ; 15 ( 4 ): 231 - 7 .
18. Tonna AP , Stewart D , West B , McCaig D. Pharmacist prescribing in the UK-a literature review of current practice and research . J Clin Pharm Ther . 2007 ; 32 ( 6 ): 545 - 56 .
19. Emmerton L , Marriott J , Bessell T , Nissen L , Dean L. Pharmacists and prescribing rights: review of international developments . J Pharm Pharm Sci . 2005 ; 8 ( 2 ): 217 - 25 .
20. Stewart DC , George J , Bond CM , Diack HL , McCaig DJ , Cunningham S. Views of pharmacist prescribers, doctors and patients on pharmacist prescribing implementation . Int J Pharm Pract . 2009 ; 17 ( 2 ): 89 - 94 .
21. McCann LM , Haughey SL , Parsons C , Lloyd F , Crealey G , Gormley GJ , Hughes CM. A patient perspective of pharmacist prescribing: ''crossing the specialisms-crossing the illnesses'' . Health Expect . 2015 ; 18 : 58 - 68 .
22. Oborne A , Dodds L. Seamless pharmaceutical care: the needs of the community pharmacist . Pharm J . 1994 ; 253 : 502 - 6 .
23. Forster A , Murff H , Peterson J , Gandhi T , Bates D. The incidence and severity of adverse events affecting patients after discharge from the hospital . Ann Intern Med . 2003 ; 138 ( 3 ): 161 - 7 .
24. Royal Pharmaceutical Society. Pharmacist access to the Patient Health Record . 2015 . http://www.rpharms. com/policy-pdfs/ patient-health-record-2015 .pdf. Accessed 26 May 2016 .
25. O'Leary KJ , Liebovitz DM , Feinglass J , Liss DT , Evans DB , Kulkarni N , Landler MP , Baker DW . Creating a better discharge summary: improvement in quality and timeliness using an electronic discharge summary . J Hosp Med . 2009 ; 4 ( 4 ): 219 - 25 .
26. Munday A , Kelly B , Forrester J , Timoney A , Mcgovern E. Do general practitioners and community pharmacists want information on the reasons for drug therapy changes implemented by secondary care? Br J Gen Pract . 1997 ; 47 ( 422 ): 563 - 6 .
27. Urban R , Paloumpi E , Rana N , Morgan J. Communicating medication changes to community pharmacy post-discharge: the good, the bad, and the improvements . Int J Clin Pharm . 2013 ; 35 ( 5 ): 813 - 20 .
28. Burke S , Neilson E. Pharmacists and the new intermediate care agenda . London: Royal Pharmaceutical Society of Great Britain ; 2002 .
29. Amin H , Dave K , Barnett N. Ways clinical pharmacists can add value in intermediate care settings . Clin Pharm . 2011 ; 3 : 378 - 9 .
30. Miller R , Darcy C , Friel A , Scott M , Toner S. Consultant pharmacist case management of older people in intermediate care: a new innovative model . Eur J Pers Cent Healthc . 2016 ; 4 ( 1 ): 46 - 52 .