The Rural Pharmacy Practice Landscape: Challenges and Motivators

Journal of Multidisciplinary Healthcare Dovepress open access to scientific and medical research Journal of Multidisciplinary Healthcare downloaded from https://www.dovepress.com/ by 222.110.97.79 on 17-Jun-2020 For personal use only. Open Access Full Text Article ORIGINAL RESEARCH The Rural Pharmacy Practice Landscape: Challenges and Motivators This article was published in the following Dove Press journal: Journal of Multidisciplinary Healthcare Catherine A Hays Selina M Taylor 1 Beverley D Glass 2 1 1 Centre for Rural and Remote Health, James Cook University, Mount Isa, Queensland, Australia; 2Pharmacy, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia Background: Health outcome delivery for rural and remote Australian communities is challenged by the maldistribution of the pharmacy workforce. High staff turnover rates, reduced pharmacist numbers, and reliance on temporary staff have placed great strain on both state health services and rural community pharmacies. However, recent changes to the demographic profile of the rural pharmacist including a lower average age and increased time spent in rural practice highlights a more positive future for the delivery of better health outcomes for rural communities. The aim of this study was to investigate the factors that motivate and challenge pharmacists’ choice to practice rurally. Methods: Rural pharmacists were invited to participate in semi-structured interviews using purposive non-probability sampling. Twelve pharmacists were interviewed with early-, middle- and late-career pharmacists represented. Participants described their experiences of working and living in rural and remote locations. Three themes emerged: workforce, practice environment and social factors, which were examined to determine the underlying challenges and motivators impacting rural and remote pharmacy practice. Results: Lack of staff presented a workforce challenge, while motivators included potential for expanded scope of practice and working as part of a multidisciplinary team. While social isolation has often been presented as a challenge, an emerging theme highlighted that this may no longer be true, and that notions of “rural and remote communities as socially isolated was a stigma that needed to be stopped”. Conclusion: This study highlights that despite the challenges rural pharmacists face, there is a shift happening that could deliver better health outcomes for isolated communities. However, for this to gain momentum, it is important to examine both the challenges and motivators of rural pharmacy practice to provide a platform for the development and implementation of appropriate frameworks and programs to better support the rural pharmacy workforce. Keywords: pharmacy, workforce, rural and remote, health outcomes Introduction Correspondence: Catherine A Hays Centre for Rural and Remote Health, James Cook University, PO Box 2572, Mount Isa, Queensland 4825 Australia Tel +61 7 4745 4500 Fax +61 7 4749 5130 Email 227 submit your manuscript | www.dovepress.com Journal of Multidisciplinary Healthcare 2020:13 227–234 DovePress © 2020 Hays et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). http://doi.org/10.2147/JMDH.S236488 Powered by TCPDF (www.tcpdf.org) There has, for many years, been a shortage of pharmacists in rural and remote Australia,1–3 with only 7.8% of Australian pharmacists working outside major cities or inner regional areas, as reported in 2017.4 In addition to being one of the most frequently consulted health professionals in Australia, pharmacists are often the first contact for primary health, especially in rural areas.5,6 Due to limited accessibility of health care in these isolated communities, rural pharmacists play an essential role in rural communities, often providing an expanded scope of pharmacy and health-care services compared to their metropolitan counterparts, including health promotion and education, Dovepress Journal of Multidisciplinary Healthcare downloaded from https://www.dovepress.com/ by 222.110.97.79 on 17-Jun-2020 For personal use only. Hays et al vaccinations, and disease screening and management.5,7 However, there are currently no specific programs in Australia for rural pharmacy to play an enhanced role. Despite an increase in pharmacists reported in Australia, analysis of global workforce capacity trends from 2006 to 2012, the authors mentioned that an increase in workforce density does not necessarily describe distribution.8 This has implications for accessibility, as health-care professionals generally tend to gravitate to urban rather than rural areas. It is therefore questioned whether the predicted over supply of pharmacists in Australia by 2025, will address the current maldistribution of pharmacists.1–4 A demographic profile of a rural and remote pharmacist in Australia was identified by Smith et al in 2013, which places these pharmacists as 15 years older than the national average, over 50% from a rural background with an even gender distribution.1 Rural pharmacists have expressed satisfaction with their role, giving reasons such as a rewarding and close relationships with their patients, lifestyle, business opportunity and financial incentives to practice rurally.9 On the negative side, balancing workload with lifestyle, and family commitments, professional isolation and some financial constraints have been put forward as being challenging.9,10 Taylor and Glass recently published on the influence of curriculum and clinical placements on pharmacists’ choice to practice rurally, where they found that rural placements had a significant impact, while the curriculum had little effect.11 There also appears to have been a shift in the demographic profile of the rural pharmacist from 2013, with 65% being female, which more accurately reflects the current gender distribution of pharmacists in Australia.11 This together with the fact that over 60% of the respondents were in the age group 25–45 years, having spent over 6 years in rural practice, signals a more positive future for the delivery of better health outcomes for rural communities.11 This is aligned with previous findings that rural lifestyle influences the decision to practice rurally. However in contrast to the findings by Smith et al in 2013, a rural origin was not found to be a significant determinant of choosing to (...truncated)