Pharmacists interpretation of public health competencies for practice

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Pharmacists interpretation of public health
competencies for practice

• McHattie, L.W., Diack, H.L., Pfleger, D.E.,
  McCaig, D.J. and Stewart, D.C.

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Previous research

• Presented in 2007 and 2008
• Specialists in Pharmaceutical Public Health
  (Delphi study)
• Use National Standards to identify education and
  training needs
• Community pharmacists (postal survey)
• Consider they do only half of the full range of
  public health framework

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Follow up research

• Is Community Pharmacists perception of practice
  accurate?
• How can we investigate this from a
  participant-centred approach?
• Challenges to study recruitment Regulatory
  changes and associated survey fatigue

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Aim

• To investigate community pharmacists
  interpretation of Public Health Practice national
  occupational standards in relation to workplace
  practices
• Skills for Health and Public Health Research
  Unit 2009

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Background 2008

• Identification through Community Pharmacy
  registration mailing lists
• Random selection by Chief Pharmacists
• N40 in each of Glasgow and Grampian Health Board
  areas
• Failed recruitment for focus groups of
  non-specialist community pharmacists in 2008
• Response rate 3/80 4!

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What is a Vignette?

• A vignette is a short description of a person or
  a social situation which contains precise
  reference to what are thought to be the most
  important factors in the decision-making or
  judgement-making processes of respondents.
• ALEXANDER, C.S. and BECKER, H.J., 1978. The use
  of vignettes in survey research. Public opinion
  quarterly, 42(1), pp. 4

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Why Vignette methodology?

• Qualitative methods unreliability
• Quantitative force participants to make
  pre-determined choices
• Vignette mixes both approaches with improved
  reliability and less information bias

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Vignette methodology

• Participants are given a scenario upon which to
  build their responses, or
• Develop a scenario in response to a question eg
  Describe how you would respond to ..
• The scenario is built by group consensus
• Detail is added until the group decide saturation
  is reached

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Vignette discussion
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Pilot

• In-house community pharmacists (n4)
• 2 public health outbreaks
• Head-lice
• Food poisoning
• Explain how you would
• Identify a potential outbreak
• Take action to control the outbreak

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Pilot

• Results
• 2 scenarios too confusing
• Matching process too time-consuming
• Changes
• Use head-lice scenario only common
• Use numbering of competence areas
• Use Skills for Health headings as guide for
  participants

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Amended protocol

• Participants
• Community pharmacy champions
• Grampian and Lothian
• Start with motivated practitioners
• One group in each area (n10 x2)
• Governance
• Ethical approval
• RGU Research Committee
• NOSREC full ethical application not required

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Recruitment

• Electronic
• Covering letter and information sheet
• Acceptance of participation to PI
• Disseminated by Pharmacy Champions co-ordinator
• Lunch provided
• Research meeting after/before scheduled Health
  Board meeting

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Skills for Health framework
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Overview of Core Competence

• Surveillance and assessment of the population's
  health and wellbeing
• Assessment of the populations health and
  wellbeing, including managing, analysing,
  interpreting and communicating information that
  relates to the determinants of health and
  wellbeing, needs and outcomes.

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Performance Criteria

• Surveillance and assessment of the population's
  health and wellbeing
• 1. Collect and collate routine data on health and
  wellbeing and needs using a range of tools and
  techniques
• 2. Analyse routine data on health and wellbeing
  and needs using basic analytical techniques
• 3. Collect and collate non-routine data on health
  and wellbeing and needs that is specific to own
  area of expertise or practice, using specified
  methods and tools
• 4. Analyse non-routine data on health and
  wellbeing and needs that is specific to own area
  of expertise or practice, using basic analytical
  techniques
• 5. Interpret data on health and wellbeing within
  own area of expertise or practice
• 6. Communicate and disseminate findings on the
  health and wellbeing of a population to others.

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Key elements

• Collecting data, collating data, analysing data,
  interpreting data
• Making recommendations based on data
• Identifying areas and mechanisms for data
  collection
• Implementing recommendations
• Overseeing implementation of recommendations

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Methods

• Hand written notes (facilitator)
• Observation of group
• responses and dynamics
• Digital recording of session
• Annotated transcription
• of responses (during break)
• Disseminated back to group
• to verify for accuracy/ comment

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Methods matching process

• Tagging of activities with competences
• Annotated transcriptions of scenario
• Skills for Health framework
• Matched by
• Individual
• Group
• Assessor (independent, SVQ assessor) in separate
  room
• Discussion between group and assessor to consider
  perception analysis

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Vignette
Wed phone other pharmacies in our area to see
if they had the same problem. If they said Yes,
wed probably see if the area affected was larger
than just one school
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Results

• Grampian 7 in attendance
• N5 completed forms
• Lothian 8 in attendance
• N4 completed forms
• Participants who left early part-completed forms,
  but were not included in analysis

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Analysis

• Competences numbered 1-9 with sub headings
• Individual matches entered into SPSS
• Frequencies collated for each group to give a
  group response
• Where group frequency was gt 50 this was entered
  as a positive response to practice criteria
• Assessor judgement was dichotomous for each
  criteria/group

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Results We dont do.
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Skills for Health framework
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Results Dont do.
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Results Dont do.
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Comparisons

• Group 1
• Pharmacists consider they do
• 16/36 practice areas
• Assessor considers they do
• 21/36 practice areas

• Group 2
• Pharmacists consider they do
• 33/36 practice areas
• Assessor considers they do
• 13/36 practice areas

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Limitations

• Small sample size
• Public Health specialists
• 2 Health Board areas
• One assessor
• Innovative methodology
• How representative?

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Conclusions

• Community pharmacists
• Do NOT consider themselves to be
• Leaders
• Involved in research
• Involved in policy development  
•  
• Are 'doing' surveillance, although according to
  our previous research they claimed not to be
• Report working largely in a vacuum, with little
  partnership working within the community.

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Conclusions

• Community pharmacists should be operating at
  level 5 in terms of public health practice.
• They appear to be operating at level 4 in some
  areas and level 3 for others

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Where do we go from here?

• Implications for rolling out public health policy
  
•  
• Larger study
• Community pharmacists (non-specialists)
• Inform policy makers
• Use vignettes in public health teaching
• Refer to National Standards in service
  development