Expanded practice in rural community pharmacy: a macro-, meso and micro-level perspective

Introduction: Expanding community pharmacists' scope of practice, in rural and remote locations has the potential to improve access to health care and health outcomes. Internationally, a lack of support from other health professionals (HPs) has presented a barrier to the uptake of expanded pharmacy models. Rural allied health workers, including pharmacists, however, already work across an extended scope using generalist and specialist skills to meet unique community needs with limited infrastructure for support. Limited data on expanded practice from Australia prompted this study to explore Australian rural and remote doctor, nurse and allied health perspectives of expanded pharmacy services in non-metropolitan settings. Methods: An ethnographic lens of rural culture was applied to this descriptive qualitative study. Semi-structured, in-depth interviews were conducted with HPs working in rural and remote locations in Australia. Inductive and deductive thematic analysis was guided by a multi-level lens of macro- (policy level), meso(HP level) and micro- (consumer and community level) perspectives. The World Health Organization (WHO) framework for integrated people-centred health services provided strategies to align to the theoretical framework for the analysis. Results: Twenty-three rural and remote HPs (doctors (8), nurses (4), allied HPs (11)) participated. Key themes identified included supportive government and funding provisions (macro); collaboration with other health providers (meso); ensuring pharmacists have the required knowledge, skills, quality assurance and safety measures in place (meso); pharmacists' capacity, including time and space (meso); and opportunity to empower and engage consumers through rural community pharmacies (micro). Conclusion:As pharmacists internationally continue to develop their expanded scope of practice, these results provide the first evidence for Australian rural pharmacists to consider when planning for and developing expanded practice models. Recognition of challenges and motivators for pharmacists' expanded practice are highlighted. Engagement of both government and rural health providers is seen as crucial for expanded models of pharmacy practice to evolve to deliver improved health outcomes for rural and remote communities.