Investigating the implementation of reimbursed Community Pharmacy Services in German Community Pharmacies

Background: In June 2022 five different community-pharmacy-services got reimbursable for German community pharmacies. Aim of the Study: In our study we aimed to investigate the implementation of the reimbursed community- pharmacy-services in German community pharmacies. Methods: Therefore we created an online survey, that has been distributed to all community pharmacies nationwide by the chambers of pharmacists. In this study we included pharmacies with and without offer of reimbursed community-pharmacy-services. We asked about the implementation of the services (i), barriers to the implementation (ii), solving strategies to overcome these barriers (iii) and future perspectives and wishes (iv) of the community pharmacies. Results: 218 pharmacists from community pharmacies all over Germany participated, including 176 pharmacists working in offering and 42 in non-offering pharmacies. (i) Most of the offering pharmacies offered blood pressure control in hypertension (94%), assuring proper inhalation techniques for patients receiving a new device or a device change (92%) and medication review for patients with polymedication (89%). Medication review with follow-up for patients taking immunosuppressants post-transplantation (13%) or for patients taking oral anticancer drugs (18%) has been offered by fewest. (ii) Barriers for the implementation have been a lack of time (median 47.5%) and pharmaceutical staff (median 40.5%), high documentation requirements (median 48%) and letting patients fill in the privacy-policy (median 37.5%). Especially for the three services concerning medication review pharmacists reported communicating with physicians (median 33.5%) and the fear of competing with physicians (median 27.5%) as one of the main barriers in implementing these services. (iii) To overcome these barriers mainly offering pharmacists developed standardized procedures (median 34%), promoted the community-pharmacy-services (median 31%) and took advanced trainings (median 42%). (iv) Despite these barriers two of three pharmacists can imagine offering community-pharmacy-services in their pharmacies in the future. Regarding the future perspectives, again medication review with follow-up for patients taking immunosuppressants post-transplantation or for patients taking oral anticancer drugs are much less likely to be offered. To increase the number of community-pharmacy-services offered, the participating pharmacists wished for less bureaucracy (median 58.5%) and support in communication with patients (median 24%) and physicians (median 24.5%). Conclusion: In conclusion we found that although many German pharmacies already offer reimbursed community-pharmacy-services, there are still strong barriers to widespread implementation. Therefore a deeper understanding of the barriers to implementation and the wishes of the community pharmacies is needed so that patients can benefit fully from the advantages of these services in the long term.