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The impact of population ageing is significant, multifaceted and characterised by frailty and multi-morbidity. The COVID-19 pandemic has accelerated care pathways and policies promoting self-management and home-based care. One under-researched area is how patients and family caregivers manage the complexity of end-of-life therapeutic medicine regimens. In this position paper the authors bring attention to the significant strain that patients and family caregivers experience when navigating and negotiating this aspect of palliative and end-of-life care.

Focussing on self-care and organisation of medicines in the United Kingdom (UK) context, the paper examines, builds on and extends the debate by considering the underlying policy assumptions and unintended consequences for individual patients and family care givers as they assume greater palliative and end-of-life roles and responsibilities.

Policy makers and healthcare professionals often lack awareness of the significant burden and emotional work associated with managing and administering often potent high-risk medicines (i.e. opioids) in the domiciliary setting. The recent “revolution” in professional roles associated with the COVID-19 pandemic, including remote consultations and expanding community-based care, means there are opportunities for commissioners to consider offering greater support. The prospect of enhancing the community pharmacist's medicine optimisation role to further support the wider multi-disciplinary team is considered.

The paper takes a person-focused perspective and adopts a holistic view of medicine management. The authors argue for urgent review, reform and investment to enable and support terminally ill patients and family caregivers to more effectively manage medicines in the domiciliary setting. There are clear implications for pharmacists and these are discussed in the context of public awareness, inter-professional collaboration, organisational drivers, funding and regulation and remote care delivery.

The main purpose of this exploratory study is to investigate the attitude of pharmacists, as small- and medium-sized enterprise (SME) owners, toward new technologies, and more precisely, toward the adoption of mobile apps for mobile health (mHealth). Such apps are generally used to improve customer satisfaction and loyalty. This study measures pharmacists’ subjective experiences of mobile apps for mHealth and aims to understand how these pharmacists make sense of these apps.

The study adopted the narrative inquiry technique combined with critical event analysis. Participants' experiences were categorized based on how they viewed new technology tools. Interpretative inductive analysis identified precise aspects of the sense making illustrative of non-adoption or confused adoption of new technologies by pharmacists.

This study investigates to what extent new technology tools such as mobile apps affect retailers and more precisely the reasons why mobile apps are and are not adopted by retailers, as potential users, in the pharmaceutical industry. We identified four aspects of sense making that illustrated non-adoption or confused adoption of new technologies by pharmacists. These aspects are deeply discussed in the paper and are referred to the dimensions of confusion to confidence; suspicion to trust; frustration to education; mistrust to cooperation.

The main limitation of the present study is the limited number of territories investigated. This limitation arose because of the exploratory nature of the available research, which is generally based on case studies, and the lack of clear operationalization of the research available at the time of data collection. Another limitation is that the sample included only SMEs operating in the Italian pharmacy industry.

Many studies have highlighted the opportunities related to new mobile apps in the business-to-business market. Several have investigated customer interest in such new technology. If some contributions have indirectly investigated the acceptance of information technology tools, to the best of our knowledge, no study has been conducted to investigate directly and precisely the level of pharmacists' acceptance, use, and willingness to adopt information technology (e.g., mobile apps) for customer service in mHealth and mainly the reasons of non-adoption.

This study aims to explore the downstream pharmaceutical supply chain (PSC) and provides insight to the delivery process of medicines and associated operational inefficiencies.

An exploratory, qualitative approach was adopted to examine PSC inefficiency within two European contexts, namely, the UK and Greece. Data was gathered through interviews and a thematic analysis conducted to analyse the data and identify challenges faced by both supply chains(SCs).

The medicines delivery system needs to be enhanced in terms of quality, visibility, speed and cost to perform effectively. The findings demonstrated that although the healthcare SCs in the two European contexts have different operational structures, the results are in concordance with each other. Financial, communication, waste and complexity issues were the major concerns.

To the knowledge this is the first study to examine aspects of the medicines SC via a cross-case analysis in the UK and Greece and extends the body of knowledge. A broader sample of responses is warranted to further validate these findings.

The study outputs can inform pharmacies’ strategic to instigate targeted improvement interventions. The implications of which may be extrapolated further to other European healthcare organisations.

This research contributes to the academic literature by adding further theoretical insights to SC strategy development, especially those that have been characterised as highly complex. The study identifies four key areas of intervention needed within this SC (in both countries) to promote higher level efficiencies and effectiveness.

The purpose of this paper is to determine patient expectation and perception of pharmaceutical care services in order to measure the level of patient satisfaction provided by Indonesia’s health coverage (IHC) system.

A patient satisfaction survey was conducted at primary-level and secondary-level health facilities operating under IHC system. The assessment was performed using a closed-ended questionnaire that had been tested for validity and reliability. The patients’ point of view was evaluated based on their expectation and perception of six dimensions of the pharmaceutical care services they had received. Patient satisfaction was calculated based on the gap between their expectation and their perception.

A total of 602 patients participated in this research. The levels of the patients’ expectation of the pharmaceutical care services provided at primary-level health facilities range from high (3.39) to very high (3.54), whereas at secondary-level health facilities, the range was from low (2.04) to very high (3.75). This indicates that patients have a higher expectation of the provided pharmaceutical care services compared to the actual experience of the healthcare services that they received, resulting in a low value in the measurement of patient satisfaction levels.

The high level of patient expectation is an opportunity for pharmacists at both primary-level and secondary-level health facilities to continue developing pharmaceutical care services. Improving drug information service, patient counseling and reducing patient waiting time can be good ways to increase patient satisfaction within pharmaceutical care services.

A range of strategies to improve pharmaceutical care has been implemented by population health management (PHM) initiatives. However, which strategies generate the desired outcomes is largely unknown. The purpose of this paper is to identify guiding principles underlying collaborative strategies to improve pharmaceutical care and the contextual factors and mechanisms through which these principles operate.

The evaluation was informed by a realist methodology examining the links between PHM strategies, their outcomes and the contexts and mechanisms by which these strategies operate. Guiding principles were identified by grouping context-specific strategies with specific outcomes.

In total, ten guiding principles were identified: create agreement and commitment based on a long-term vision; foster cooperation and representation at the board level; use layered governance structures; create awareness at all levels; enable interpersonal links at all levels; create learning environments; organize shared responsibility; adjust financial strategies to market contexts; organize mutual gains; and align regional agreements with national policies and regulations. Contextual factors such as shared savings influenced the effectiveness of the guiding principles. Mechanisms by which these guiding principles operate were, for instance, fostering trust and creating a shared sense of the problem.

The guiding principles highlight how collaboration can be stimulated to improve pharmaceutical care while taking into account local constraints and possibilities. The interdependency of these principles necessitates effectuating them together in order to realize the best possible improvements and outcomes.

This is the first study using a realist approach to understand the guiding principles underlying collaboration to improve pharmaceutical care.

The purpose of this study is to identify best practices for innovative primary care models and to describe a potential future primary care (PC) model for Texas to address the burden of chronic disease in a population-based approach.

A systematic literature review was conducted and identified 1,880 published records through PubMed using 26 search terms. After abstract and full-text review, 70 articles remained as potential models.

Although there is already a severe shortage of physicians in Texas, emerging practice patterns and choices among physicians are likely to erode access to primary care services in the state. Health-care leaders are encouraged to consider models such as complex adaptive systems for team-based care, pharmacist hypertension care management program and combined nurse-led care management with group visit structure.

As with any study, this research has its limitations; for example, models that might work in one state, or under a unique state-funded academic medical center, might not be “do-able” in another state within the nuances of a different funding mechanism.

Results of this research provide a model for implementing IPCM for the state of Texas first and will guide IPCM planning and implementation in other states.

This study is “land grant-centric” and focused on carrying out the mission of a major, top-tier research university with an emerging college of medicine at an academic medical center.

There is more to primary care than solely medical and nursing services. Models of Child Health Appraised (MOCHA) explored the role of the professions of pharmacy, dental health and social care as examples of affiliate contributors to primary care in providing health advice and treatment to children and young people. Pharmacies are much used, but their value as a resource for children seems to be insufficiently recognised in most European Union (EU) and European Economic Area (EEA) countries. Advice from a pharmacist is invaluable, particularly because many medicines for children are only available off-label, or not available in the correct dose, access to a pharmacist for simple queries around certain health issues is often easier and quicker than access to a primary care physician or nursing service. Preventive dentistry is available throughout the EU and EEA, but there are few targeted incentives to ensure all children receive the service, and accessibility to dental treatment is variable, particularly for disabled children or those with specific health needs. Social care services are an essential part of health care for many extremely vulnerable children, for example those with complex care needs. Mapping social care services and the interaction with health services is challenging due to their fragmented provision and the variability of access across the EU and EEA. A lack of coherent structure of the health and social care interface requires parents or other family members to navigate complex systems with little assistance. The needs of pharmacy, dentistry and social care are varied and interwoven with needs from each other and from the healthcare system. Yet, because this inter-connectivity is not sufficiently recognised in the EU and EEA countries, there is a need for improvement of coordination and with the need for these services to focus more fully on children and young people.

This paper aims to examine lean thinking in medical commodities supply chains by considering its applications and success factors. It determines the drivers and wastes of medical commodity supply chain, and the existing lean tools and practices together with their application in the supply chain processes. The paper also examined the challenges and success factors for effective lean application in the medical commodities supply chains.

The study used qualitative approaches, in-depth interviews and focus group discussions with key informants to form the basis for data collection. Through thematic analysis, the collected data were analyzed by developing themes reflecting the objectives of the study.

The main drivers for waste associated with the supply chain were demand management, supplier development, institutional framework and governance. The wastes were observed at the level of inventory, operation costs, transaction costs, delays in terms of service, commodity delivery time and quality. Digitalization, information technology and standardization were the tools for medical supply chain. Poor infrastructure, unreliable internet supply, environmental uncertainty and poor management support were challenges to realizing an effective supply chain.

Although the qualitative approach used in the study provides detailed information, a quantitative study covers a larger sample for generalization.

Capacity building and professionalism should be given a priority because the philosophy of lean focuses on waste removal and continuous improvement, which highly depends on the quality of human resource (Brito et al., 2020). Limited human resource capabilities in supply chain management will, therefore, result into poor operational efficiency, which are wasted. Moreover, systems interoperability is key waste minimization and, therefore, demands interventions.

The government under the Ministry of Health and other key sector ministries such as local and regional governments should better understand the role of the waste drivers and adopt system-wide reforms to support improvements to remove waste in the medical supply chain. For example, the current institutional framework creates an administrative block and hence leads to wastes. This bureaucratic procedure should be removed to minimize wastes along the chain.

This study is among the first studies to determine applicability and implementation of lean in a resource-constrained context. The paper identifies contextual factors for lean implementation. This paper focused on a holistic view of the entire supply chains to enhance a well-functioning supply chain in delivering health commodities.

Bureaucracy to a large extent entrenches orderliness and productive means of achieving goals in both public and private organisations across the world. However, bureaucracy is not suitable in the management of hospitals due to its peculiar nature of operations. This study investigates the conundrum of bureaucratic processes and health-care service delivery in government hospitals in Nigeria.

The study surveyed 600 outpatients and attendees visiting tertiary and government hospitals in Nigeria using descriptive design to obtained data from the respondents. A research instrument, questionnaire, was used to gather data. Out of the 600 outpatients visiting the 20 hospitals in government and tertiary hospitals, 494 responses were returned from the attendees. The study employed random sampling strategy to collect the information.

The findings of this study were that service delivery in government hospitals were in adverse position on all the four constructs of bureaucratic dimensions as against quality of service delivery in hospitals in Nigeria. It discovered that bureaucratic impersonality cannot impact on the quality of service delivery in government hospitals in Nigeria. Separation and division of labour among health workers have no significant effect on quality service delivery in government hospitals. Formal rules and regulations (administrative procedure, rules, and policies) prevent quality service delivery in government hospitals in Nigeria. Also, patient’s waiting time was not significant to the quality of service delivery in government hospitals.

The results are constrained with dimensions of bureaucratic processes. Thus, the implication of this study is that bureaucracy in the Nigerian public hospitals is an unnecessary marriage which should be carefully separated and de-emphasised for quality service delivery in the hospitals to thrive.

Largely, this study is practical essential as it unearths the irrelevant operations procedure that hinder progress in Nigerian hospitals.

The study accomplishes recognised importance to survey how bureaucracy impedes quality service delivery in government hospitals. This study has provided a vital clue to elements that will bring rapid attention to patients’outcome in Nigerian hospitals and health-care facilities which hitherto has not been emphasised. The study has contributed to the existing body of knowledge associated to healthcare service quality in developing country.

This study aims to determine the factors and dynamic systems behaviour of essential medicine stockout in public health-care supply chains. The authors examine the constraints and effects of mental models on medicine stockout to develop a dynamic theory of medicine availability towards saving patients’ lives.

This study uses a mixed-method approach. Starting with a survey method, followed by in-depth interviews with stakeholders within five health-care supply chains to determine the dynamic feedback leading to stockout and conclude by developing a network mental model for medicines availability.

The authors identified five constraints and developed five case mental models. The authors develop a dynamic theory of medicine availability across cases and identify feedback loops and variables leading to medicine availability.

The need to include mental models of stakeholders like manufacturers and distributors of medicines to understand the system completely. Group surveys are prone to power dynamics and bias from group thinking. This survey’s quantitative output could minimize the bias.

This study uniquely uses a mixed-method of survey method and in-depth interviews of experts to assess the essential medicine stockout in Nigeria. To improve medicine availability, the authors develop a dynamic network mental model to understand the system structure, feedback and behaviour driving stockouts. This research will benefit public policymakers and hospital managers in designing policies that reduce medicine stockout.