Practitioners express a positive attitude but encounter challenges related to limited knowledge, confidence, practice opportunities, time constraints, professional competence, and reimbursement issues in delivering home pharmacy services. Additionally, a disparity exists between practitioners' perceived services and patient expectations. Notwithstanding governmental initiatives, the absence of a standardized system hampers the implementation of home pharmacy services, necessitating ongoing adaptations.
4.1 Discrepancies Between Policy and Practice
In recent years, the Chinese government has introduced various policies to promote home pharmacy services and integrate them into the practice of family doctor teams. However, the low percentage of practitioners (19.8%) and patients (5.8%) actively engaging in or receiving these services in our study indicates that they have not received sufficient attention and are not yet considered standard practice [21, 22]. Similarly, a study in the United States found that community pharmacists allocate 72% of their time to dispensing and business management, leaving only 28% for consultation and drug use management [23]. In the Netherlands, community pharmacists spent only 14.2% of their time on advanced pharmaceutical cognitive services [24]. Despite the consensus on the crucial role of community pharmacists in providing patient-centered care, they are often limited to their traditional roles, such as drug supply, dispensing, compounding, and management [25, 26]. This discrepancy is potentially linked to human resource constraints and the absence of proper compensation for pharmacists’ efforts invested in offering more advanced services like patient consultation [27], which undermines their motivation to a considerable extent [28, 29]. Therefore, it is essential to consider establishing a sustainable reimbursement model for pharmacy services in China, as in the United States ($5 per prescription) [30], Canada ($19 per clinical service) [31], and Germany (EUR 90 per 80 min) [32]. Such a model would not only incentivize practitioners but also enhance the quality and coverage of pharmacy services.
4.2 Key Players in Home Pharmacy Services
Interdisciplinary collaboration in home pharmacy services has been validated, as indicated by a majority of patients (42.4%) favoring the pharmacist-physician model in our study. Collaborative initiatives among pharmacists, physicians, and nurse practitioners have yielded positive outcomes, including improved decision-making, continuity of care, and patient safety [33, 34]. In the United States, pharmacists significantly reduce hospital readmission rates by 25%-50% through integrated pharmaceutical services within healthcare teams [35]. The successful transition of pharmacists from drug compounding and dispensing to patient care has been widely observed [36]. In the United Kingdom, pharmacists actively participate in medication reviews (91.4%) and management of polypharmacy cases (84.0%) [37]. Consequently, patients and practitioners have high expectations of pharmacists [38, 39], with over 70% of practitioners recognizing the necessity for home-visiting services [40].
Furthermore, clinical pharmacy services benefit elderly populations prone to comorbidity and polypharmacy [41, 42]. Community pharmacists catering to elderly patients living at home achieve substantial reductions in non-adherence rates (38–14%) and drug-related problems (94–58%) (P < 0.001) [43]. Considering that China's disabled elderly population is projected to surpass 77 million by 2030, harnessing the potential of pharmacists becomes imperative to provide optimal care and alleviate the growing burden on the healthcare system [44].
4.3 Challenges in Professional Capacity
Community pharmacists have shown a strong interest in pharmacy practice [45–47]. However, our study found that less than one-third of practitioners feel confident in providing these services. In China, concerns have been raised regarding the declining education levels and insufficient professional capacity among community pharmacists. Between 2014 and 2020, only one-third held postgraduate or bachelor's degrees [48, 49]. Similar situations have been observed in other countries as well, where a large proportion of community pharmacy clients lack adequate medication knowledge [50, 51], leading to low confidence.
Of the surveyed practitioners, 43.2% identified their institutions' failure to offer or mandate home pharmacy services as a challenge, while 15.9% cited conflicts with their regular work schedules. The absence of established routines and time constraints presents significant barriers for pharmacists to conduct post-discharge home visits [52]. Inadequate training [53, 54], limited recognition from physicians [55], and poor staff support [56] are perceived as additional hurdles. Training emerges as the top incentive, playing a crucial role in improving research motivation and professional capacity [57, 58], consistent with previous systematic review findings [59].
4.4 Limitations
This study has several limitations that should be acknowledged. Firstly, the study was geographically confined to Shanghai, which may limit the generalizability of the findings to other regions in China. Future research should aim to include a larger and more diverse sample to capture regional and demographic variations. Secondly, data were collected through self-reported questionnaires, which may introduce biases related to differences in respondents' accuracy and completeness of recollection. Also, as a pilot study, some aspects were not fully explored, such as the privacy and security of patients’ health information, which may be handled by multiple individuals in an interdisciplinary model [60–63]. Despite these limitations, this study presented innovative insights based on real-world data, quantitatively analyzing the perceptions, attitudes, and demands of both patients and practitioners regarding home pharmacy services. We also identified and underscored the importance of addressing the existing barriers and challenges in service delivery, potentially providing valuable references for policymakers, practitioners, and researchers in this field.