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      Providing care to marginalised communities: a qualitative study of community pharmacy teams

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          Abstract

          Background

          Health inequalities in the UK are widening, particularly since the COVID-19 pandemic. Community pharmacies are the most visited healthcare provider in England and are ideally placed to provide and facilitate access to care for those most disadvantaged.

          Aim

          To explore the experiences and needs of community pharmacy teams in providing care for marginalised groups and how this has changed since the COVID-19 pandemic.

          Design and setting

          A qualitative study in community pharmacy and across primary care.

          Method

          Semi-structured interviews were undertaken with members of community pharmacy teams, primary care network (PCN) pharmacists, GPs, and nurses in the North of England.

          Results

          In total, 31 individuals participated in an interview (26 pharmacy staff, three GPs, and two nurses). Most participants acknowledged that their pharmacy had become busier since COVID-19 because of increased footfall compounded by patient difficulties in navigating remote digital systems. Few participants had received any formal training on working with marginalised communities; however, organisational barriers (such as lack of access to translation facilities) combined with interorganisational barriers (such as lack of integrated care) made it more difficult to provide care for some marginalised groups. Despite this, the continuity of care provided by many pharmacies was viewed as an important factor in enabling marginalised groups to access and receive care.

          Conclusion

          There are opportunities to better utilise the skills of community pharmacy teams. Resources, such as access to translation services, and interventions to enable better communication between community pharmacy teams and other primary care services, such as general practice, are essential.

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          Most cited references35

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          Using the framework method for the analysis of qualitative data in multi-disciplinary health research

          Background The Framework Method is becoming an increasingly popular approach to the management and analysis of qualitative data in health research. However, there is confusion about its potential application and limitations. Discussion The article discusses when it is appropriate to adopt the Framework Method and explains the procedure for using it in multi-disciplinary health research teams, or those that involve clinicians, patients and lay people. The stages of the method are illustrated using examples from a published study. Summary Used effectively, with the leadership of an experienced qualitative researcher, the Framework Method is a systematic and flexible approach to analysing qualitative data and is appropriate for use in research teams even where not all members have previous experience of conducting qualitative research.
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            Patient-centred access to health care: conceptualising access at the interface of health systems and populations

            Background Access is central to the performance of health care systems around the world. However, access to health care remains a complex notion as exemplified in the variety of interpretations of the concept across authors. The aim of this paper is to suggest a conceptualisation of access to health care describing broad dimensions and determinants that integrate demand and supply-side-factors and enabling the operationalisation of access to health care all along the process of obtaining care and benefiting from the services. Methods A synthesis of the published literature on the conceptualisation of access has been performed. The most cited frameworks served as a basis to develop a revised conceptual framework. Results Here, we view access as the opportunity to identify healthcare needs, to seek healthcare services, to reach, to obtain or use health care services, and to actually have a need for services fulfilled. We conceptualise five dimensions of accessibility: 1) Approachability; 2) Acceptability; 3) Availability and accommodation; 4) Affordability; 5) Appropriateness. In this framework, five corresponding abilities of populations interact with the dimensions of accessibility to generate access. Five corollary dimensions of abilities include: 1) Ability to perceive; 2) Ability to seek; 3) Ability to reach; 4) Ability to pay; and 5) Ability to engage. Conclusions This paper explains the comprehensiveness and dynamic nature of this conceptualisation of access to care and identifies relevant determinants that can have an impact on access from a multilevel perspective where factors related to health systems, institutions, organisations and providers are considered with factors at the individual, household, community, and population levels.
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              THE INVERSE CARE LAW

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                Author and article information

                Contributors
                Role: Research associate
                Role: Professor of medical sociology
                Role: Senior clinical lecturer
                Role: Professor of pharmacoepidemiology
                Role: Lecturer
                Role: Research fellow
                Journal
                Br J Gen Pract
                Br J Gen Pract
                bjgp
                bjgp
                The British Journal of General Practice
                Royal College of General Practitioners
                0960-1643
                1478-5242
                January 2024
                29 December 2023
                29 December 2023
                : 74
                : 738
                : e49-e55
                Affiliations
                National Institute for Health and Care Research (NIHR) School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester; NIHR Greater Manchester Patient Safety Research Collaboration, The University of Manchester, Manchester, UK.
                National Institute for Health and Care Research (NIHR) School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester; NIHR Greater Manchester Patient Safety Research Collaboration, The University of Manchester, Manchester, UK.
                National Institute for Health and Care Research (NIHR) School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester; NIHR Greater Manchester Patient Safety Research Collaboration, The University of Manchester, Manchester, UK.
                NIHR School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester; NIHR Greater Manchester Patient Safety Research Collaboration, The University of Manchester; Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
                Wolfson Institute of Population Health, Queen Mary University of London, London.
                National Institute for Health and Care Research (NIHR) School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester; NIHR Greater Manchester Patient Safety Research Collaboration, The University of Manchester, Manchester, UK.
                Author notes
                CORRESPONDENCE Kelly Howells NIHR School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK. Email: Kelly.howells@ 123456manchester.ac.uk
                Author information
                http://orcid.org/0000-0002-6795-2749
                http://orcid.org/0000-0002-0539-928X
                http://orcid.org/0000-0003-3298-8423
                http://orcid.org/0000-0002-2958-915X
                http://orcid.org/0000-0002-7161-4355
                http://orcid.org/0000-0002-7281-2492
                Article
                10.3399/BJGP.2023.0267
                10755997
                38154937
                74c9660e-3482-4418-99ab-a29c77c08497
                © The Authors

                This article is Open Access: CC BY 4.0 licence ( http://creativecommons.org/licences/by/4.0/).

                History
                : 30 May 2023
                : 26 June 2023
                : 13 September 2023
                Categories
                Research

                community pharmacy services,healthcare inequalities,medically underserved populations,primary health care,qualitative research

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