Canadian Pharmacists Journal - May/June 2019 - 190

Original Research
Similar to the findings of systematic reviews4-6
of community pharmacy−based services, interviewees in the Bloom Program had limited
expectations of their pharmacists. Experiences
in the Bloom Program changed expectations of
the patient-pharmacist relationship. Pharmacists
offered and engaged in many activities, including
providing social support, health system navigation
and solutions or interim measures to close gaps in
the health care system. More than half of recorded
activities undertaken by Bloom pharmacists were
on nonmedication management activities.1 As
per the definition of professional pharmacy services by Moullin et al.,7 these services fall under
the umbrella of "other health care services" as a
part of "professional pharmacy services." These
"other" activities performed by pharmacists are
often poorly measured and evaluated in the current evidence base. Improving the characterization and measurement of these activities, many of
which fall outside of dispensing, is needed given
the present climate that demands providing value
for money to payers and key stakeholders such
as pharmacy owners. For example, social support, which was highly valued by Bloom Program
patients and can often redirect time from core
dispensing activities, is poorly defined, described
and measured in pharmacy practice research, and
this has been a longstanding issue.8
Typically, the impact of "nondispensing roles,"
including health promotion activities, has focused
on measures of patient satisfaction. Satisfaction
is important but it is not the most appropriate
measure to capture the impact of these activities,
and to date, patient satisfaction has often been
conducted with nonvalidated, ad hoc measures,9
not systematically. Other primary care researchers have stressed the importance of measuring
the patient experience in primary care. In 2014,
Laberge et al.10 reported on survey findings of the
Quality and Costs of Primary Care Canada study
and demonstrated that the most highly valued
aspects of primary care from the patient's perspective, with most important first, were 1) continuity
and coordination, 2) communication and patientcentred care, 3) patient activation and 4) access.
Some of these values are contained within Wong
and Haggerty's11 proposed 6 dimensions, each
with subdimensions, of primary health care items
that are important to measure from patients' perspectives. These 6 dimensions include 1) access,
2) interpersonal communication, 3) continuity and coordination, 4) comprehensiveness of
190



services, 5) trust and 6) patient-reported impacts
of care. Significant challenges exist with measurement of these constructs, but research in this area
continues to evolve.11 From a pharmacy practice
perspective, there is limited research regarding
the measurement of these constructs. Access,
for example, is often oversimplified in pharmacy
practice research with pharmacists cited as one
of the "most accessible" health care professionals. Although many frameworks exist regarding
access, according to Levesque et al.12 access is
viewed "as the possibility to identify health care
needs, to seek health care services, to reach the
health care resources, to obtain or use health care
services and to actually be offered services appropriate to the needs for care." Further, they define 5
dimensions from the supply side of care, including approachability, acceptability, availability and
accommodation, affordability and appropriateness. From the patient perspective, they define
"abilities," including the ability to perceive needs
for care, seek, reach, pay and engage. Application of such frameworks would be beneficial in
pharmacy practice research in the future to more
fully characterize the breadth of pharmacists' and
pharmacy team members' interventions. The
Bloom Program improved several dimensions of
access of participants. From our interview data,
using the supply side factor of approachability
as an example and based on the work of Richard
et al.,13 the Bloom Program provided patients
with more navigation and information, referral
and triage to other services and proactive identification of health needs. From the demand side
for patients, modelled after the work of Levesque
et al.12 and Richard et al.,13 the Bloom Program
enhanced the ability of clients to perceive (e.g.,
increased health and service literacy), to seek
(e.g., through education and self-management
coaching), to reach (e.g., pharmacies are in most
communities in Nova Scotia14) and to pay (e.g.,
minimized out-of-pocket expenses). Given the
complexity related to many of these constructs
and with some constructs and their measurement less well established in the research literature, more work is required for pharmacy practice
researchers to align with other stakeholders who
are working to evaluate the patient experience in
primary care.
Moving forward and based on the positive
experiences of participants with lived experience of mental illness and addictions in the
Bloom Program, it will be important to evaluate
C P J / R P C  *  M ay / J u n e  2 0 1 9  *  V O L  1 5 2 ,  N O  3
Canadian Pharmacists Journal - May/June 2019

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