Bridging the gap between expanded pharmacy services and payment models: A jurisdictional scan
Bibliographic record
Abstract
BACKGROUND: Over the past few decades, pharmacists' roles have expanded beyond dispensing to include medication reviews, minor ailment prescribing, and vaccinations. In British Columbia, Canada, the fee-for-service model has been recognized as a barrier to service uptake. To design future payment models that support uptake, it is important to examine the impacts of models used in other jurisdictions. OBJECTIVES: To examine pharmacy remuneration models minor ailments provided by pharmacists across Organization for Economic Co-operation and Development (OECD) countries. The objectives of this study were to (1) identify the structure, funding mechanisms, and provider-level incentives for these models and (2) to assess the reported impacts of these models on service uptake, cost-effectiveness, health care access, and associated barriers and facilitators within community pharmacy settings. METHODS: We conducted a literature review to investigate the payment structures for pharmacists providing expanded services for minor ailments. Guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we searched MEDLINE and EMBASE databases from January 1, 2003, to September 20, 2023, focusing on pharmacy services, remuneration, and minor ailments in OECD countries such as the United Kingdom, Australia, New Zealand, the United States, etc. RESULTS: The search yielded 1662 records, of which 11 primary studies and 5 systematic reviews met the inclusion criteria, which examined 3 payment models for pharmacies providing minor ailment services: fee-for-service, performance-based payment models (PBPM) and capitation models. Fee-for-service models were found to encourage dispensing based on volume but provided little incentive for quality care. PBPM models were effective in promoting quality care but were noted to lack flexibility. Evidence on capitation models was minimal. CONCLUSION: This overview of remuneration models explored alternative payment models to encourage expanded pharmacist services. The review highlights that various payment models come with their own unique benefits, such as cost savings and improved patient care. When designing a payment model, it is essential to prioritize stakeholder engagement and address equity concerns.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".