The potential role of community pharmacy staff in reducing patient delay in consulting with symptoms of rheumatoid arthritis: a qualitative study

Abstract

<h4>Background: </h4> Rheumatoid arthritis (RA) is a chronic inflammatory arthritis which can cause joint damage and reduced quality of life. Early treatment of RA within 3 months of symptom onset is associated with improved clinical outcomes. However, this window of opportunity is often missed. One important factor that contributes to treatment delay is that patients with symptoms of RA often delay consulting their general practitioner (GP). Previous research indicates that patients with inflammatory arthritis are likely to visit pharmacies for advice before consulting their GP. Therefore, pharmacists are well positioned to identify patients with symptoms of early inflammatory arthritis and sign post them appropriately. This research examines community pharmacy staff’s knowledge, perceptions and approaches to management of patients presenting with symptoms of RA in order to identify training needs and other opportunities for intervention to enhance the role of pharmacy staff in the pathway to care. Methods Semi-structured interviews were conducted with 19 community pharmacy staff with varying roles in the West Midlands, UK, during a 12 month period (2017–2018). The interviews were audio-recorded, transcribed and analyzed using thematic analysis facilitated by NVivo 12. Results Community pharmacy staff (including pharmacists, pharmacy managers, technicians, dispensers and pre-registration pharmacists) had a range of knowledge and differing perceptions of RA and what action should be taken when patients present with symptoms of RA. These can be grouped into four themes: (1) Variations in perceptions and knowledge about RA. (2) The role of the pharmacy in increasing public awareness about RA. (3) The role of the pharmacy staff in facilitating access to the GP. (4) Practical considerations for pharmacy based interventions. Conclusion Amongst community pharmacy staff, there is wide variation in the understanding of RA and the importance of early treatment. This study identifies opportunities for enhanced training of community pharmacists and other pharmacy staff in relation to inflammatory arthritis as well as other pharmacy-based interventions, such as public awareness campaigns about RA and other musculoskeletal conditions. This could result in enhanced signposting to rapid GP consultation for inflammatory symptoms and reduced treatment delay.