A qualitative exploration of community pharmacy culture, professionalism and professional identity formation in the context of substance dependency

Introduction: Substance dependency is a significant problem within Scotland (McAuley et al, 2023, Lancet Public Health;8:e484–93). Treatment pathways include opioid substitution therapy and needle provision services from community pharmacies. However, experiencing stigma within healthcare is unfortunately not uncommon (See Me, 2022, Scottish Mental Illness Stigma Study), and within community pharmacies there is evidence of discriminatory attitudes towards people with substance dependency (Radley et al, 2017, J Public Health 2017;39(4):846-855). The aim of this study is to explore community pharmacy culture, in the context of people with substance dependency (PwSD), through the lens of student and early career pharmacists and to understand the influence on professional identity formation. Methods: Semi-structured interviews were conducted with Pharmacy Undergraduates from Scottish Schools of Pharmacy; Foundation Year and Newly Qualified Pharmacists. The interviews explored observations and experiences on the practice observed in relation to the Medication Assisted Treatment standards and Trauma Informed Care principles, focusing on stigma, community pharmacy culture, professionalism and professional identity. Interviews were undertaken by six peer researchers between September and November 2023, under the supervision of two experienced researchers. Interviews lasted between seventeen and sixty minutes and were analysed using NVivo. Analysis followed familiarisation with the text; initial coding; identification of emerging key themes and sub-themes; and data organisation. Results: There were 28 participants. Stigmatisation of PwSD attending a pharmacy was a prominent aspect noted from the interviews. Observations included negative stereotyping of people, as well as different and adverse treatment because of judgements made by pharmacy staff and the general public about substance dependency. Positive care provision in pharmacies was also reported on, with empathetic longitudinal relationships providing a positive role model for participants. Participants valued the exposure to practice and the opportunity to make judgements that would mould the type of pharmacist they wanted to become. A number observed that their university course prepared them poorly for the reality of supporting PwSD, and that more input was required to enable them to develop a robust professional identity. Conclusions: The findings demonstrate four key themes: the abiding presence of stigmatisation that could be observed by pharmacy students and early career pharmacists; the value of observing positive and negative care experiences in practice; the effect on the student’s appraisal of professionalism in pharmacy practice and the decisions made about their own professional identity; the requirement for further preparation in the undergraduate course to enable optimal transition to work and ability to support PwSD. Funding: Pharmacy Management (PM Healthcare) provided a £500 unconditional grant to support this work.