Characteristics and Factors Influencing Clinical Pharmacy Services in Small Hospitals in British Columbia: A Theory-Informed Survey.

Background: Most hospitals in British Columbia have fewer than 200 beds, yet the clinical pharmacy services provided and factors influencing their delivery in this context are unknown. Objectives: To describe on-site clinical pharmacy services and associated contextual barriers and enablers in small BC hospitals. Methods: Between January and April 2022, an internet-based survey questionnaire was deployed to all pharmacy licence holders at BC hospitals with fewer than 200 beds (n = 23 licence holders representing 58 hospitals). Site characteristics, clinical activities, and barriers to and enablers of clinical pharmacy services (according to the Consolidated Framework for Implementation Research [CFIR]), as well as free-text responses, were captured. Results: Of the 23 licence holders invited to participate, 18 (78%) responded, representing 37 (64%) of the small hospitals. Provision of clinical pharmacy services was reported at 27 (73%) of the 37 hospitals. Resolution of drug therapy problems and patient education were delivered at all of these hospitals. Conversely, the comprehensive patient care bundle and discharge medication reconciliation were never performed at 15 (56%) and 11 (41%), respectively, of these 27 hospitals. Of the 9 CFIR barriers, insufficient external networking and insufficient resources were reported by 17 (94%) and 16 (89%), respectively, of the 18 respondents. Funding and staffing barriers were reported, using free text, by 14 (78%) and 13 (72%), respectively, of the 18 respondents. Of the 21 CFIR enablers, the following 5 were reported by all respondents: agreement that clinical services are supported by adequate evidence, that such services will improve quality, that they will meet patient needs, that they will satisfy patients, and that a strong need exists for these services. Conclusions: On-site clinical pharmacy services were delivered at most small BC hospitals; however, opportunities exist to expand clinical services. Pharmacy leaders should implement change strategies that overcome contextual barriers and enhance enablers.