Funding community pharmacy dispensing: A qualitative exploration of current and alternate models leading to the development of quality focused funding principles

BACKGROUND: Performance-linked remuneration for pharmacists' dispensing in which payment may be adjusted based on an outcome of the service, has been introduced by some funders in the US. However, in most countries, pharmacists' dispending is still remunerated on a set fee-for-service (sFFS) basis. OBJECTIVE: To assess sFFS and performance-linked payment concepts and identify quality-focused funding principles for dispensing within an Australian context. METHODS: Within an adaptation framework, the study used thematic analysis of interviews with Australian community pharmacy stakeholders to evaluate the existing sFFS dispensing payment model, determine the fit of key elements of a performance-linked payment model, and evaluate acceptance of a simple performance-linked model. We induced quality-focused dispensing payment principles from the data. RESULTS: sFFS funding is not ideal for either patients or the profession as it encourages pharmacists to dispense quickly rather than commit time and expertise in accordance with each patient's requirements. However, the lack of specificity and correlation between pharmacists' services and patient outcomes is an impediment to using performance-linked payment in Australia. CONCLUSIONS: Quality-focused principles within a fee-for-service model should separate payment for commercial aspects of dispensing from professional aspects, which should include a schedule of time-based payments linked to patient and medication risk factors.