“They’re pushing people towards pharmacy”: An exploration of community pharmacy’s role in the management of musculoskeletal conditions

Abstract

Background: Musculoskeletal (MSK) conditions significantly burden individuals, healthcare resources, and the economy. Current advice for common MSK conditions includes pharmacological and non-pharmacological treatment through lifestyle changes and self-management strategies, such as weight management and exercise. However, access to self-management support is often inequitable and highly variably, with the optimal promotion of these strategies unclear. Given recent policy recommendations to extend the community pharmacy role in healthy living services, this thesis explores community pharmacy practice in supporting MSK conditions.

Methods: This multi-method thesis comprises three studies. First, a systematic review explored non-pharmacological MSK interventions delivered by community pharmacy. Study two, a national survey of community pharmacy staff and other healthcare professionals (HCPs), explored knowledge, attitudes and beliefs toward current practice and an extended role for MSK support. Finally, an ethnography used observations (n=4 sites, 92 hours) and interviews (n=19 staff) to explore in-depth real-world community pharmacy practice related to support for MSK conditions.

Findings: The review found limited evidence for the effectiveness of self-management and lifestyle interventions, with greater impact seen when community pharmacy collaborates in multidisciplinary teams for targeted MSK care. Survey findings (n=33 pharmacy staff; n=79 other HCPs) highlighted enthusiasm for an extended role but identified barriers such as limited signposting resources and concerns about capabilities needed to deliver enhanced MSK care. Ethnographic findings revealed that self-management and lifestyle advice were rarely provided in practice due to the 'awkward work' for both staff and customers. Capacity for extended lifestyle services was shaped by locality, economic and social contexts, and internal pharmacy layout. MSK-specific advice predominantly focused on pharmacological symptom management and was entangled within the complex issue of opioid misuse.

Conclusion: Policy directives envision community pharmacy as a healthcare provider that can embrace the delivery of new health promotion services delivering lifestyle and self-management support. This research highlights that, in practice, these expectations may not always feasible and current support for MSK conditions may remain largely medication based with self-management and lifestyle advice limited within community pharmacy practice.

Date of Award	27 Feb 2025
Original language	English
Awarding Institution	Northumbria University
Supervisor	Nicki O'Brien (Supervisor) & Tim Rapley (Supervisor)