Measurement of patient satisfaction with community pharmacy services: a review

Assessment of satisfaction of attendees of healthcare centers in Jordan with community pharmacy services of pharmacies they usually use

Before extending the range of services provided, maximizing the usefulness of current procedures within community pharmacy settings is needed, as the scope of pharmacy services is evolving in different dimensions. The present study aims to assess the degree of factors affecting the satisfaction of traditional community pharmacy services using population data collected from patients attending academic and public healthcare centers in Jordan. A validated, pretested, and adapted survey instrument has been utilized to assess the satisfaction of contemporary services delivered by community pharmacists in different dimensions. Linear regression analysis evaluated the predictors associated with higher total satisfaction scores with community pharmacy services. The present study included 642 patients attending healthcare centers. Different dimension scores, such as explanation and consideration, scored similarly, with values ranging from 64.5% - 69.7% of the maximum possible score. The mean total scale score was 67.2% of the total possible scores. Using the linear regression analysis, respondents who were satisfied with their treatment plans were likely to have higher satisfaction with community pharmacy services. The increased number of prescription medications and increased age were associated with lower satisfaction with community pharmacy services. Results indicated that healthcare policymakers might be confident in the services within the community pharmacy setting; however, there is always room for more robust quality control activities.

Dispensation of outpatient hospital medicines by hospital only versus hospital-community pharmacies collaboration: a cross-sectional study and survey of patient's satisfaction

Goal

To describe the experience of a dispensing model of outpatient hospital medicines (OHM) via collaboration of hospital and community pharmacies, and to explore patient satisfaction with the strategy as compared with the hospital pharmacy only service.

Background

Patient satisfaction is an important component of the quality of health care.

Study

A new model of dispensing OHM was conducted in the Outpatients Unit of the Service of Hospital Pharmacy of Hospital del Mar, in Barcelona, Spain. Participants were patients on stable chronic treatment with clinical or social fragility, immunocompromised patients, and those whose residence was located at a distance from the hospital that justified drug delivery through the community pharmacy. A cross sectional study was done using an ad hoc 14-item questionnaire collecting demographic data, duration of treatment, usual mode of collecting medication, and the degree of satisfaction regarding waiting time for the collection of medication, attention received by professionals, information received on treatment, and confidentiality.

Results

The study population included a total of 4,057 patients (66.8% men) with a mean age of 53 (15.5) years, of whom 1,286 responded, with a response rate of 31.7%. Variables significantly associated with response to the survey were age over 44 years, particularly the age segment of 55-64 years (odds ratio [OR] 2.51) and receiving OHM via the community pharmacy (OR 12.76). Patients in the community pharmacy group (n = 927) as compared with those in the hospital pharmacy group (n = 359) showed significantly higher percentages of 'satisfied' and 'very satisfied' (p < 0.001) in the waiting time for the collection of OHM (88.1% vs. 66%), attention received by professionals (92.5% vs. 86.1%), and information received on treatment (79.4% vs. 77.4%). In relation to confidentiality, results obtained were similar in both pharmacy settings.

Conclusion

Dispensing OHM through the community pharmacy was a strategy associated with greater patient satisfaction as compared with OHM collection at the hospital pharmacy service, with greater accessibility, mainly due to close distance to the patient's home. The participation of community pharmacists could further optimize the care received by patients undergoing OHM treatment.

Service quality, outpatient satisfaction and loyalty in community pharmacies in Turkey: A structural equation modeling approach

Background

The sustainability of community pharmacy services is dependent on service quality, patient satisfaction, and patient loyalty. While community pharmacies are perceived as medical units in terms of drug dispensing, they are also businesses that engage in social interaction with patients.

Objectives

To propose a certain model to evaluate the impact of different service factors on the level of satisfaction and to reveal the relationship between satisfaction and loyalty.

Methods

This cross-sectional study was conducted in the province of Afyonkarahisar, Turkey, between March 20, 2022, and December 30, 2022. The research data were collected with a questionnaire that included demographic information, selected service factors, satisfaction, and loyalty. The data obtained from 402 participants were analyzed using structural equation modeling (SEM).

Result

The mean age of the participants was 32.02 ± 11.81, 53.9% were female, 58.7% were employed, 54.1% had a bachelor's degree, 11.7% had a chronic disease, and 16.1% were taking medication regularly. The findings of the study showed that communication and attitude (β = 0.22; t = 3.90), medicine supply (β = 0.43; t = 7.62), and pharmacy environment (β = 0.26; t = 4.23) positively affected patient satisfaction in community pharmacies. Service promptness did not have a significant effect on patient satisfaction (β = 0.07; t = 1.18). The most effective service factor on patient satisfaction was medicine supply (β = 0.43). In addition, the research results determined that patient satisfaction strongly affects patient loyalty in community pharmacies (β = 0.72, t = 11.24).

Conclusions

While community pharmacies can increase patient satisfaction through service factors, they can increase patient loyalty by improving patient satisfaction. Community pharmacies that want to have satisfied and loyal patients should focus more on service factors. Community pharmacies should not only meet the medical expectations of patients but also meet their social expectations.

Beyond satisfaction in person-centered pharmacy services

Patient self-reported satisfaction is commonly used as an assessment of service experience and quality for community pharmacy services. This commentary discusses alternative foundational approaches to evaluating service experience and quality in patient-centered care. It describes historical and recent literature pertaining to the development and use of satisfaction measures for service design and patient experience assessment. It then highlights potential limitations of patient satisfaction as an assessment tool for patient-centeredness and patient experience identified in the pharmacy literature, which include criticisms that use of patient satisfaction may compromise accuracy in measuring quality due to factors such as patients having poor knowledge of and low expectations for quality and having a predisposition toward rating satisfaction highly when experiencing no-cost and/or unfamiliar services. Moreover, satisfaction measurements may change based on service exposure, with patient preferences for service offerings changing with increased service exposure and variation in patient-specific and environmental factors. After discussing limitations and criticism of patient self-reported satisfaction, we introduce alternative assessments methods which may facilitate more accurate assessments of patient experience and patient-centered pharmacy services such as patient-reported outcomes measures (PROMs), patient-reported experience measures (PREMs), and human-centered design techniques such as journey mapping, prototyping, and user testing to design and assess patient-centered pharmacy services. These alternative assessments are rooted in, or related to preferred implementation science approaches to establishing, evaluating, and sustaining pharmacy services.

Patient satisfaction and associated factor at red cross pharmacies in Addis Ababa, Ethiopia

BACKGROUND

Patient satisfaction is a crucial aspect of healthcare, reflecting the positive feelings patients experience when using a service. It serves as an indicator of the gap between expected and actual service quality from the patient's perspective. Measuring patient satisfaction is recommended for healthcare providers at all levels as it contributes to improvement efforts. In recent times, pharmacy services have evolved beyond merely supplying medications to becoming more patient-centered and caring. Given the high number of patients relying on the limited Red Cross community pharmacies in the city, this study aims to assess patient satisfaction and identify factors associated with patient satisfaction towards Red Cross Pharmacies in Addis Ababa, Ethiopia.

PATIENTS AND METHODS

Cross sectional study design was conducted from August 15 to August 30, 2022 in three Red Cross Pharmacies in Addis Ababa. Patients were selected by Convenience sampling technique. Structured questionnaire was used to assess patient satisfaction. Bivariate and Multivariate logistic regression were computed to assess statistical association between the outcome variable, and independent variables. SPSS version 21 was used for analysis.

RESULTS

Four hundred seven participants were willing and completed the study. The overall satisfaction towards Red Cross pharmacy service was 60.4%. Inadequate counselling was main reason for dissatisfaction (45%). Regarding associated factors, unavailability of some medications (Adjusted odds ratio = 0.393, 95% CI: 0.208-0.741), unfair medication cost (Adjusted odds ratio = 0.613, 95% CI: 0.607-0.910), and lack of organized pharmacy work flow (Adjusted odds ratio = 0.105, 95% CI: 0.049-0.221) were negatively associated with clients' satisfaction.

CONCLUSION

This study provides significant insights into patient satisfaction with Red Cross pharmacy services in Addis Ababa, Ethiopia, revealing an overall patient satisfaction rate of 60.4%. While a substantial number of patients had positive experiences, dissatisfaction due to inadequate counseling was a notable concern. Factors negatively associated with patient satisfaction, including medication unavailability, unfair cost, and a lack of organized workflow, further highlight the need for targeted interventions to improve patient experiences. Addressing these issues will be critical to enhance pharmaceutical care services and bridge the gap between patient needs and satisfaction.

Exploring stakeholders' perspectives on the quality of services provided through community pharmacies

INTRODUCTION

It is important to understand the factors impacting the quality of services provided through community pharmacies. Exploring how key stakeholders perceive good quality in these services is a logical first step. This could also inform the development of quality measures, such as quality indicators (QIs).

AIM

To identify key stakeholders' perspectives on the quality of services provided through community pharmacies in Norway, specifically by exploring their experiences and perceptions about what constitutes good service quality.

METHODS

A convenient sampling approach was used to recruit participants for five semi-structured focus groups from Facebook, pharmacy chains, and patient organizations. The interviews with twenty-six participants were conducted via Microsoft Teams. Interviews were transcribed verbatim, and an inductive thematic analysis with a reflexive approach was used.

RESULTS

Four main themes emerged from the analysis; 1) sufficient and substantively suitable information to cover individual needs, 2) communication skills and relationships with the pharmacy professionals, 3) customer satisfaction with knowledgeable employees and conveniently located pharmacies, and 4) factors that affect the pharmacy working environment.

CONCLUSION

This study has identified areas that pharmacy professionals and customers regard as essential to define good quality of community pharmacy services. Effective communication skills, appropriate provision of information, customer satisfaction, and working environment are all essential factors when developing quality metrics for community pharmacies.

Assessing Patient Satisfaction with Community Pharmacy Services: A Large Regional Study at Punjab, Pakistan

PURPOSE

Patient satisfaction can be used to assess the quality of services provided at pharmacies. Our aim was to determine the level of patient satisfaction with pharmacy services and related factors at community pharmacies located in Punjab, Pakistan.

METHODS

A questionnaire-based cross-sectional study was conducted from May 2021 to July 2021 by administering the questionnaire to the patients using stratified random sampling method. Survey instrument comprised 4 sections including demographics, satisfaction towards provision of facilities, the provision of information, their accessibility to patients, the relationship between pharmacists and patients and the continuity of care provided. Categorical data were represented by percentages. Descriptive statistics were calculated for satisfaction scores. Simple and multiple logistic regression models were used to find the odds ratios. A p-value of less than 0.05 was considered statistically significant.

RESULTS

Response rate of the survey was 92%. Only 30% of patients agreed that the pharmacist was available for counseling on their visit. About 52% agreed that the counseling time provided by pharmacist was enough. Most of the pharmacy patients (61%) trusted the pharmacist regarding any query about medicine and were satisfied with the way the pharmacist resolved issues. Mean satisfaction score of the pharmacy patients was 45.75 with a range of 25 (highly satisfied) to 66 (highly dissatisfied).

CONCLUSION

The provision of community pharmacy services to patients was not satisfactory. Furthermore, the absence of pharmacist in the pharmacy and the lack of provision for counseling time raised concerns.

Attitudes of Community Pharmacy Service Users towards Vaccination Programs in Pharmacy: A Cross-Sectional Survey-Based Study in Croatia

BACKGROUND

The aim of this study was to explore community pharmacy service users' attitudes and opinions towards vaccination programs in pharmacy conducted by a doctor of medicine or a pharmacist.

METHODS

The questionnaire used in this study comprised 40 items about demographics, sources of information, attitudes about vaccination, attitudes about vaccination in community pharmacies, and willingness to pay for such a service.

RESULTS

A total of 385 people participated in this study. Injection was the preferred route of administration of vaccine for more than half of study participants (50.6%). Univariate analysis showed that those who had a healthcare worker as a family member and those familiar with the HPV vaccine had better attitudes; however, those results were no longer significant after factoring in other variables in multivariate analysis. More than half (59.2%) of the study population would consider vaccination service in community pharmacies only if it were free or covered by the national health insurance.

CONCLUSIONS

More than half of the participants believed that providing vaccination services in community pharmacies would result in greater vaccination rates for seasonal illnesses. However, around half would prefer that it were conducted exclusively by a physician. Less than 10% of the study participants would pay out of their pocket for such a service.

Nature and perceived benefits of patient-initiated consultations in community pharmacies: A population survey

Background

The role of community pharmacists in enhancing patient care has received increased attention. However, there is a paucity of literature on the nature, frequency, and perceived impacts of patient-initiated consultations in community pharmacies.

Objectives

We aim to describe the profile of patients seeking advice from community pharmacists as well as the nature and impact of those consultations.

Methods

A survey was conducted with Quebec adults who had consulted a pharmacist in the previous four weeks. Data was collected in 2017 and 1104 agreed to participate (25.3%). Of those, 93 were withdrawn due to incomplete data and 98 failed to meet the inclusion criteria. Sample representativeness was ensured by quota sampling (gender, age) after stratification by region.

Results

Among the 913 respondents, 46% had consulted a pharmacist more than once during the four weeks prior to the survey. Individuals with a university degree consulted less often than those without (1.97 vs. 2.17 times; t = 2.0; p < .05) and participants with one or several chronic diseases consulted more frequently than those having no chronic disease (2.18 vs. 1.94 times; t = 5.7; p < .05). Older adults (55+) consulted more often for themselves compared to younger (18–34) and middle-aged (35–54) adults (1.53 vs. 1.31 vs. 1.44 times; F = 4.0; p < .05). Concerning the consultations, 58% were related to medications and 33% to health problems. In terms of impacts, 81% of consultations were perceived to have prevented the use of other healthcare resources. Patient satisfaction with their consultations was high with an average score of 8.75 on a 10-point scale (SD = 1.63).

Conclusions

Findings reveal that the reasons for consulting a community pharmacist are diverse, most being related to medications or health issues. Patients reported that pharmacists were able to manage most consultations without referring them to other health care resources or professionals, and their satisfaction with their consultation was high.

MeSH terms

Community pharmacy; counselling; patient satisfaction; primary health care; surveys and questionnaires.

Real-World Impact of Transferring the Dispensing of Hospital-Only Medicines to Community Pharmacies During the COVID-19 Pandemic

OBJECTIVES

In Portugal, the dispensing of most outpatient specialty medicines is performed exclusively through hospital pharmacies and totally financed by the National Health Service. During the COVID-19 first wave, the government allowed the transfer of the dispensing of hospital-only medicines (HOMs) to community pharmacies (CPs). This study aimed to measure the value generated by the intervention of CP in the dispensing of HOM.

METHODS

A single-arm, before-and-after study with 3-month follow-up was conducted enrolling a randomly selected sample of patients or caregivers with at least 1 dispensation of HOM through CP. Data were collected by telephone interview. Main outcomes were patients' self-reported adherence (Measure Treatment Adherence), health-related quality of life (EQ-5D 3-Level), satisfaction with the service, and costs related to HOM access.

RESULTS

Overall 603 subjects were recruited to participate in the study (males 50.6%) with mean 55 years old (SD = 16). The already high mean adherence score to therapy improved significantly (P < .0001), and no statistically significant change (P > .5757) was found in the mean EQ-5D score between baseline (0.7 ± 0.3) and 3-month follow-up (0.8 ± 0.3). Annual savings account for €262.1/person, arising from travel expenses and absenteeism reduction. Participants reported a significant increase in satisfaction levels in all evaluated domains-pharmacist's availability, opening hours, waiting time, privacy conditions, and overall experience.

CONCLUSIONS

Changing the dispense setting to CP may promote better access and satisfaction. Moreover, it ensures the persistence of treatments, promotes savings for citizens, and reduces the burden of healthcare services, representing a crucial public health measure.

Virtualization and standardization of a health-system specialty pharmacy call center

DISCLAIMER

In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

PURPOSE

The coronavirus disease 2019 (COVID-19) pandemic provided an opportunity to change how health-system specialty pharmacy (HSSP) call center operations are organized. This article describes the steps taken to virtualize the current operations of a specialty pharmacy services call center and evaluate the impact.

SUMMARY

The onset of the COVID-19 pandemic and its impact on the normal provision of healthcare necessitated that HSSPs drastically modify existing procedures to both accommodate the expectations of staff and overcome the many barriers to care being experienced by patients. To fully understand and improve upon the workflow processes of an HSSP call center, a combination of qualitative feedback from patients, quantitative claims data, and quality metrics was evaluated. This project was divided into 3 phases: phase 1 (baseline) from July 2020 through August 2020, phase 2 (implementation) from September 2020 through December 2020, and phase 3 (analysis) from January 2021 through March 2021. Phase 1 included baseline review of workflow. Phase 2 encompassed development of new standard operating procedures (SOPs), making critical decisions to promote virtual capabilities of staff, and collaboration with team members to increase efficiency of current workflow. During phase 3, an evaluation of operational and service-related metrics was conducted to determine the impact of phase 2 workflow changes. Optimization of the specialty pharmacy call center allowed for staff members to transition to remote work to minimize exposure risk and prioritize the safety of patients and team members.

CONCLUSION

The call center team was able to transition to fully remote operations, implement new SOPs, and undergo significant workflow changes to optimize performance while still maintaining all call center metric goals and without increased complaints from patients or errors. This approach allowed for added staff value and safety and improved organization during the COVID-19 pandemic.

Publics’ Perceptions of Community Pharmacists and Satisfaction with Pharmacy Services in Al-Madinah City, Saudi Arabia: A Cross Sectional Study

Background and Objectives: Pharmacists play a major role in serving patients and delivering pharmaceutical services to the community. It is unclear whether the public fully appreciates what pharmacists can do as key health care providers. This study aims to examine public perceptions of community pharmacists and levels of satisfaction with pharmacy services. Materials and Methods: A cross-sectional study was conducted on a randomly selected sample population (n = 1000) in Saudi Arabia over a period of six months from January through June 2019. A 40-item, structured, self-administered questionnaire was used, comprised of questions on the demographics characteristics of the respondents and their satisfaction with pharmacy services. Descriptive statistics were used to analyze the data. Results: The response rate of the survey was 76.92%. Public opinions were influenced by pharmacists’ availability and knowledge, service promptness, and counseling services. Overall, 80.5% of respondents agreed that community pharmacists treat them with respect. Doctors were identified as the preferred source of drug therapy consultation by 58.7% and pharmacists by 41.29%. About 72.8% of respondents agreed that pharmacists provided them with clear instructions about medication use, and 70.2% trusted pharmacists’ opinions about medications. About 62.5% of respondents expressed satisfaction with pharmacists, and 64.8% with pharmacy services. Conclusions: Customers’ opinions were influenced by pharmacists’ availability and knowledge, pharmacy service promptness, pharmacy location, waiting area, medication knowledge, and counseling. However, the public was greatly satisfied with community pharmacists’ professionalism and pharmaceutical services. This positive perception provides an opportunity for pharmacists to extend their roles as healthcare professionals.

Patients', pharmacists', and prescribers' attitude toward using blockchain and machine learning in a proposed ePrescription system: online survey

Objective

To evaluate the attitudes of the parties involved in the system toward the new features and measure the potential benefits of introducing the use of blockchain and machine learning (ML) to strengthen the in-place methods for safely prescribing medication. The proposed blockchain will strengthen the security and privacy of the patient’s prescription information shared in the network. Once the ePrescription is submitted, it is only available in read-only mode. This will ensure there is no alteration to the ePrescription information after submission. In addition, the blockchain will provide an improved tracking mechanism to ensure the originality of the ePrescription and that a prescriber can only submit an ePrescription with the patient’s authorization. Lastly, before submitting an ePrescription, an ML algorithm will be used to detect any anomalies (eg, missing fields, misplaced information, or wrong dosage) in the ePrescription to ensure the safety of the prescribed medication for the patient.

Methods

The survey contains questions about the features introduced in the proposed ePrescription system to evaluate the security, privacy, reliability, and availability of the ePrescription information in the system. The study population is comprised of 284 respondents in the patient group, 39 respondents in the pharmacist group, and 27 respondents in the prescriber group, all of whom met the inclusion criteria. The response rate was 80% (226/284) in the patient group, 87% (34/39) in the pharmacist group, and 96% (26/27) in the prescriber group.

Key Findings

The vast majority of the respondents in all groups had a positive attitude toward the proposed ePrescription system’s security and privacy using blockchain technology, with 72% (163/226) in the patient group, 70.5% (24/34) in the pharmacist group, and 73% (19/26) in the prescriber group. Moreover, the majority of the respondents in the pharmacist (70%, 24/34) and prescriber (85%, 22/26) groups had a positive attitude toward using ML algorithms to generate alerts regarding prescribed medication to enhance the safety of medication prescribing and prevent medication errors.

Conclusion

Our survey showed that a vast majority of respondents in all groups had positive attitudes toward using blockchain and ML algorithms to safely prescribe medications. However, a need for minor improvements regarding the proposed features was identified, and a post-implementation user study is needed to evaluate the proposed ePrescription system in depth.

Access to the healthcare system: Experiences and perspectives of Pakistani immigrant mothers in New Zealand

Worldwide, there is limited literature on Pakistani immigrants' challenges and experiences accessing healthcare services for their children and themselves. In this article, we present a case study of Pakistani immigrant mothers in New Zealand to explore their experiences and perspectives on navigating the healthcare system of a new country. Data was collected from 23 mothers in Wellington through in-depth semi-structured interviews, which each lasted 60 to 80 min. Participants had been living in New Zealand for an average of 3.25 years and were mostly highly educated. They talked about their prior knowledge and experiences regarding the New Zealand healthcare system. Lack of knowledge, different expectations, and experiences of healthcare services inhibited their utilization of healthcare. Most mothers treated their children at home before visiting a general practitioner (GP) due to previous perceived unsatisfactory experiences, such as lack of availability of GP appointments for the same or next day, or long waiting times at emergency departments and after hours medical facilities. Immigrant mothers need to feel they are getting the right services at the right time to ensure and promote better health outcomes. Identifying the barriers and promoting information about the healthcare system can play an essential role in the appropriate use of health services by immigrant mothers.

The Quality of Pharmaceutical Services in the New Normal Era on Outpatient Loyalty at the Pharmacy Installation of the Daya General Hospital

Background: The quality of pharmaceutical services is an important factor in ensuring the quality of health services in hospitals. In this current era of the new normal, improving the quality of pharmaceutical services is closely related to patient satisfaction and loyalty. Objective: The purpose of this study was to examine and analyze the effect of pharmaceutical service quality on loyalty through mediating outpatient satisfaction at the Pharmacy Installation of Daya General Hospital. Method: This research was a quantitative study with an analytical observational study design. Respondents in this study were 120 outpatients at the Pharmacy Installation. The data analysis method used was univariate and bivariate analysis through the Statistical Package for the Social Sciences (SPSS) program and multivariate Structural Equation Modeling (SEM) with the AMOS program. Results: Satisfaction affected the loyalty of outpatients at the Pharmacy Installation. The most dominant indicator was feeling satisfied in the satisfaction variable, with a loading factor of 0.93. In the loyalty variable, the most dominant indicator was the loyalty aspect, with a loading factor of 0.41. The direct effect of pharmaceutical service quality on loyalty was 0.550, while the indirect effect mediated by patient satisfaction was 0.303. Conclusion: The direct effect was greater than the indirect effect of service quality on the loyalty of outpatients at Daya General Hospital.

Patients' Satisfaction with the Community Pharmacy Services in Iran

Objective:

This study aimed to measure patient satisfaction with community pharmacy in Isfahan, Iran, in 2019.

Methods:

In this cross-sectional study (2019), we selected 104 pharmacies located in the second largest city of Iran (Isfahan) based on systematic random sampling and at least five clients at different times of a day who finished the process of obtaining medications from the pharmacies were randomly selected for a short and structured interview using the Persian version of the MacKeigan and Larson questionnaire for measuring patients' satisfaction with pharmacy services.

Findings:

The reliability of the questionnaire was confirmed after distributing 520 among the patients (r = 0.958). No significant difference was observed between sex, marital status, housing status, and total satisfaction score based on the results. In addition, there was a significant difference between educational levels, location, job status, insurance status, real income, and total score of satisfaction (P < 0.05). Our results revealed acceptable satisfaction in some aspects, such as paying attention to pharmacists, the general condition of the pharmacy, and their technical competence. On the other hand, the patients were not satisfied enough in different aspects, for example, counseling, accessibility to their needed drugs, and expenses.

Conclusion:

Patient satisfaction needs to be improved and enhanced in the case of counseling the patients on their medications, and drug accessibility and expenses remain the primary source of dissatisfaction in the studied population, which should be noted by the Iranian Food and Drug Organization and other related authorities.

Factors influencing the implementation of pharmaceutical care in outpatient settings: A systematic review applying the Consolidated Framework for Implementation Research

BACKGROUND

Pharmaceutical care in outpatient settings is a type of health service that has been shown to contribute to decreasing drug-related morbidity and mortality rates. However, every process of implementing a new service brings about changes and transformations in the work routine, thus posing challenges.

OBJECTIVES

This systematic review aims to identify barriers to and facilitators for the implementation of pharmaceutical care in outpatient settings by applying the CFIR method, a framework based on the theory of health services, used to analyze and synthesize research data, which can direct strategies for the service to work as planned.

METHODS

A systematic review was conducted exploring the barriers to and facilitators for the implementation of pharmaceutical care in outpatient settings. The MEDLINE, EMBASE, CINAHL, COCHRANE, and LILACS databases were consulted.

RESULTS

Eight studies were included: five qualitative ones, two mixed-method ones, and a quantitative one. The most frequent CFIR constructs identified were Patient Needs and Resources (n = 30, 10.75%), Knowledge and Beliefs about the Intervention (n = 31, 11.11%), Networks and Communications (n = 34, 12.19%), and Available Resources (n = 56, 20.07%). The most cited barriers were: insufficient human resources, patients' unawareness of the existence of the pharmaceutical care service, and pharmacists' resistance to changes. Facilitators included: the opportune presentation of the service to the healthcare team; the use of electronic devices for specific guidance; and the assessment of patient satisfaction.

CONCLUSIONS

This systematic review allowed detecting key guidelines to improve the implementation process, including (1) defining an implementation method and exploring it extensively during the pre-implementation phase, (2) ensuring human and financial resources, (3) determining how the new service will interact with other existing services. More research is needed to understand how these factors can affect the implementation of clinical services.

Self-medication consultations in community pharmacy: an exploratory study on teams' performance, client-reported outcomes and satisfaction

Background:

Community pharmacy teams (CPTs) have an established role in assisting self-medication, contributing to the safe and effective use of non-prescription medicines.

Objective:

The study aimed to describe CPTs’ performance in self-medication consultation, client-reported outcomes, and satisfaction. A secondary purpose was to develop an explanatory model for better understanding clients’ satisfaction with this service.

Methods:

Descriptive, cross-sectional exploratory study. Data were collected in a purposive sample of pharmacy clients recruited in six community pharmacies in Portugal. CPTs adopted a structured approach to self-medication consultations, encompassing 11 quality criteria (five for case evaluation and six for counselling). An evaluation score, a counselling score and an overall quality score were estimated. Client-reported outcomes and satisfaction were ascertained via a follow-up telephone interview. Besides descriptive statistics, the association with several independent variables on the clients’ overall satisfaction was explored, using linear regression.

Results:

Product-based dispensing was more frequent for lower educated clients. Reported compliance with the criteria by CPTs was overall high (93.95% of maximum compliance), mostly missing the ‘other medication’ questioning. Most clients (93%) reported improvement after the consultation. Clients’ satisfaction score was 4.70 out of 5. The variables that seem to better explain clients’ overall satisfaction are pharmacy loyalty, the evaluation score, and the female gender.

Conclusions:

Clients’ reported outcomes were favourable, as well as satisfaction with the service. Clients’ satisfaction appears to be determined by consultation quality (evaluation score), suggesting the advancement of the pharmacists’ clinical role. A larger study is warranted to confirm these findings.

Knowledge, Attitude, and Practice on Antibiotics and Its Resistance: A Two-Phase Mixed-Methods Online Study among Pakistani Community Pharmacists to Promote Rational Antibiotic Use

Antibiotic resistance (ABR) is an emerging global threat to public health. Substantial evidence has indicated that community pharmacists (CPs) can play a critical role in managing the ever-increasing threat of antibiotic resistance. This study aimed to determine the knowledge, attitude, and practices of CPs (n = 180) towards antibiotics and antibiotic resistance as well as to improve the rational use of antibiotics. A two-phase mixed-methods (quantitative and qualitative) online study was conducted in Pakistan from August 2019 to March 2020 by using validated questionnaires and semi-structured interview data. Different statistical methods were used to tabulate the quantitative data, whereas inductive thematic analysis was conducted to categorize themes from the qualitative data and to draw conclusions. Approximately 64.4% of the CPs were male (mean: 29–33 years old). Overall, CPs had good knowledge of and were familiar with multidrug-resistant organisms and their roles in ABR (65.6%, median = 1, and IQR = 1), although their knowledge was poor in differentiating some antibiotic groups with their respective ABR patterns (31.1%, median = 1, and IQR = 1). Most CPs have a positive attitude towards antibiotics, with most (90.0%) identifying ABR as a critical issue in public health (median = 1 and IQR = 0). Overall, CPs’ practices towards antibiotics were somewhat acceptable, where they leaned towards educating patients about the rational use of antibiotics (52.8%, median = 1, and IQR = 1). The two main themes discovered (antibiotics and counseling of patients) were related to self-medication, while educational intervention is the main subtheme. ABR is multifactorial, with subthemes related to budget, time constraints, incompetent staff, the absence of CPs, the lack of training, and the enforcement of laws and regulations being the needs of the hour in Pakistan. Effective antibiotic stewardship programs, patient education, and awareness campaigns about antibiotics and ABR along with training of the CPs are important factors that have to be addressed in a timely manner.

A Pilot Australian Pharmacist Health Coaching Trial of Participants with Poorly Controlled Hypertension: A Qualitative Study of Participants' and Coaches' Experiences

OBJECTIVE

An exploratory qualitative study was conducted to explore how stakeholders - participants and coaches experienced, and made sense of, being involved in coaching for people with poorly controlled hypertension.

METHODS

Two pharmacists provided monthly health coaching sessions to twenty participants for three-months. Qualitative semi-structured interviews of participants were carried out by pharmacist coaches at baseline, one month, and at three months post-study completion. The pharmacist health coaches were also interviewed. Participant and pharmacist audio-recorded interviews were transcribed verbatim and analyzed thematically.

RESULTS

Twenty participants with poorly controlled hypertension received health coaching. Analysis of the transcripts from participant interviews indicated the emergence of three main themes "beliefs about and management of hypertension", "reflection on health goals" and "understanding of and experiences from health coaching". Only one theme emerged from the pharmacist interviews: "logistics of health coaching in pharmacy".

CONCLUSION

Analysis of interviews showed that participants experienced a variety of positive health changes. Changes included a better understanding of health coaching, more realistic beliefs about hypertension, and improved management of hypertension and health goals. Participants were also positive about their experiences of coaching. Interviews with the pharmacists revealed factors such as planning, teamwork, and time management which are related to the implementation and provision of health coaching in community pharmacy practice which could be overcome through consideration and planning.

Public's perspectives on guideline-recommended self-medication consultations in German community pharmacies

The aim of this study was to assess the public's opinions and expectations of self-medication consultations in German community pharmacies with special emphasis on the acceptance of guideline-recommended consultation. In a cross-sectional study in the city centre of Leipzig, Germany, we conducted a questionnaire-based survey administered via an interview with passers-by from June to September 2018. The structured questionnaire contained questions assessing (I) previous experience with self-medication consultations, (II) possible reasons for declining self-medication consultations, (III) the attitude towards information gathering and (IV) expectations of self-medication consultations. (I) 92% of the 963 respondents stated they were generally satisfied with self-medication consultations in community pharmacies. Around one-fifth of all respondents claimed that they would like to be asked more health-related questions (22%) and receive more information on non-prescription drugs (20%). (II) Privacy issues (39%) and reluctance to talk about some medical conditions (43%) were the most frequent reasons for declining self-medication consultation. (III) Respondents understood the need for answering guideline-recommended questions (85-96%) and did not mind being asked these questions (70-96%). (IV) Most of the respondents expected to be counselled even if they did not ask for it directly (69%). Pharmacies were further expected to recommend the best drug, even if it was not what the customer initially intended to buy (87%). However, more than half of the respondents would consider counselling as unimportant if they knew exactly which medication they wanted to buy (56%) or if they had used the non-prescription drug before (70%). The majority also expected to receive guideline-recommended drug information (each item at least 52%). Thus, our study shows that respondents were mostly in line with the required standards of self-medication counselling guidelines. Customers expect high-quality counselling on self-medication. These findings support pharmaceutical staff's understanding of customers' barriers and expectations during self-medication consultations.

Factors associated with patient satisfaction towards pharmacy services among out-patients attending public health clinics: Questionnaire development and its application

Introduction

Patient satisfaction is widely used to measure quality of healthcare by identifying potential areas for improvement. Aim of study is to assess patient satisfaction towards pharmacy services and its associated factors using newly developed questionnaire among outpatients attending public health clinics.

Materials and methods

Public Health Clinic Patient Satisfaction Questionnaire (PHC-PSQ) towards pharmacy services was developed using exploratory factor analysis and Cronbach’s α. A cross-sectional study was conducted among 400 patients visiting the pharmacy in three randomly selected public health clinics recruited via systematic random sampling. Data was collected using a set of questionnaire including PHC-PSQ. Factors associated with patient satisfaction was analysed using multiple linear regression.

Results

Final PHC-PSQ consisted of three domains (administrative competency, technical competency and convenience of location) and 22 items with 69.9% total variance explained. Cronbach's α for total items was 0.96. Total mean score for patient satisfaction was 7.56 (SD 1.32). Older age and higher education were associated with lower patient satisfaction mean score. Patients who had visited the pharmacy more than once in the past three months, perceived to be in better health status and had a more correct general knowledge of pharmacists expressed higher patient satisfaction mean score.

Conclusions

PHC-PSQ is a newly developedtool to measure patient satisfaction towards pharmacy services in public health clinics in Malaysia. Patient satisfaction was relatively high. Age, education, frequency of visit, self-perceived health status and general knowledge of pharmacists were factors significantly associated with patient satisfaction.

Promoting Community Pharmacy Practice for Chronic Obstructive Pulmonary Disease (COPD) Management: A Systematic Review and Logic Model

Purpose

This study aimed 1) to identify and analyse the professional services provided by community pharmacists for chronic obstructive pulmonary disease (COPD) management; and 2) to develop a logic model for community pharmacy practice for COPD management.

Methods

A systematic review with a logic model was applied. English-language databases (PubMed, Web of Science, Embase, and Scopus) and a Chinese database (CNKI) were searched for articles published between January 2009 and June 2019. Studies concerning pharmacists and COPD were identified to screen for studies that focused on professional services provided at a community pharmacy level. Evidence on economic, clinical, and humanistic outcomes of interventions was summarized.

Results

Twenty-five articles were included in this study. Four categories of COPD-related interventions by community pharmacists were identified: 1) primary prevention; 2) early detection; 3) therapy management; and 4) long-term health management. The most common outputs examined were improvement in inhaler technique, medication adherence, and rate of smoking cessation. The clinical (improved quality of life, reduced frequency and severity of symptoms and exacerbation), humanistic (patient satisfaction), and economic (overall healthcare costs) outcomes were tested for some interventions through clinical studies. Contextual factors concerning pharmacists, healthcare providers, patients, facilities, clinic context, and socio-economic aspects were also identified.

Conclusion

Studies in the literature have proposed and examined different components of professional services provided by community pharmacists for COPD management. However, relationships among outcomes, comprehensive professional services of community pharmacists, and contextual factors have not been systematically tested. More well-designed, rigorous studies with more sensitive and specific outcomes measures need to be conducted to assess the effect of community pharmacy practice for COPD management.

What free services do pharmacists offer? Investigating the provision of unfunded pharmacy services in community pharmacies

BACKGROUND

Globally, pharmacists report to be providing free or partially subsidised patient-focused services in order to meet healthcare needs of their communities. Budget cuts to pharmacy contracts are reported to challenge the provision of such services. Limited information exists identifying the types of unfunded services provided in community pharmacies.

OBJECTIVES

To identify the types of services which pharmacists report to provide that are not reimbursed by the government, insurance companies or paid for by the patient.

METHODS

Semi-structured focus group discussions with pharmacists were conducted stimulating narratives from community pharmacists across New Zealand about the types of unfunded pharmacy services they provide. Discussions were audio recorded and transcribed verbatim. Inductive coding of the data was carried out using QSR International Nvivo 11 for Windows. A semantic thematic analysis was carried out.

RESULTS

Twenty-four pharmacists took part in the focus groups across five regions in both the North and South Islands of New Zealand. Key themes identified from focus groups were: 'Standalone unfunded services', 'Services funded elsewhere' and 'Leakages from the current funding model'. Pharmacists reported that unfunded patient-focused services accounted for 15%-50% of their daily activities. Pharmacists stated that they believed these services often led to reduction of disease progression, hospitalisations and improved quality of life. Pharmacists also stated that given budget cuts, these services are not sustainable.

CONCLUSIONS

Pharmacists report to offer many professional services without remuneration. In some cases, these services make up a substantial part of the pharmacist's time. Further budgetary constraints and increased competition may put these services at risk of being lost. Findings from this study can be applied to unfunded pharmacy services elsewhere, as worldwide pharmacy faces many similar challenges, particularly where there are budget cuts and decreasing revenue in other jurisdictions.

Satisfaction and experiences of patients taking fingolimod and involved in a pharmacy-based patient support program in Switzerland - a qualitative study

BACKGROUND

Fingolimod is an oral multiple sclerosis drug that is considered a specialty drug due to its high cost and safety issues. The Fingolimod Patient Support Program (F-PSP) is a specialty pharmacy service developed to ensure the responsible use of fingolimod by promoting patient safety and medication adherence. This study aims to explore the satisfaction, experiences and perceptions regarding the F-PSP among patients currently involved in this program or recently withdrawn.

METHODS

A qualitative study was conducted via individual, face-to-face semistructured interviews with patients involved in the F-PSP. The interviews were audio-recorded, transcribed verbatim, coded and analyzed via thematic content analysis.

RESULTS

The main themes identified from the interviews (n = 17) were overall perception of the F-PSP, perception of the pharmacist-led consultations, perception of the tools (electronic monitor and drug intake graph), reasons to participate or potentially withdraw, and suggestions for improvements. Participants perceived the F-PSP as a reassuring support that complemented their medical care, providing a more human, personalized and person-centered approach than usual pharmacy care. Pharmacist-led consultations were valued for the medication-related and holistic support they provided. The importance of the pharmacist's attitude was emphasized. The electronic monitor was valued for promoting daily medication adherence and allowing the involvement of relatives, which reassured participants and their relatives. The participants appreciated the drug intake graph because it provided an objective overview of medication adherence, thereby reassuring, rewarding, and motivating them. The main reason to join the program was to be supported, especially with respect to medication adherence.

CONCLUSIONS

Participants were satisfied with the F-PSP, each for different reasons. Their feedback enabled the identification of measures for the optimization of the F-PSP and should facilitate its dissemination and transfer to other drugs/diseases/populations. Essential elements of generic pharmacist-led patient support programs considered valuable from the patients' perspective were identified.

Patient Experiences at Enhanced-Service Pharmacies in Iowa

Objectives

As payment systems are evolving, the role of community pharmacists has expanded from simply dispensing prescriptions to actively providing care to patients. Little is known about patients' experiences with enhanced pharmacy services under the pay-forperformance model. In Iowa, Wellmark implemented its Value-Based Pharmacy Program (VBPP) where pharmacists receive capitation for performance on a set of quality measurements. Therefore, the objective of this study was to evaluate the quality of services and pharmacies from patients' perspective in VBPP. A structured interview guide developed from the service quality model was used for this study.

Methods

We conducted telephone interviews with patients from 6 community pharmacies participating in VBPP between December 2017 and January 2018. Patients who were aged between 21 and 90 years, had Wellmark prescription drug coverage, were currently on at least three medications with one or more of the medications for a chronic condition and had received enhanced pharmacy services were invited for the study. The semi-structured interview transcripts were coded and analyzed using an inductive approach of thematic analysis.

Results

Interviews were completed by 25 patients. Most of them were female and the average age was 59. More than half of the patients were taking at least five medications for chronic conditions. A majority of the patients received medication synchronization and immunization. A total of 13 themes across the service quality dimensions were identified. Patients thought their pharmacists were reliable, responsive, knowledgeable and trustworthy when they provided services. Pharmacy services were accessible and perceived as high quality. Privacy was not a big concern for most patients. Patients had a somewhat limited view regarding how pharmacists helped them maintain health.

Conclusion

Patients' perceptions of enhanced pharmacy services and pharmacies were generally positive while their understanding of pharmacists' clinical role was limited.

Comparison of patient satisfaction with pharmaceutical services of postal pharmacy and community pharmacy

Background

The growing drive in South Africa to contain medicine cost has seen the emergence of postal pharmacy as an alternative mechanism to dispense chronic medicines. Patient satisfaction with pharmaceutical services has received limited attention in South Africa.

Aim

The aim of this study was to compare the level of patient satisfaction with pharmaceutical services between postal and community pharmacies.

Setting

The research was conducted in the eThekwini Municipality, KwaZulu- Natal Province, South Africa in July and August 2014.

Methods

A cross-sectional quantitative study using a randomised, telephonic questionnaire survey was conducted. Selected land telephone numbers were called until a sample size of 250 community pharmacy participants and 125 postal pharmacy participants was obtained.

Results

Nine hundred and five telephone calls were made to obtain a sampling frame of 375 (41.44%) respondents, 250 for community and 125 for postal. After adjusting overall satisfaction by removing financial satisfaction, there was no significant difference between satisfaction in the two groups (p = 0.471). Postal pharmacy participants reported a higher level of financial satisfaction (p = 0.001). Community pharmacy participants reported a higher level of satisfaction with counselling or explanation (p = 0.028) and less medicine wastage (p < 0.001).

Conclusions

Patient satisfaction with pharmaceutical services provided by either community or postal pharmacy was not significantly different. However, community pharmacies tend to address patients' specific concerns more effectively. With the move to National Health Insurance, policymakers need to ensure that they provide high-quality pharmaceutical services and are more inclusive of community pharmacies to deliver quality care.

The patient experience in a community pharmacy mental illness and addictions program

Background

The Bloom Program was designed to enhance pharmacists' care of people with lived experience of mental illness and addictions in Nova Scotia. The Program's demonstration period was from September 2014 to December 2016 and included a qualitative evaluation of the patient experience.

Methods

Patients were recruited for individual interviews through Bloom Program pharmacies. Interviews were transcribed verbatim and analyzed following Braun and Clarke's 6-step approach for thematic analysis.

Results

Ten patients were interviewed between May and June 2016. Ten themes were determined through data analysis and included medication management, accessing pharmacists in a new way, providing social support, bridging service gaps, providing interim care, reducing financial barriers, navigation and advocacy, holistic approaches, empowerment through knowledge and awareness and collaboration.

Discussion

Pharmacists expectedly provided medication management activities to patients for both physical and mental health concerns in the Bloom Program. Many activities conducted with Bloom Program patients fell outside of dispensing roles and medication management. These activities, such as social support, triage, navigation and increasing access, which were highly valued by patients, are poorly measured and assessed in pharmacy practice research.

Conclusion

Participants in the Bloom Program reported the significant contributions of pharmacists and pharmacy teams in their overall health and wellness. Future evaluations of interventions like the Bloom Program should include measurement of constructs valued by patients and also consider impacts on inequalities and inequities. Pharmacy practice researchers can benefit from other research and evaluation being conducted for primary care interventions.

A new model for pharmacies? Insights from a quantitative study regarding the public's perceptions

BACKGROUND

Worldwide community pharmacies are shifting their role in the healthcare system from simple medication dispensers to health care providers. High levels of satisfaction with pharmacy services were found in previous studies. This study has two main goals. The primary goal is to describe the levels of satisfaction and knowledge regarding pharmacy services in Portugal. The secondary goal is to explore the perceptions and the utilisation of pharmacy services by the Portuguese. This statement includes exploring the impact of a set of variables on both perceptions and uses of pharmacies in regard to services that are currently offered as well as to new services that may be provided in the future.

METHODS

A face-to-face survey of closed-ended questions was applied to a nationwide representative sample of the Portuguese population in September 2015. The sample was weighted based on population distribution across regions, habitat, age and gender. Data analysis comprises descriptive statistics and Multiple Correspondence Analysis to explore different typologies of respondent's orientation toward community pharmacy.

RESULTS

A total of 1114 interviews comprised the study. Of the respondents, 36% used the pharmacy as a first resource when seeking to treat a minor ailment, and 54% reported that they use the pharmacy as a first resource when seeking answers about medicines. Of those who visited their pharmacy at least once in the previous year, 94% were either globally satisfied or very satisfied. The level of acknowledgement of pharmacy services' was also high among the Portuguese. Of the participants, 29% considered there could be more services available in pharmacies that are currently provided by other health care facilities. The construction of a typology of orientations towards community pharmacy practice resulted in three outcome groups: "Motivated" (63%), those with a connection to a pharmacy; "Settled" (23%), mainly those who had a pharmacy nearby; and "Demobilised" (14%), those who are weakly tied to a pharmacy.

CONCLUSIONS

The vast majority of the Portuguese population has a strong positive attitude towards their community pharmacy, as expressed by the high levels of satisfaction with, and positive evaluation of, the pharmacy's services.

Factors influencing national implementation of innovations within community pharmacy: a systematic review applying the Consolidated Framework for Implementation Research

Background

To meet emergent healthcare needs, innovations need to be implemented into routine clinical practice. Community pharmacy is increasingly considered a setting through which innovations can be implemented to achieve positive service and clinical outcomes. Small-scale pilot programmes often need scaled up nation-wide to affect population level change. This systematic review aims to identify facilitators and barriers to the national implementation of community pharmacy innovations.

Methods

A systematic review exploring pharmacy staff perspectives of the barriers and facilitators to implementing innovations at a national level was conducted. The databases Medline, EMBASE, PsycINFO, CINAHL, and Open Grey were searched and supplemented with additional search mechanisms such as Zetoc alerts. Eligible studies underwent quality assessment, and a directed content analysis approach to data extraction was conducted and aligned to the Consolidated Framework for Implementation Research (CFIR) to facilitate narrative synthesis.

Results

Thirty-nine studies were included: 16 were qualitative, 21 applied a questionnaire design, and 2 were mixed methods. Overarching thematic areas spanning across the CFIR domains were pharmacy staff engagement (e.g. their positive and negative perceptions), operationalisation of innovations (e.g. insufficient resources and training), and external engagement (e.g. the perceptions of patients and other healthcare professionals, and their relationship with the community pharmacy). Study participants commonly suggested improvements in the training offered, in the engagement strategies adopted, and in the design and quality of innovations.

Conclusions

This study’s focus on national innovations resulted in high-level recommendations to facilitate the development of successful national implementation strategies. These include (1) more robust piloting of innovations, (2) improved engagement strategies to increase awareness and acceptance of innovations, (3) promoting whole-team involvement within pharmacies to overcome time constraints, and (4) sufficient pre-implementation evaluation to gauge acceptance and appropriateness of innovations within real-world settings. The findings highlight the international challenge of balancing the professional, clinical, and commercial obligations within community pharmacy practice. A preliminary theory of how salient factors influence national implementation in the community pharmacy setting has been developed, with further research necessary to understand how the influence of these factors may differ within varying contexts.

Trial registration

A protocol for this systematic review was developed and uploaded onto the PROSPERO international prospective register of systematic reviews database (Registration number: CRD42016038876).

Electronic supplementary material

The online version of this article (10.1186/s13012-019-0867-5) contains supplementary material, which is available to authorized users.

Consumers' Perceptions About Pharmaceutical Care Provided by Community Pharmacists in China in Relation to Over-the-Counter Drugs: A Qualitative Study

While patient-centered care is highly anticipated nowadays, investigation of consumers’ perceptions and expectations about pharmacist’s pharmaceutical care when providing over-the-counter (OTC) drugs is sparse. This article aimed to explore consumers’ perceptions regarding the pharmaceutical care that community pharmacists provide in relation to OTC drugs. Semistructured interviews were conducted with consumers recruited (N = 97) in Yinchuan City, China. The 4 main themes that emerged were expectations on pharmaceutical care, attitude toward pharmacist’s competence, experience of self-medication, and suggestions for improving pharmaceutical care. Most participants had high expectations on community pharmacists to recommend the right medicines, to advise them about the effective use of drug, to advise them about the safe use of drug, and to recommend economic drugs. However, their previous experiences at community pharmacy were far from satisfaction reportedly, leading to a general distrust in pharmacist’s certification and qualification, knowledge, communication skills, and attitude. As a result, the participants turned to self-medication based on their personal experiences, their relatives’ experiences, the information on drug label, and the information distributed in the mass media. Realizing the need to improve pharmaceutical care, the participants also made improvement suggestions specific to community pharmacist, community pharmacy, and the government.

Patients' Anticipation for the Pharmacies of Rural Communities: A Qualitative Study from Pakistan

Background: Community pharmacies are an integrated part of healthcare systems worldwide. In low and middle income countries like Pakistan, the paradigm of pharmacy practice is shifting from dispensing medicines to clinical activities. There are disparities in these practices according to location. Pharmacies in urban localities are better than those in rural areas. This qualitative study was conducted to explore patients' expectations and current practices in rural pharmacies. Methods: A cohort of adult pharmacy visitors (aged > 18 years) that reside in rural community was selected. Consenting participants were recruited by purposive sampling technique until thematic saturation level was achieved. A total of 34 patients were interviewed. Face-to-face interviews were conducted using a semi structured interview guide. All the data were transcribed and used to originate the themes. Results: On analysis, a total of 20 themes were obtained. Sixteen themes pronounced the current provided services. Four themes provided some suggestions for the development of better pharmacies. On call services to provide medicines, limited free extended pharmacy services, interest in patients' wellbeing, appropriate referral, vaccination, free medical camp, medical services at home, first aid, and counseling were appreciated by patients. Patients stated that medicines are inappropriately stored in unhygienic conditions, prices of medicines are comparatively high, and medicines are substandard. Unavailability of medicines, inept dispensing, limited staffing with poor knowledge, limited working hours, and quackery promotion are challenges in rural pharmacy practice. Patients say that non marginal pricing, informative services, new legislation, and proper vigilance by officials can improve the pharmacy services in rural communities. Conclusions: Patients alleged that rural pharmacies perform deprived practices. To improve service, new legislation and the proper implementation of existing law is needed.

Patient Satisfaction with Community Pharmacies Services: A Cross-Sectional Survey from Punjab; Pakistan

Purpose: Patient satisfaction can identify specific areas of improvement in community pharmacy services. Currently in Pakistan, no evidence exists in this regard. This study was conducted to determine the needs of patients and the current standards of pharmacies. Methods: A cross-sectional study was conducted between October 2016 and June 2017. A pilot tested questionnaire was used to collected the data from 1088 patients of 544 community pharmacies. Likert scale and one way ANOVA was used to analyze the data. Results: The response rate of community pharmacies was 80% and that of purchasers was 68.1%. The mean age of participants was 35.2 years. The mean overall satisfaction score of participants was 2.78/5.00. Many patients were dissatisfied (1.65/5.00) with parking facilities provided by pharmacies. Pharmacy service time fulfilled the requirements of most patients (4.16/5.00). The counseling person’s good attitude (3.99/5.00) was credited by purchasers. Level of patient satisfaction with the availability of medicines (3.19/5.00), safe storage of medicines in pharmacy stores (3.66/5.00), and quality of medicines (3.41/5.00) were almost moderate. Many patients were very satisfied (4.35/5.00) with readable instructions for their medications. Approximately half of the patients were dissatisfied with the waiting time. Many patients were also dissatisfied (2.28/5.00) with the knowledge of the counseling person. Patients perceived that staff interest in patient recovery (2.24/5.00) was low. No significant difference in level of satisfaction with regard to participant’s characteristics was found. Conclusions: The current study demonstrated a low level of patient satisfaction with regard to community pharmacy services in Pakistan. These services need improvement.

Assessing patient satisfaction with the Medication Management Review service delivered in Jordan

Objective

To investigate the effect of the Medication Management Review (MMR) service on the number of treatment-related problems (TRPs), patient satisfaction and factors affecting patient satisfaction.

Methods

This prospective, randomized controlled trial was conducted at community pharmacies in Amman, Jordan. Eligible patients were randomized into active and control groups. A validated Pharmaceutical Care Manual was used for data collection and to identify TRPs for both groups. Identified TRPs for patients in the active group were resolved at the pharmacist level or sent to the patients’ physicians for approval and implementation. Patients in both groups were followed up at 3 months to determine the number of TRPs end of the study. Patients in the active group completed a validated, Likert scale MMR-satisfaction questionnaire. Factors affecting satisfaction were assessed through multiple regression analysis.

Key findings

Outpatients with chronic conditions (n = 160) were recruited into the study, with mean age 53.01 ± 15.39; mean number of medical conditions of 3.56 ± 1.15 and 4.73 ± 1.79 mean number of medications. A mean number of 5.37 ± 3.01 TRPs per patient was identified, with no significant difference between both groups (active group n = 82, 5.57 ± 2.68; control n = 78, 5.18 ± 3.36, P = 0.412). At follow-up, significantly lower number of TRPs were identified for patients in the active group compared to patients in the control group (1.06 ± 1.30 versus 4.53 ± 3.43, P &lt; 0.001). Majority of patients were satisfied/very satisfied with the service (n = 77, 94.5%). A lower number of TRPs at follow-up (B = −0.438; t = −4.477, P &lt; 0.001) and higher number of TRPs agreed upon and implemented (B = 0.553; t = 6.949, P &lt; 0.001) were significantly associated with higher level of patient satisfaction.

Conclusion

The MMR has proven to be an effective pharmaceutical care service when delivered in a developing country, such as Jordan. It led to high patient satisfaction, which was significantly associated with lower number of TRPs at follow-up.

Patient satisfaction with a chronic kidney disease risk assessment service in community pharmacies

BACKGROUND

Patient satisfaction is an important determinant of the feasibility and sustainability of community pharmacy screening services. However, few studies have evaluated this, with no such study performed for a chronic kidney disease risk assessment service.

OBJECTIVE

The aim was to determine patient satisfaction with a chronic kidney disease risk assessment service performed in community pharmacies.

SETTING

Community pharmacies in the state of Tasmania, Australia.

METHOD

An anonymous nine-item satisfaction survey, with Likert-type scales, was developed following a literature review of existing surveys. Reliability of the nine-item scale was determined using Cronbach's alpha. Patients were asked an additional question on willingness to pay, with choices of amount from $5 to $25. The satisfaction survey was mailed to 389 patients who participated in the chronic kidney disease risk assessment study.

MAIN OUTCOME MEASURE

Patient level of satisfaction with and willingness to pay for the chronic kidney disease service.

RESULTS

Responses from 143 participants were included in the final analysis. Cronbach's alpha for the nine-item satisfaction scale was 0.87. The majority of participants agreed that the time required to undergo the risk assessment process was justified (90.2%); overall, they were satisfied with the chronic kidney disease risk assessment service (90.0%) and they felt comfortable with the pharmacist referring their results to their doctor (88.9%). Of 136 participants who answered the question on willingness to pay, 62.9% indicated that they would pay for the chronic kidney disease service. Of these, 29.2, 25.8 and 19.1% were willing to pay $20, $10 and $5, respectively.

CONCLUSION

Patient satisfaction with the community pharmacy-based chronic kidney disease risk assessment was high. These findings provide support for the implementation of the service within community pharmacy practice.

Nível de satisfação dos usuários e verificação do conhecimento dos farmacêuticos em farmácias públicas do Espírito Santo, Brasil

Resumo O objetivo do presente estudo foi determinar o nível de satisfação dos usuários de farmácias públicas e verificar o conhecimento dos farmacêuticos com relação à dispensação de medicamentos. Trata-se de um estudo descritivo, realizado em municípios de uma mesma região, no interior do Estado do Espírito Santo, no período de maio a agosto de 2013. Os dados foram coletados por meio de questionário estruturado. Para a análise estatística, foi utilizado o Software SPSS20. Para os dados que apresentaram distribuição normal foram aplicados o teste t student ou ANOVA, enquanto que para os demais foram aplicados os testes Mann-Whitney ou Kruskal -Wallis. A correlação de Spearman foi utilizada para avaliar a satisfação do paciente em relação ao tempo de atendimento e ao tempo de espera. O nível de significância adotado para os testes foi de 5%. Os principais resultados obtidos foram o alto nível de insatisfação por parte dos usuários e a correlação com o tempo de espera até o atendimento. Além disso, o conhecimento dos farmacêuticos em relação à dispensação foi classificado como satisfatório/regular. Conclui-se que são necessárias medidas na gestão de serviços farmacêuticos para atender as expectativas dos usuários na dispensação de medicamentos.

Investigating the organisational factors associated with variation in clinical productivity in community pharmacies: a mixed-methods study

Background

Community pharmacies play a key role in health-care systems, dispensing prescriptions and providing medicine-related services. Service provision varies across community pharmacy organisations and may depend on organisational characteristics, such as ownership, staffing and skill mix.

Objectives

To inform the commissioning of community pharmacy services by (1) exploring variation in clinical productivity (levels of service delivery and service quality) in pharmacies, (2) identifying the organisational factors associated with this variation and (3) developing a toolkit for commissioners.

Design

Mixed-methods study: community pharmacy survey, administrative data analysis, patient survey, stakeholder interviews and toolkit development.

Setting

Nine socioeconomically diverse geographical areas of England.

Participants

Stage 1: community pharmacies in nine study areas. Stage 2: in 39 pharmacies, two consecutive samples of approximately 30 patients each following receipt of (1) dispensing and (2) medicines use review (MUR) services. Pharmacy and commissioning representatives from across all types of pharmacy and study sites.

Main outcome measures

Stage 1: dispensing, MUR, new medicines service volume and safety climate. Stage 2: patient satisfaction, Satisfaction with Information about Medicines Scale (SIMS) and Medication Adherence Report Scale (MARS).

Data sources

Stage 1: (i) community pharmacy activity data; (ii) socioeconomic and health needs data; and (iii) community pharmacy questionnaire (ownership type, organisational culture, staffing and skill mix, working patterns, management structure, safety climate, pharmacy–general practice integration), all linked by pharmacy postcode and organisational ‘F’ code. Stage 2: (i) patient questionnaire (background, patient satisfaction, SIMS, MARS); (ii) semistructured stakeholder interviews (variation in quantity and quality of service provision, opportunities and barriers to clinical productivity, mechanisms by which different organisational characteristics may help or hinder clinical productivity). Quantitative data were analysed by fitting a series of fixed-effects linear, logistic and multilevel logistic regression models in Stata® (version 13; StataCorp LP, College Station, TX, USA). Qualitative data were analysed thematically using a framework approach in NVivo10 (QSR International, Warrington, UK).

Results

In stage 1, 285 out of 817 pharmacy questionnaires were returned [valid response rate 34.6% (277/800)]. In stage 2, 1008 out of 2124 patient questionnaires were returned [valid response rate 46.5% (971/2087)]. Thirty pharmacy and 10 commissioning representatives were interviewed face to face or by telephone. Following integration of stage 1 and 2 findings, clinical productivity was associated with pharmacy ownership type, organisational culture, staffing and skill mix, and pharmacy–general practice relationships. Extra-organisational associations included local area deprivation, age profile and health needs, pharmacy location, public perceptions and expectations, supply chain problems, commissioning structures/processes, levels of remuneration and legal/regulatory constraints. Existing arrangements for monitoring clinical productivity focused primarily on quantity.

Limitations

Non-random selection of study sites and non-participation by four major pharmacy chains limited generalisability. Investigation of the full scope of pharmacy service provision was prevented by a lack of available activity data for locally commissioned services. Quantitative exploration of service quality was limited by available validated measures.

Conclusions

These findings have important implications for community pharmacies and service commissioners, highlighting the importance of ownership type, organisational culture, staffing and skill mix for maximising the delivery of high-quality pharmacy services and informing the development of a commissioners’ toolkit.

Future work

Future studies should (1) develop tools to measure community pharmacy service quality; (2) describe and evaluate different models of skill mix; and (3) explore how services are commissioned locally from community pharmacies and the extent to which local needs are met.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

Customers' perceptions of and satisfaction with medicine retail outlet services in Addis Ababa, Ethiopia: a cross-sectional study

OBJECTIVES

The aim of this study was to assess customers' perceptions of and satisfaction with MRO services in Addis Ababa and to explore factors associated with their satisfaction and reasons for visits.

METHODS

A cross-sectional survey was conducted among customers selected from 28 MROs in Addis Ababa, using multi-stage sampling techniques. Simple descriptive statistics and multivariable logistic regression at 95% confidence interval were used for the analysis.

KEY FINDINGS

Of 396 respondents, 324 (81.8%) visited MROs to purchase prescription medicines. A majority (338/396; 85.4%) of them perceived that pharmacists and druggists (pharmacy professionals) play a major role in healthcare delivery. A third (140/396; 35.4%) of the respondents agreed with the statement that pharmacy professionals are more concerned about patient care than about their business. Regarding reasons for visiting, being married was positively associated with buying over-the-counter, higher educational status was linked with more satisfaction. Overall, 56.8% (225/396) of the respondents reported that they were satisfied with the service provided by MROs.

CONCLUSION

Customers of MROs had mixed perceptions of and satisfaction with the current service. Marital status and age were associated with the reason for visiting, while the educational level was associated with the level of satisfaction. The overall positive perceptions and satisfaction about MROs should be taken as an opportunity to promote and improve pharmaceutical services rendered in MROs, to ensure that the public is receiving maximum benefit.

The impact of a person-centred community pharmacy mental health medication support service on consumer outcomes

BACKGROUND

Mental illness is a worldwide health priority. As medication is commonly used to treat mental illness, community pharmacy staff is well placed to assist consumers.

AIM

To evaluate the effectiveness of a multifaceted, community pharmacy medication support service for mental health consumers.

METHOD

Pharmacists and pharmacy support staff in three Australian states were trained to deliver a flexible, goal-oriented medication support service for adults with mental illness over 3-6 months. Consumer-related outcome measures included perceptions of illness and health-related quality of life, medication beliefs, treatment satisfaction and medication adherence.

RESULTS

Fifty-five of 100 trained pharmacies completed the intervention with 295 of the 418 recruited consumers (70.6% completion rate); 51.2% of consumers received two or more follow-ups. Significant improvements were reported by consumers for overall perceptions of illness (p < 0.001), the mental health domain of quality of life (p < 0.001), concerns about medication (p = 0.001) and global satisfaction with medication (p < 0.001). Consumers also reported an increase in medication adherence (p = 0.005).

CONCLUSIONS

A community pharmacy mental health medication support service that is goal-oriented, flexible and individualised, improved consumer outcomes across various measures. While further research into the cost-effectiveness and sustainability of such a service is warranted, this intervention could easily be adapted to other contexts.

Marketing activity in the community pharmacy sector - A scoping review

BACKGROUND

Community pharmacy ownership requires engaging with marketing strategies to influence consumer behaviour. There is a plethora of information from trade journals, expert opinion, and published discussion surrounding this issue. Despite this, evidence relating to the efficacy of marketing activity within the pharmacy sector is scant.

OBJECTIVES

To review how marketing activity has been conceptualised in the community pharmacy sector and to determine the evidence for the effect of marketing activity.

METHODS

Seven databases were systematically searched using a scoping review framework with the reporting protocol of PRISMA-P. The search yielded 33 studies that were analysed for year of publication, journal, country of focus, and framework of marketing.

RESULTS

The majority of marketing research papers focused on the United States and were published in healthcare journals. These were various marketing strategy elements, including; segmentation, targeting, differentiation, and positioning. Also evident was research regarding marketing mix, which predominately involved the "4Ps" model. Actual marketing activity comprised little of the research.

CONCLUSIONS

Research into marketing activity in community pharmacy is limited, and little evidence is available to show the effects of such activities. Future research needs to demonstrate the causality for the effect of marketing activities on consumer behaviour and economic outcomes.