Behavioural aspects surrounding medicine purchases from pharmacies in Australia

When procedures meet practice in community pharmacies: qualitative insights from pharmacists and pharmacy support staff

OBJECTIVES

Our aim was to explore how members of community pharmacy staff perceive and experience the role of procedures within the workplace in community pharmacies.

SETTING

Community pharmacies in England and Wales.

PARTICIPANTS

24 community pharmacy staff including pharmacists and pharmacy support staff were interviewed regarding their view of procedures in community pharmacy. Transcripts were analysed using thematic analysis.

RESULTS

3 main themes were identified. According to the 'dissemination and creation of standard operating procedures' theme, community pharmacy staff were required to follow a large amount of procedures as part of their work. At times, complying with all procedures was not possible. According to the 'complying with procedures' theme, there are several factors that influenced compliance with procedures, including work demands, the high workload and the social norm within the pharmacy. Lack of staff, pressure to hit targets and poor communication also affected how able staff felt to follow procedures. The third theme 'procedural compliance versus using professional judgement' highlighted tensions between the standardisation of practice and the professional autonomy of pharmacists. Pharmacists feared being unsupported by their employer for working outside of procedures, even when acting for patient benefit. Some support staff believed that strictly following procedures would keep patients and themselves safe. Dispensers described following the guidance of the pharmacist which sometimes meant working outside of procedures, but occasionally felt unable to voice concerns about not working to rule.

CONCLUSIONS

Organisational resilience in community pharmacy was apparent and findings from this study should help to inform policymakers and practitioners regarding factors likely to influence the implementation of procedures in community pharmacy settings. Future research should focus on exploring community pharmacy employees' intentions and attitudes towards rule-breaking behaviour and the impact this may have on patient safety.

Exploring health literacy competencies in community pharmacy

BACKGROUND

Health literacy is the ability to obtain, interpret and use health information. Low rates of health literacy in Australia have been suggested, but no validated measure exists.

OBJECTIVE

To explore health literacy competencies in a sample of community pharmacy consumers.

DESIGN

Structured interviews were undertaken by a team of researchers during August, 2009. The instrument was derived from available literature, measuring aspects of functional, interactive and critical health literacy regarding use of medicines.

SETTING AND PARTICIPANTS

Twelve community pharmacies in the Brisbane region, Australia.

RESULTS

Six hundred and forty-seven consumers participated; 64% were women. A wide distribution of ages was evident. English was the first language of 89% of respondents. More than half of the sample (55%), predominantly aged 26-45 years, was tertiary educated. While 87% of respondents recognized a sample prescription, 20% could not readily match the prescription to a labelled medicine box. Eighty-two percentage of respondents interpreted 'three times a day' appropriately, but interpretation of a standard ancillary label was highly variable. Advanced age, less formal education, non-English-speaking background and male gender were independently related to lower performance in some variables.

DISCUSSION

This health literacy measure applied comprehension and numeracy skills required of adults receiving prescription medications. While the majority of consumers adequately performed these tasks, some behaviours and responses were of sufficient concern to propose additional verbal and written information interventions by pharmacy staff.

CONCLUSIONS

This research provides insight into issues that may affect consumers' appropriate use of medicines and self-efficacy. Initiatives to improve public health literacy are warranted.