By: Ali M. K. Hindi BPharm, MScEllen I. Schafheutle PhD, MRes, MSc, FFRPSSally Jacobs BSc, PhD
Published in Health Expectations, An Internation Journal of Public Participation in Health Care and Health Policy
08 November 2017
Abstract
Background
The United Kingdom has been at the forefront of enhancing pharmacist roles and community pharmacy services, particularly over the past decade. However, patient and public awareness of community pharmacy services has been limited.
Objective
To identify and synthesize the research literature pertaining to patient and public perspectives on: existing community pharmacy services, extended pharmacist roles and strategies to raise awareness of community pharmacy services.
Search strategy & inclusion criteria
Systematic search of 8 electronic databases; hand searching of relevant journals, reference lists and conference proceedings. UK studies investigating patient or public views on community pharmacy services or pharmacist roles from 2005 to 2016.
Introduction
In recent decades, the advancement of the pharmacy profession has seen a movement away from a traditional supply function towards more clinically orientated activities. Community pharmacies are the most frequently visited health‐care destinations leading policymakers to recognize the importance of extending community pharmacists’ roles to meet growing public demands. This has led to novel reimbursement structures being implemented across many health‐care systems, including Australia, Canada, New Zealand and the United States, which fund cognitive services as well as medicines supply.
Findings
- Public cognizance
- The theme of public cognizance concerned how community pharmacies are held within the mindset of patients and the public.
- The theme of public cognizance concerned how community pharmacies are held within the mindset of patients and the public.
- Awareness and use of pharmacy services
- Low public or patient awareness of extended pharmacy services was a common finding. The pharmacy setting appeared to be portrayed as a dispensary (medicines supply) and place for medicines purchase as well as advice on minor ailments. Nearly half (48.3%) of participants in one study chose “to dispense” as the most common reason for using pharmacies followed by the purchase of medicinal (22%) and non‐medicinal products.
- Low public or patient awareness of extended pharmacy services was a common finding. The pharmacy setting appeared to be portrayed as a dispensary (medicines supply) and place for medicines purchase as well as advice on minor ailments. Nearly half (48.3%) of participants in one study chose “to dispense” as the most common reason for using pharmacies followed by the purchase of medicinal (22%) and non‐medicinal products.
- Perceptions of pharmacists
- Patient and public perceptions of pharmacists seemed to influence their preferences for pharmacy‐led services. There appeared to be resistance to acknowledge the pharmacist as an essential member of the health‐care team. Members of the public rated the importance of pharmacist roles with regard to certain public health issues relatively low in a questionnaire study, whilst activities linked to their traditional roles such as advice on medication usage, side‐effects and disposal were rated highest. Only 1% of patients in a survey chose “trust in the pharmacist” as a reason to visit the pharmacy, yet in another survey, trust in pharmacists was high.
- Patient and public perceptions of pharmacists seemed to influence their preferences for pharmacy‐led services. There appeared to be resistance to acknowledge the pharmacist as an essential member of the health‐care team. Members of the public rated the importance of pharmacist roles with regard to certain public health issues relatively low in a questionnaire study, whilst activities linked to their traditional roles such as advice on medication usage, side‐effects and disposal were rated highest. Only 1% of patients in a survey chose “trust in the pharmacist” as a reason to visit the pharmacy, yet in another survey, trust in pharmacists was high.
- Barriers
- Studies repeatedly raised a perceived lack of privacy and confidentiality as a barrier to using extended pharmacy services, with the pharmacy environment not considered an appropriate venue for private discussions. Particular concerns were about busyness and conversations being overheard, particularly regarding private matters. In addition, 2 studies revealed the specific dissatisfaction of service users with supermarket pharmacies in terms of privacy. It was apparent that patients and members of the public were unfamiliar with consultation rooms offered at UK pharmacies since the introduction of the new community pharmacy contracts. One survey demonstrated low utilization of consultation rooms, with only 28.8% and 19.4% of respondents experiencing advice or services in private rooms, respectively.
Discussion
International literature addressing the first theme, “public cognizance,” confirms that low public awareness is not exclusive to the United Kingdom. The considerable lack of awareness of extended pharmacy services and pharmacist roles suggests that more could be done to promote the pharmacy setting as an attractive venue for health‐care delivery. Nevertheless, little has been done in the way of promoting pharmacy services or enhancing public understanding of pharmacists’ knowledge and skills.
Perceptions of physicians being at the top of the health‐care hierarchy were also common in other countries, including Australasia, North America, Europe and Middle East. This is borne out in evidence where physician‐pharmacist collaboration in clinical settings has been shown to significantly improve patient outcomes. However, physicians have shown a reluctance to support pharmacist integration due to their unawareness of extended services. Moreover, physicians believe that clinical roles are better suited for themselves, that pharmacists lack the training or ability to carry out extended roles, and have suspicion of pharmacists’ financial motives. Physicians have also been concerned that extending pharmacist roles and granting them more access to patient information would compromise patient confidentiality and threaten physicians’ health‐care authority. In order to achieve better recognition and integration of physician and pharmacy services, it will be crucial to develop a better understanding of each other’s knowledge, skills and potential contribution to patient care.
Regarding patient and public attitudes towards pharmacy services, international literature confirms findings from this review that the convenience of community pharmacies and having well‐established patient‐pharmacist relationships are key facilitators for the usage of pharmacy services. So if it is indeed important that patients experience services in order to build rapport with their pharmacists, fully acknowledge their worth and consider recommending them to peers, then pubic promotion campaigns can only go so far. Furthermore, when designing effective community pharmacy services, it will be important to take patients’ preferences into account, where access to and convenience of pharmacy services is particularly valued.
Privacy and confidentially of the pharmacy environment, or rather the lack thereof, was considered a major barrier for using advanced pharmacy services. Moreover, patient and public awareness of private consultation rooms remains low, despite their existence being a requirement of the new community pharmacy contract. Furthermore, patients/the public perceived pharmacists’ limited authority to be a barrier for broadening roles. Whilst the introduction of pharmacist independent prescribing in 2006 has gone some way to overcoming this, integration within the wider primary care team remains crucial. The introduction of “summary care records,” a scheme introduced in 2016, which permits a range of health‐care professionals, including pharmacists and pharmacy technicians, to access core clinical and medication information, with the patient’s consent, may prove to be another important step towards integration and autonomy.
Conclusions
This systematic review provides an update of the patient and public perceptions of community pharmacy services since the introduction of a revised contractual framework for community pharmacy in the United Kingdom, which introduced funding for cognitive services. Whilst the majority of the literature suggests that patient and public opinions about community pharmacy services are positive, awareness of pharmacy services beyond medicines supply remains low. Patients still look to their physicians, so successful integration of pharmacy services into the primary care pathway will be essential. For this to be achieved, pharmacists’ clinical skills beyond medicines supply need to be recognized and embraced by patients and physicians alike. Furthermore, potential barriers within pharmacy, such as low pharmacist confidence, reorganization of workload to accommodate high‐quality services effectively and the potential conflict a commercial environment poses, also need to be addressed. Ease of access and convenience of pharmacies present a major advantage for their usage. Future research should explore different approaches to increasing awareness, evaluate the effectiveness of different methods of promotion and understand what the public as well as other stakeholders consider to be effective.
Source: https://onlinelibrary.wiley.com/doi/full/10.1111/hex.12639
Image Source: Unsplash.com
Analysis:
I chose this article because it was rich in information on my focus topic. This article is an analysis of many studies conducted about the public’s perception of pharmacists all over the world, and it points out a lot of key issues. First, there is a lack of public awareness of what pharmacists really do, and for that, they are undervalued and seen as pill clerks. Second, there is a perception of physician supremacy in the health field, in which the physician is seen as the expert and the pharmacist is seen as the assistant who simply gives you the thing the physician told you that you needed. Thereafter, there is a lack of connection between pharmacists and physicians, which creates this confusion and could be a reason why pharmacists are undervalued. Lastly, the environment of the pharmacy itself creates barriers for why patients don’t consult pharmacists more often.
