Background
Methods
Design
Setting and participants
Data collection
1. | What sort of pharmaceutical services do you provide? |
2. | Do you think that the provision of pharmaceutical care would generate more income for you? |
3. | What do you understand by the term “osteoporosis”? |
4. | What would an osteoporosis management service in a pharmacy comprise? |
5. | In your opinion, how aware do you think the general public is about osteoporosis? |
6. | When did you last refer someone with osteoporosis to a doctor? |
7. | Do you face any difficulty when dealing with people with osteoporosis? |
8. | What would encourage you to provide osteoporosis disease state management services? |
9. | If you were to start providing osteoporosis disease state management services, what form of support would you require? |
Theoretical framework
Data analysis
Rigor and trustworthiness
Results
Provision of osteoporosis disease state management services by community pharmacists
“.. all the medications have side effects such as don’t lie down to minimize the risk of side effects, don’t drink coffee after you take Fosamax® and must be compliant, what happen if miss dose, you have to take it immediately, if too close, then skip the previous one, don’t double the dose.” − 31-year-old female
Screening using heel ultrasound
“… Bone scan on (the) ankle might not be that accurate….. (Screening for osteoporosis using heel ultrasound) is also a trigger point for them (clients) to discuss… what osteoporosis (is all about)…”-54-year-old female“…. we can actually utilize the machine, but double edge is when suppliers come in they have something in their mind. (If) I (use) this machine, at the end of the day I would like to have some sales…” – 30-year-old male
Screening using osteoporosis questionnaires
“…. I will just tell (customers) what are the causes… even actually osteoporosis, we can use and calculate based on your age and weight, osteoporosis risk score, you’ll tell them which category fall on.”—30-year-old male
Barriers to providing osteoporosis disease state management services
Lack of public awareness
“So far, we don’t really have (any) customer that comes to the pharmacy and say “I want to prevent osteoporosis,” but they come and say “I want to do blood sugar screening” or the other like cholesterol, but particularly for osteoporosis, nobody comes….”—46-year-old female
“… One of the reason for me, osteoporosis is not something that I target is because there is lack of public campaign… If there is a public campaign, and then concurrent together (with) pharmacies then we will be able to get the numbers that we hope for…” - 51-year-old female
Osteoporosis is a ‘hidden’ disease
“I think because osteoporosis is actually a hidden kind of health condition, because most people don’t know they have osteopenia or osteoporosis until they do the scan or if they have a fracture. Not like other conditions sometimes you know they may have symptoms”—39-year-old female
High cost of osteoporosis medication
“… sometimes it might be financial reason as well, and you know they may wanted to use the money for other most significant kind of condition than this, because they don’t feel the pain, maybe they will ignore until latest stage when it became serious.”—39-year-old female
“… (Medications) are quite expensive and there’s no demand. I didn’t keep it (osteoporosis medications) … unless the customer’s request and she can provide prescription, then I’ll keep.”—29-year-old male
Lack of accurate and validated screening tools for osteoporosis in community pharmacy
“…of course we know (ultrasound is) not 100 % accurate … for some customers who are more health conscious they also know. So, I will advise them to go to (the) hospital…”—43-year-old male
“… When we want to discuss about bone health, sometimes they (customers) want to see some proofs. So, we must do some sort of test … the problem is we don’t have that machine…”—42-year-old female
“…normally we just depended on the supplier to provide us with the screening test, unless we buy the machines for ourselves, then solve the problem…”- 42-year-old female
Lack of pharmacists’ knowledge
“I’m not that confident because I do not have a big picture of what is the treatment, what is the medicine, all the apparatus they are using, that one is too much doctor thing for me. So, the management part, I am not that familiar.” - 37-year-old female
Lack of time to counsel about bone health
“…then for us to attend the customers, we have to allocate special time to educate, to counsel the customers, it’s not touch and go thing. It’s like counseling anything about health. Time is the factor that I said…”—42-year-old male
“…osteoporosis counseling involves many things such as diet, exercise, exposure to sunlight, muscle mass, body weight and so on. We (will need) to talk about (this) for half an hour …”—43-year-old male
Lack of collaboration between pharmacists and doctors
“… That’s the problem with our healthcare system … I think because both of us, doctors and pharmacists, can dispense, both doctors and pharmacists are doing business … conflict of interest … very seldom community pharmacists get prescriptions (from doctors).” - 42-year-old female
“… (osteoporosis) is quite familiar to me, but the problem is about the diagnostic part, yet to be confirmed by doctor… we might have some difficulties in order to know what stages they are, whether they have osteoporosis or not. To me, unless the clients are actually eager to know, we can share more; otherwise osteoporosis might be the part that everybody missed.”—26-year-old male
“… whenever customers come in complaining bone pain, knee pain, that is the time we start to get actively involve, usually as a pharmacist; (to initiate a) management plan or counseling, we depend on doctors’ diagnosis…”—33-year-old male
Lack of continuity of care
“… I notice that we have regular customers, but sometimes they shop around. They will go asking for prices at different pharmacy, and then they will buy this thing from this pharmacy because is about RM2 cheaper. So, they don’t actually stay at one pharmacy usually.”—39-year-old female
Facilitators in the provision of osteoporosis disease state management services
Continuing education support on osteoporosis
“…We need to keep on educating ourselves, because there will be new knowledge on osteoporosis, new supplements, new results for taking calcium, new awareness. This support is very important for us, as a pharmacist.”—42-year-old male
Support from healthcare industries
“…I think screening provided by certain (pharmaceutical) company will encourage people to be more aware of this problem in my area. I believe this will trigger the awareness of osteoporosis.”—47-year-old female
A simple and unbiased educational material regarding osteoporosis for patients
“… if you have the booklet or anything about osteoporosis from independent sources, we can just give it to the customer when we are busy so they can read it… if it is from the (medical) company, definitely it will focus on their products.”—33-year-old female
Public health campaigns on osteoporosis
“…the activities, we can go to school, where you can reach the young generation or offices… where the government can help us to penetrate the mass public.” - 42-year-old male
Inter-professional collaboration practices
“…basically we can’t work with one hand … collaboration with (the clinic or private doctors) will be quite a good one in the sense that you refer (patients) for DXA scan and it’s a win-win situation and (the doctors) get pay for their DXA and subsequently whatever they have prescribed or not, (patients) can always come back to the pharmacist.”—30-year-old male
Government reimbursement for pharmacists’ services
“Well, in my opinion … it is a good start … if we are reimbursed for counseling … that will motivate us very much.”—42-year-old male