Background
Methods
Study design
Setting
Recruitment
Data collection
Data analysis
Results
Age-group (years) | Number of visits to the pharmacist in general practice* | Ethnicity | Location from where participants were recruited | |
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Patients (n = 20) | 40–49 (n = 2) 50–59 (n = 5) 60–69 (n = 5) 70–80 (n = 6) 80+ (n = 2) | 1 to 12 times | White British (n = 13) White Irish (n = 3) Other White (n = 2) Arab (n = 1) Other Asian (n = 1) | West London (n = 7) Surrey (n = 9) Berkshire (n = 4) |
Themes
Theme 1: awareness
There was also uncertainty, and often confusion, about the roles of general practice-based pharmacists and whether or not contact would be ongoing.I had been coming to this practice for 24 years and I didn’t know that there was a pharmacist here. It’s possibly not my fault, they don’t advertise, promote, they don’t explain enough … I got a text [message] saying “make an appointment with the pharmacist” … [I was thinking] “What are they talking about”? “Where”? (Participant 5)
Nearly all participants emphasised the need to promote the presence of pharmacists in general practice, to raise patients’ awareness and therefore encourage the uptake of pharmacists’ services. Numerous methods of promotion were proposed, such as television advertisements; messages on practice websites, social media accounts, waiting room screens and noticeboards, including introducing the pharmacist amongst the healthcare team photographs; posters and leaflets; and establishing visible consultation spaces for pharmacists.I still don’t know why a patient would want to see a pharmacist in the general practice. I can’t get my head around that. ‘Cause if I want to ask the pharmacist something I go into the actual pharmacy. I’m not aware of the full extent of what they do. (Participant 10)
Apart from the existence of general practice-based pharmacists, additional information needs of patients included the specific services offered by pharmacists; reasons to contact pharmacists; what is outside the pharmacist’s remit; and the potential benefits of seeing the pharmacist.I have three housemates registered in this practice and I can spread it by mouth, “You know that there’s a pharmacist that attended to me today, they helped me a lot by giving me information”. (Participant 13)If a GP feels “well, this particular problem would be better decided by a pharmacist” [then they should] refer. But that doesn’t seem to happen very often. (Participant 20)
Theme 2: accessibility
Similarly, some participants claimed that there was far less waiting time with pharmacists’ appointments, both with scheduling an appointment and in the waiting room. There were some suggestions that seeing the pharmacist should become the first stage when an appointment at the practice is required.The receptionist says “Oh yes, the [pharmacist is] in today. I’ll just ask them to chat to you”, and it’s done within a day. Or the reception will say, “They’re not in today but they’ll be in tomorrow and I’ll get them to call you”. (Participant 15)
A few participants, however, reported occasional difficulties in getting appointments with pharmacists covering multiple practices, due to reduced availability and/or uncertainty about the exact days pharmacists were present in a specific practice. Likewise, one participant was frustrated not to directly be put through to the pharmacist, as phone calls were often returned at inconvenient times. Another one complained about pharmacists sometimes cancelling their appointments last moment. Some participants called for larger numbers of pharmacists, weekend sessions, appointments on the same day as GP appointments and availability of drop-in clinics.People ring for a GP appointment and they can be at death’s door … [and] it’s Monday and they [receptionist] tells you “We can slot you in on Friday”. With a pharmacist on board, they can [see] you and if it’s something more serious they would speak to the doctor. It’s a faster system … you could have an 11 o’clock appointment for a GP and you won’t be seen until 12-12.30. With the pharmacist, it may run over five minutes, it may be ten minutes but no more than that. (Participant 1)
[Seeing] the pharmacist should be an equal opportunity [to the GP], a choice for patients. Even if you went through a telephone screening … [also] to have an online booking system which would incorporate the pharmacist. (Participant 3)
Theme 3: interactions
The perceived absence of hierarchies and judgemental approaches by nearly all participants made them feel at ease with pharmacists and established mutual familiarity and relationships.I have colitis [and] I have a suspicion that it is triggered by sugar. I tried to have a discussion with the doctor but they didn’t want to discuss it, they just said, “There is no research on that at all”. At my last meeting with the pharmacist here, I mentioned it to them. They had a really useful discussion with me about it. And I came away feeling that I had been listened to. I felt that I had an informed and adult discussion. With the doctor, often they treat you like children “the doctor knows best, this is what you’re gonna [do]”. (Participant 2)
Well sometimes when you come to the doctor, I am always conscious of the time and I don’t waffle. I don’t just waste the doctor’s time … So, there’s a certain level of anxiety, stress ... I found that with the pharmacist there was a less judgemental attitude, they were very approachable, immediate, very easy to talk to. (Participant 6)
Pharmacists, several participants claimed, visually connected with patients during consultations, which they took as an expression of being paid attention to.The pharmacist, I’ve seen them once and I feel like I’ve known them for a long time. That’s unusual ... I know the pharmacist’s name. That’s the difference. I’ve seen loads and loads of doctors here, more than once, and I don’t know their names. (Participant 3)
Many participants emphasised the caring attitude of pharmacists, which they attributed to fewer time-constraints compared to GPs.They [pharmacist] looked me straight in the eye and I think sometimes if you’re not looking at someone, you’re probably wandering with your mind, whereas, they were concentrating on me. (Participant 12)
Several participants claimed that, as a result of longer appointment times, pharmacists were thorough in their approach, including concomitantly managing multiple co-ailments and developing structured care plans.They [pharmacists] are very dedicated in what they do, they’re empathetic … the doctors, once the ten minutes are up, they stand up [and] you haven’t even finished and you have to go. I hate that. I think that’s dreadful. (Participant 8)
One participant, however, was afraid that pharmacists occasionally exceeded competency and requested more referrals to specialist care.I had a new set of blood tests done which showed that my cholesterol levels had increased … They [pharmacist] went through my lifestyle, diet, exercise, where I live … They were thorough … [and] set a good plan to go forward, [to] have a review after three months and see how we go … I [also] had some twitching in my calf muscle, they weren’t quite sure what it was, so they saw one of the GPs in the practice and chased it through with them. (Participant 7)
Nearly all participants emphasised the information/explanation that pharmacists provided, including the analytical way this was conveyed, which was seen to allow patients to fully understand their medication or condition and convince them to accept the pharmacist’s advice.The [pharmacist] went through my list of other medications [as well] and dismissed the ones that I didn’t really need to keep on my repeat because I wasn’t having them … They said “Let’s take them off because if you do need them in the future, they can be put back on again”. No GP has ever said that to me before. So, you can see how older people just have this long list of medications that they may, if they don’t realise, still be taking. (Participant 17)
Conversely, a few participants stated that pharmacists should consider potential side effects of medications upfront (rather than trailing different medications) and explain everything about medications without having to be prompted. One participant mentioned that pharmacists should also consider alternative therapies, such as natural substances and homeopathic remedies. Another participant was disappointed about pharmacists not recording condition−/medication-related history, hence having to re-provide these details in subsequent consultations.The [pharmacist] has given me some reading material to take away with regards to possible injection [for my diabetes]. They showed me with a dummy pen how it would be administered. So, yeah, it was very informative. They took the time to actually explain [everything] … the book of information, they took the time to actually go through the pages, give a brief outline, how it may or may not influence me. (Participant 14)
My fear was that the medical people were going to keep pushing statins at me, regardless of my side effects. But they [pharmacist] said, “Look, we won’t try any more”. So, I was reassured by the fact that I’m not going to be pushed statins forever and I feel completely reassured that my interests are being properly looked after in terms of prescribing medication. (Participant 11)
A lot of doctors made me feel quite a hypochondriac … with the pharmacist, you feel a sense of security after leaving them. (Participant 1)
Theme 4: feedback
There was no consensus amongst participants on the preferred way to collect patient feedback on general practice-based pharmacists. Various means were proposed, such as face-to-face interviews; questionnaire forms, either as hard copies or online, including using tick-boxes or rating scales or human faces mirroring satisfaction level; and politely reporting concerns directly to pharmacists. Most participants stated that the overall process of feedback provision should be quick, to encourage participation. As such, participants claimed, any feedback collection tool should be short in length.Usually the feedback, the result of that doesn’t go back to the people … Is that [feedback] making any difference, is that making any improvement? Did anybody read it? Has it been put in practice? (Participant 4)
It’s easier [to collect feedback instantly] because I could have forgotten half of what [the pharmacist] told me in an hour or so’s time. I’d go “What did they say about my tablet”? … So, [it would be good] to get at me [for feedback] quickly afterwards, while I remember things. (Participant 19)
The public wants [to give feedback] right at the time they are having the consultation … because if they give [a form] to you, then you go back to your office and you set it down and two or three days later you have more things piled up and you never send the feedback. (Participant 5)
Discussion
Comparison with existing literature and realistic discussion
Function of interaction | Brief description |
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Fostering the relationship | Refers to establishing rapport and connection between practitioner and patient. |
Gathering information | Refers to collecting as much information as possible from the patient to understand their needs from the encounter. |
Providing information | Refers to offering information to the patient to facilitate understanding. |
Decision making | Refers to enabling patients’ deliberation and decision making, including developing action plans. |
Enabling disease- and treatment-related behaviour | Refers to fostering self-management of the patient. |
Responding to emotions | Refers to showing empathy and assisting patients in developing positive emotions. |
Strengths and limitations
Implications
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Appropriately educate patients and the public about general practice-based pharmacists, including roles and responsibilities.
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Ensure pharmacists are present in the practice for an adequate amount of time each week, ideally on a daily basis, and explicitly communicate rotas to patients by also establishing an effective triage system to prevent exhaustion of pharmacists’ resources.
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Secure the prerequisites for efficient interactions with patients, for example, adequate appointment lengths.
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Design a formal, quick and attractive feedback mechanism for patients.