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Table 3 additional quotations from respondents

From: Supporting respiratory patients in primary care: a qualitative insight from independent community pharmacists in London

Theme/ Subtheme Respondents’ Quotations
Theme 1: Services and Limitations of patient support
Subtheme: Services provided to respiratory patients “We do MURs or NMS for these patients…. We also do flu vaccination and smoking cessation.” (CP10)
“MURs, we are targeting respiratory MURs, smoking cessation my colleague does…. We do NMS… We do flu vaccines at the moment” (CP13)
“Usually NMS and Smoking cessation service, MUR, flu vaccination.” (CP14)
Subtheme: Barriers to patient support “I think biggest barrier would be time, resources. It is basically, I think we need to think about rearranging our time table so it would mean that we would have to have a little bit of extra resources, the only time I bring people in the consultation room when I have a locum”. (CP6)
“Lack of training probably and again yea not having placebo inhalers, these two things” (CP7)
Patients’ attitudes and cooperation to have the service, the ability to recruit patients, the willingness to participate, and the time we have to spend with patients (CP16).
“Time, because it can take 10–15 min each intervention especially when you want to check technique. Correct reimbursement, because it comes out of our time. Barriers would be mainly time and reimbursement. If we got to have tools supplied on a regular basis like my placebos go back to while ago so I have to keep asking the reps, we do not see the reps any more so we don’t get placebos unless we ring the manufacturer.” (CP10)
Theme 2: Fragmented primary care
Subtheme: Lack of communication with other HCPs “And there is also I feel lack of information coming from the prescriber, for example: with the preventer steroid inhalers they don’t say to them (the patients) use it regularly… so they (the patients) just use the reliever whenever they need, and with the other one (preventer) they end up in trouble because they don’t realise it is far better to manage.” (CP11)
“There is a bit of resistance from patients because they are saying we are repeating what the practice nurses may have done. The practice nurse may have gone through all this with them and then they are wondering why is the pharmacist doing it as well”.(CP17)
“…even we can’t access the GP surgery, communication is so bad, telephones are always busy, receptionists get the doctor to call back…” (CP3)
Subtheme: Lack of access to patients’ records “I think what is a barrier at the moment and what would help us and I think it is for the future, they are going to allow us clinical access with our smart card for us to know so with our smart card not only we will be able to look at the drug history of the patient but we should be able to look at the clinical history.” (CP4)
Theme 3: The need and acceptability of new technologies to support respiratory patients
Subtheme: Relative advantage “it shows they are using their device properly, using it on timely basis because unlike when I am talking to them, I am trusting them to say yes I am using my inhaler. I am depending on the trust; I am using my inhaler twice a day without fail. Whereas, this device would say you don’t use your device twice a day, you are telling me that you use it. It allows us to actually say here you are to proof that sometimes you are not using the device properly, sometimes you are not taking enough drug, sometimes you are missing it totally, you are not using it enough etc…so yea I am for that technology” (CP12)
“yea definitely, I think it will be good for some patients because at least this way even doctors will be able to get feedback about this. The information you are getting/creating here gets referred back essentially to a prescribing body about usage and about the technique being used correctly. There is no point of prescribing something and then not assessing the patients, there is a gap between usage and compliance and being used properly. I mean you need to make sure the drug is being used effectively so then assess the patient thereafter so this information should be good for the doctor to get back.”(CP18)
Subtheme: Compatibility “Sometimes it is easier with technology, isn’t it? It can make things easy for you.” (CP10)
“We see the information gathering from technology tends to be more useful so information gathering in old ways tends to be difficult to actually utilise whereas it tends to be easier analysed with that technology to benefit the patient. Easier to analyse and use.” (CP13)
Subtheme: Complexity “I mean as long as it is efficient, as long as it does not affect therapy then I will be happy to and as long as it is easy to use.” (CP14)
“It has some beneficial factor (2b) and easy to use (2c). Going with the time. Sometimes it is easier, isn’t it? It can make things easy for you.” (CP10)
Subtheme: Trialability and observability “By collecting preliminary data, if something new or new sort of advice come up that would bring benefit to the patient so obviously yes.” (CP15)
“If I am offering something that I tried and I know works, they (patients) are advised that it works and if they use it and find it works then they are more likely to be happy.” (CP11)
Theme 4: The need to promote the clinical role of community pharmacists
  “In MUR we will find out whether or not the product is working, if we see that the product is not actually doing what is supposed to do then we have to refer them back to the GP, it is not for us to say, we can’t make clinical recommendations.” (CP16)
Theme 5: Professional identity
  “We would like to have the funded COPD service back when we were actually caring for the patients before when we were providing the COPD service….But you have to value the pharmacist time then, at the moment nobody is valuing the pharmacist time. If I was providing all these services and not getting paid for it then there is no value to my service yea, there is no value to my establishment, where I am going to get the money for to provide all this, right?” (CP3)
“You can spend 10 min with the patient but you can’t spend half an hour unless it is properly funded you know that’s the only thing, it is easier to spend 10 mins that’s fine but if you are going into a lot of details with the patient then you need an extra funding to do all the extra services. It’s like an extra service, then we can spend half an hour with the patient and go through all the queries and all the problems.” (CP21)