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Table 3 Quotes for participant themes

From: Considerations of Australian community pharmacists in the provision and implementation of cognitive pharmacy services: a qualitative study

Category Themes Quotes
Services Pharmacists had trouble recalling all the services provided in their pharmacy. “You know there’s probably the odd service here and now that I’ve forgotten you know. I don’t know.” (Pharmacist owner)
“Then in terms of other services and trying - just trying to have a run down my brain of what I did last week, because I do so many different things that are like, you can’t pinpoint it because it’s like going from one to another.” (Casual staff pharmacist)
Confusion about the definition of services. “What I personally provide? Can you be specific on what you call services?” (Pharmacist locum)
“I don’t know whether or not that’s something that you would consider to be a service in the normal sense of the word.” (Pharmacist owner)
“I don’t know what you would call that in terms of the realms of services... I don’t know if it’s a service. I mean I see it as a service, because it’s part of what we have.” (Casual staff pharmacist)
Disagreement about the nature of services. “Medschecks has not been something that I actually actively sit down and get them to sign a paper, but as I said, because I’m old school, you do it, just you’re not - now, I have to think about being paid for them and sometimes I don’t. I don’t. I forget to record them.” (Locum pharmacist)
I think a lot of pharmacists - I mean, I could be biased, because I’m a newer one, who’s recently come out of university, but there’s obviously a lot more focus for us to be a lot more hands on and patient interaction and you can see that in the change of pharmacy models with a lot more now coming out from behind the counter.” (Staff pharmacist)
Decreased priority for CPS compared to ‘core’ services. “So obviously, just like, dispensing and supplying medication is a priority, because that’s what people mainly come in - come in for.”(Staff pharmacist)
“Because your core business in the current model is still the scripts. […] you can’t say I’m not dispensing today, because it’s part of your Medicare requirement that you’re open and dispensing scripts. […] And I do prioritise the smooth running of the pharmacy over the services – over, over the services that I can say no to, obviously. You know, you have to counsel on new medications. You can’t not.” (Staff pharmacist)
Pharmacists placed importance on the quality of service provided. “It’s more so, you know, you trial the service, but you go 100% into the service, only to find that because you’re running it properly, the demand is so high. Whereas if you weren’t running it properly, it just, you know, wouldn’t be?” (Staff pharmacist)
Patient considerations Highly conscious of patient differences. “I find with some people, some people are really happy to hear that [we are offering these services]. Some people actually get a bit nervous when you propose that [they participate in a service], they’re just like “Oh, no, no no, I don’t want to put you to trouble, “or, “I don’t want to.” I think the idea of being in a separate area and we’re sitting down, and like, I think they find it a little bit confrontational, some of them?” (Pharmacist owner)
The importance of ‘knowing the patient’. “[After implementing extended services] I feel that we, sort of, know our patients even more - a little bit better. So, I like that. I think that’s good… I think that’s, I would say, a definite positive thing for me. ... And I think it’s nice to be able to participate in their health a little bit more. So I’d say it’s much more rewarding.” (Metropolitan pharmacist owner)
Pharmacists leveraged their relationship with individual patients to attempt to cover poor or absent doctor-patient dyads:
- In rural/remote areas
- In metropolitan areas
“…yeah there’s three doctors there part time, over the week, but they’re quite busy. So a lot of people - well, the patients come to us, a lot of the time first, if there is something, well, semi-acute, to ask if they really need to go and see them [the doctors].” (Pharmacist owner in small rural town)
“And it’s not an infrequent for a customer to say to me,,, “Oh thank god, can you explain this to me? Because I couldn’t understand a word of what the doctor’s just said to me. I could not understand the doctor. I was there for 10 min. He said things to me, and I don’t understand. Here’s a script. You explain that to me.”(Pharmacist manager in remote community)
“…my view of Pharmacy: that we’re the nexus, the connection between the patient and the doctor. Because the doctors don’t have a lot of time, you know, and people always appreciate explanation of their medication, because we have time.” (Pharmacist owner in small remote town)
“So sometimes doctors miss a lot of details, sometimes doctor’s instructions is not fair. And I have to call, every – like, I have to call a lot of times.” (Staff pharmacist in metropolitan area)
“I explained to her that the Mersyndol would make her overcoming this addiction harder. And she looked at me and she said, “No one has ever told me that. Not my doctor, no one.”” (Locum pharmacist in metropolitan area)
Pharmacist Positive outcomes motivated pharmacists towards further service innovation. “…customers have said to me – and they’re saying it constantly to me now, to the point that it sticks in my mind, that, “It’s the most useful thing that anyone’s ever done for me in a pharmacy!” (Staff pharmacist)
“In that way I find it really positive to do service provision and the teaching you get in connection with it, because you get better at explaining things, that you look into more things, makes you a better pharmacist.”(Pharmacist owner)
“I would like to see remuneration, because I do think that we could do more. And yeah, it’s to enable another pharmacist. … It would mean that we could properly dedicate a time, you know, for example. So we could schedule people in to do, well, the services, that - you know, Medschecks and any queries that come off the streets, so to speak.” (Pharmacist owner)
Pharmacists saw their role as important, although others did not always. “the number of times a patient, when I explained something to the patient in counselling, and they say, “Why didn’t the doctor tell me that?” You know, if I had a dollar for every time I’ve been told that! And I think that, that’s an important role, because a lot of people go away from the doctors, not knowing a lot that they should know. And that’s the role we play.” (Pharmacist locum)
“So the local GP was very stressed because she was trying to get him to go to these appointments, because she needed more information. But he couldn’t go. So she and I were trying to manage him, just to keep him safe, in terms of bleeding, and he’s got diabetes and heart failure and he was very complex. …so we were kind of a tag team. Which is what happens with the other doctors as well. They would - they will pass on when a patient leaves, they may ring me and say, ‘Look I spoke about this. Can you - can you please reinforce?’ or, ‘Just for your information, we spoke about this.’” (Pharmacist owner)
“I think the other healthcare professionals need to understand the role that we’re taking. And I think they need to understand that we are not actually trying to overstep them. We’re trying to offload the pressure that they’re experiencing… and the convenience [for the patient] of [providing extended services] in this day and age.” (Pharmacist manager)
The centrality of the pharmacist to the running of the pharmacy. “So pretty much everything in the pharmacy stops, unless the pharmacist’s there.” (Staff pharmacist)
“[…]one pharmacist is worth ten pharmacy assistants…”(Pharmacist owner)
Pharmacy workplace The dispensary as the pharmacist’s base. “I guess for that, particularly for Medschecks is that, you - if a pharmacist is devoting their time for, whatever it is, say 30 min, three quarters of an hour, to sit down with someone, you know, in a proper counselling room, then they can’t be doing anything else in the pharmacy. And so if someone brings in a prescription during that time or comes in for a OTC medication, that person can’t be served because you can’t be interrupted while you’re doing your Medscheck.” (Pharmacist owner)
Staffing and store layout. “I think that is, even when we had the right number of staff to do it, we still failed. And it wasn’t until we completely changed the layout of the store, you know, put the automation in that that we began to gain some traction with health services.” (Pharmacist owner)
The effect of government remuneration. “But when I look at it from a business perspective, if you have to keep the business running, you have to be very careful with where you spend your time, ok? And if you don’t get enough rewarding …. you not gonna be able to sustain your business. And that’s when I realise, oh, I see why these incentives are so essential. Because these incentives are the reason why I think, ‘Oh, it’s worth it. It’s not only I am helping patients; I am also helping the business.’ So I think incentives is important.” (Staff pharmacist)