Table 4 RE-AIM framework evaluation quotes

Reach to target population

Individual

“We don’t have a hospital as such, but we’ve got a local medical service with an attached [nursing home], and, 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].” (Participant 2, owner)

Efficacy or effectiveness in target population

Individual

“What makes service provision worth it? Making real improvements to people’s lives. That’s probably the easiest way to say it. I mean you can just say, their health, but when people say health, I think people tend to think of it very clinically. Yeah, but it’s not just about all - their cholesterol levels have come down, their sugar has stabilized. It’s not just about the pathology results. It’s also about the quality of the lives that they have afterwards, improving. You know, like the person who can breathe better because they’ve finally figured out how to use a frickin, like, asthma spray properly.” (Participant 6, owner)

“So it’s not like we bought the [machine], which is a $1000 machine, thinking, ‘Oh, we’ve got all this market for HbA1c and cholesterol testing.’ We didn’t think that at all! We thought that having this machine would augment our core service, which is the weight loss, and, and it’s ended up – because this was at my previous pharmacy – and it ended up, it ended up being really the thing that people valued, and the thing that really brought them into the pharmacy for the weight loss service. Because they weren’t worried about their weight, they were worried about their health. And so the fact that we could do that for them on the spot, was amazing for them! And so they were saying, “It’s the most useful thing I’ve ever had done for me in the pharmacy.”” (Participant 18, staff)

Adoption

Organisational (staff)

“…if I had all the resource[s] that I can have, then, what I would do is, I would love to have a pharmacist, or two! Who – who’s just dedicated to, to providing service. To providing clinical services, and things like that. I would love to have it, an outreach pharmacist who can do all the reviews for us, um, and, and - yeah. And if, if pharmacists, if pharmacists can work offsite, or do other things as well, that would be ideal as well. But it’s because of the, of the funding structures. It’s not really adequate. Yeah. So. So you don’t know – you don’t really have the resource to transform that, that’s basically [it].” (Participant 20, owner)

Organisational (institutions: i.e. community pharmacies)

“Diabetes [services], I tend to [provide] as much as possible, if the pharmacy allows me to be customer oriented pharmacy, I do like that. But not every pharmacy, I can do that. Some, some just don’t have any support in the dispensary so I have to - I’m the only one doing the dispensing. […] if you have to put an order away and put your scripts away and all of those stuff, you don’t have time to be outside [providing extra services]. And I’ve worked in both types of pharmacies...” (Participant 10, locum)

Organisational (setting: i.e. community pharmacy sector)

“Like most people come into the pharmacy and pretty much see it as a supply facility. All this with services is still a little bit with - where did that come from? And particularly when we’re seeing more as a retailer than as a service place, and I think that’s one of the problem in general in Australia, is pharmacy is seen as retailers not as health service providers.” (Participant 1, owner/consultant)

“I think professionally, when you’re - particularly in the more remote community, I think, the more you’re more highly regarded within a community as someone, you know, the town often will see: you’re an important part of that community and you’re someone that they’ll go to if they’re not well, or they’re sick, particularly in towns that might only have flying or driving health service, you know, doctors and clinics. And they might only, they might have nurse-led health services, so pharmacies can be seen as, you know, an easy first access point if someone’s not well.” (Participant 4, owner/academic)

Implementation

Organisational - consistency

“Yeah, most of the time their response is, “Oh, yeah, I’m so sorry. I, you know, I did my interventions but I didn’t do my Medschecks. And oh, I’ll do better this month.” And you do often notice an improvement though, they’ll, they’ll get their target next time. So, you have that chat, then they’re a lot better for the next few months. […] I don’t know, perhaps it’s because it’s not tied to their, their wage or a bonus, so to speak? You know, they do or they don’t do it – well, it’s the same outcome for them either way.” (Participant 19, manager)

Organisational - cost of delivery of intervention

“So the negative is probably – like I find, particularly for HMRs and the RMMRs too, is the remuneration, I find, is not really covering the cost of doing it.” (Participant 1, owner/consultant)

“I mean if we can do something for a patient that is going to be of benefit to them - of significant benefit to them - then we will go above and beyond to achieve that for them. The thing is that sometimes, it’s not a profitable thing for us, and we will accept that to a certain degree, because we just rely on the pharmacy to absorb the cost and we go, “Well we’ll write it up.””(Participant 6, owner)

Organisational -Modifications

“Look, I think that probably the pharmacist - the staffing of pharmacists, you’d have to say, would impact it the most. If you’re starting at one, and you know, you can’t do it - we need at least two. And because we’re a busy pharmacy. […] So I guess that may be why but I wouldn’t underestimate the importance of having the layout and the areas to formally services. 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.” (Participant 3, owner)

“And also I don’t want people to feel like they’re being interrogated. It’s not a formal - it’s not like a job interview. Yeah. So I want to remind them just like, ‘Hey it’s just me...’” (Participant 6, owner)

Maintenance of intervention effects

Individual

“You know, if we were providing them with a staged supply, well then, they’re not seeking any other drugs from anywhere else, you know. Like, for benzodiazepines, for example. That is a good outcome for them, for that particular person. You know, it’s not mean - it doesn’t mean that all they have to have less of it every week or something like that. It just means, at the moment they’re stable. Once they’re stable, then they can start planning things: maybe cutting down on the amount of tablets, and other things. You know, each person has different outcomes that are important to them.” (Participant 8, former locum)

Setting

“And I suppose, you know, another impact of that, of that sort of chronic lack of resource that just exists in most remote places, is that - we, one of our roles is to be there for our patients in our community, and, and that’s a really really important aspect of what we do.” (Participant 7, owner)