Table 2 Illustrative quotes from interviews with common themes

(1) Enhanced healthcare services

Healthcare Providers

Healthcare Users

Greater efficiency in healthcare delivery

It’s very good because it helps us… the consultation time shorter because we don’t explain all these things and everything. (MRS002, F)

I guess all the screening thing is good for the doctor so that they can spend less time with us and spend more time looking after the patient. (MRS022, M, Age 66)

Fostered medication literacy

Another advantage is really sit down and explain to them the individual medicine and they will understand and they will actually take accordingly. (MRS003, F, Age 39)

Ah tell me everything about the medicine because I take WARFARIN… tell me how cannot eat this cannot eat this ah tell me everything about the medicine because I take WARFARIN ah then I cannot anyhow eat. (MRS024, F, Age 69)

And the family member also can like if they also accompany him they can… they also be able to know what kind of medication the patient is taking. (MRS030, F, Age 38)

Reduced medication-related errors

Let’s say patient is new to the polyclinic, then probably the last seen hospital,… so they probably have to spend time to try to transcribe to our own system. So when transcribing, there may be chances of error… So at least when we draft for them, we have secured another additional layer… (MRS019, M, Age 32)

So, she actually did run through all the medication and updated me that it may not be those medicine that he is taking… that is having the side effect. It actually prompt me to go and alert the consultant later… and she also make a note in the system. (MRS030, F, Age 38)

Offered more personalized care

I think it’s good that the patient also gets some kind of, erm, recalibration of what they’re supposed to be taking and it’s good that it’s checked… Because sometimes, they’ll be yes yes yes you know, but actually they’re not taking the exact drug. So if somebody spends time to show them the medicine, then most likely they’d, you know. (MRS014, F, Age 34)

In depth like one-to-one session with the pharmacist, rather than you go over the counter which is very brief. I think it’s very personalized. (MRS020, F, Age 34)

(2) Challenges in delivering MRS

Healthcare Providers

Healthcare Users

Additional waiting time

They already waited so long in another consultation room, so they may refuse to come down for another consultation with the pharmacist, or they may think it’s more waiting time so that’s the only disadvantage. (MRS002, F)

If we can reduce the waiting time. Waiting time between seeing her and seeing the doctor. (MRS030, F, Age 38)

(3) Issues with patient selection and follow-up

Healthcare Providers

Healthcare Users

Patients were not prepared for MRS appointments

The patients are told to bring their medicines along so that we can do a physical medication reconciliation with them. But most of the time the patients either forget or they claim that they were not told. (MRS005, F, Age 38)

Because a lot of patients they come here, actually they don’t know what the clinic for. They come here “eh why I come to see the pharmacist?”. (MRS001, F, Age 31)

I actually thought that it was… a blood test because usually we don’t have an appointment before consultation. And whatever appointment taken before consultation should either be blood test or X-ray or whatever. So, I thought it was a blood test… it is all housed in the same polyclinic. It is just different levels. (MRS030, F, Age 38)

No opportunities for follow-up

Because… ok we can only do that if the patient comes to collect medicine. So, if the patient do not come to collect medicine then if there’s changes in medicine then we cannot reinforce. (MRS003, F, Age 39)

Because currently it’s a once off we see the patient one time and then most probably we won’t see the patient again unless they are readmitted. (MRS005, F, Age 38)

Follow up, probably if the system is able to detect a change in the patient medication, after doctor may have eh included, add in new ones or stop existing ones like that so if there is a change probably the system can prompt the pharmacist to… when there is a change in medication. (MRS030, F, Age 38)

(4) Barriers to scaling up MRS

Healthcare Providers

Healthcare Users

Non-standardized drug inventory across institutions

But of course when we do get a lot of brand changes, different institutions carry different brands, that’s the hard part as well… So like you have to start guessing. (MRS011, M, Age 28)

Yeah! tally or not or generic, cause X hospital and this Y hospital different company… (MRS028, M, Age 67)

Patient ambivalence towards a fee-for-service MRS model

Mmm, tsk, I tell you… the truth is if the patient need to pay for my service right, they probably won’t want my service… (MRS004, F, Age 32)

now I don’t think they are charging, but I think next time if they were to impose any charges, then it’s probably convincing the patient to see them. (MRS018, F, Age 32)

I don’t think we should be made to pay, cos this is a service. (MRS029, M, Age 72)

If they were to charge, I mean I don’t mind… if it’s a few dollars I am still ok. Affordable…, some of them may not be affordable…, not for me I don’t mind. (MRS025, F, Age 65)

(5) Role definition of the pharmacist

Healthcare Providers

Healthcare Users

Acceptance of pharmacist to conduct MRS

Oh, the reason is because I think if the med recon is to go through medication, erm, and then, go through doses and to have the NEHR access to double check, it falls within the scope of what the pharmacist does… (MRS013, M, Age 33)

Yup yup definitely that will help yup I think that is her specialization… so she will know which pharmaceutical is famous for doing medicine that kind of thing so I think… should take her recommendation… that is her area of specialty yes… I would think she can do that. (MRS030, F, Age 38)