Table 3 Illustrative quotes from interviews with sub-themes unique to healthcare providers

(1) Challenges in delivering MRS

Healthcare Providers

Difficulty eliciting information from patients

Then the other one is certain patient they might refuse to reveal more due to certain psychosocial issue in which umm… we can try our best to elicit the correct information. (MRS010, F, Age 33)

Umm…if patient come alone, and then they themselves don’t know what they taking, or someone pack for them. Then they have no idea at all. (MRS008, F, Age 43)

Interprofessional communication issues

Like, a doctor might be with a patient and the same time, the pharmacist wants to clarify something. So, if the pharmacist wants to clarify this and wants to communicate directly with the doctor, the doctor may be a bit busy to do that. And sometimes there can be a bit of tension. (MRS013, M, Age 33)

because we draft the ERX [prescription] on what the patient is supposed to be taking but then we will put in the remarks patient is taking like one tablet in the morning instead of two tablets in the morning right, then some doctors they do not look at the remarks then they just press approve. (MRS003, F, Age 39)

Software not user friendly

The IT system can be… improved and reduce the time to generate a PML [patient medication list] or… can help to smoothen the workflow then I think will be better. I think IT currently is the main thing and the PML actually when we need to generate is quite manual and need to key in the… indication one by one. (MRS010, F, Age 33)

Unfamiliarity with specialized medications

If I’m not familiar with the medicine, I feel like that’s the barrier. Because I’m very familiar with whatever we have here in the pharmacy, but some medication maybe is not my specialty, I might not be familiar.… I feel I cannot advise on that. (MRS016, F, Age 29)

(2) Issues with patient selection and follow-up

Healthcare Providers

Unsuitable referrals

I think that’s where the frustration come in you know, like I already so busy outside [pharmacy area], you come in for the med clinic then after that the patient doesn’t even have chronic medicine then waste my time. (MRS003, F, Age 39)

(3) Barriers to scaling up MRS

Healthcare Providers

Incomplete integration of medication records across healthcare sectors

Especially from the hospital, sometimes we can’t see the hospital medicine list. Because… private prescription and other things we can’t… it’s not connected. (MRS015, F, Age 38)

Space constraints

Cos we got no [extra] rooms, so even if we have pharmacist we cannot do [medication reconciliation service]. (MRS003, F, Age 39)

Manpower shortage

But for the workflow, sometimes when down on manpower for the pharmacist we still need to allocate one pharmacist to do this service, this one is part of the service… (MRS010, F, Age 33)

(4) Role definition of the pharmacist

Healthcare Providers

Underutilization of pharmacist’s inputs

And… perhaps if the clinicians…, don’t know that the drafted list is meant to be worked upon as the current thing and they just decide to prescribe everything from the beginning and redo, then… it will actually…, have wasted the effort of the pharmacist as they go through the recon list… (MRS013, M, Age 33)

sometimes the doctors like don’t see our, don’t see our list or don’t see our notes. So… I feel that our handover is not very good so there are times where I think the physician don’t see our notes. (MRS004, F, Age 32)

Expanding role of pharmacist

So right now is merely just… checking adherence and… any other medication-related problems but we can’t really suggest optimization because we don’t have the labs with us. (MRS005, F, Age 38)

Or if there’s a polypharmacy for the elderly can we actually cut down the medicine or optimize the medicine usage which is actually not part of the med clinic? (MRS003, F, Age 39)

… because number 1… they (the pharmacists) are able to take the responsibility of it being right or wrong. It’s… similar to doctors taking the responsibility of diagnosing something. (MRS012, F)