Introduction
Recent policy developments include an increased role for the community
pharmacist in the management of drug therapy in primary care1,2. In
such service re-design, it is increasingly recognised that patient expectations
and experiences must be considered. The Community Pharmacy Medicines Management
Project3 was a large randomised controlled trial (RCT) to evaluate
the introduction of a medicines management service by community pharmacists for
patients with coronary heart disease (CHD). The RCT included an assessment of
patients’ experiences and expectations using interviews and questionnaires. A
subset of the results of the baseline and follow up questionnaires are reported
here.
Methods
The questionnaire was developed, based on a literature review and previous
patient questionnaires used by the authors. The survey included items on
demography, experiences, and a series of statements asking patients what they
would like to happen when they visited the pharmacy to collect prescribed
medicines. Experiences of, and satisfaction with, the medicines management
service per se were also included at follow-up. Subjects were mailed a
questionnaire with a covering letter and a reply-paid envelope. Reminders were
sent two weeks after the initial mailing. The survey was completed at baseline
(pre-intervention) and follow-up (12 months post-intervention). The returned
questionnaires were optically scanned into SPSS v11.5. The section on patients’
preferences on what they would like to happen when they visit the pharmacy for
prescription medicines were analysed using a factor analysis with varimax
rotation to identify any underlying main domains. The internal reliability of
the scales developed from these factors was assessed using Cronbach’s α
statistic. Only these data are reported here.
Results
At baseline, 1364 of 1441 questionnaires (intervention and control) (95%)
were returned. At follow-up, 1153 of 1355 questionnaires (85%) were returned. At
baseline, most respondents were aged over 65 years (76%), male (69%), retired
(71%) and white (100%). Factor analysis of the intervention group at baseline
identified three domains of patients’ preferences. The first domain (16 items)
included medicines review jointly from the doctor and the pharmacist (68%),
advice on effectiveness and safety of medicines (50-92%), privacy (54%), short
waiting times (80%), closer partnership and communication with the pharmacist
(63-92%). This first domain appeared to be more important to patients than the
second domain (two items), which covered general lifestyle issues and specific
health problems (58-61%). There was least support for the third domain (one
item), which was for the pharmacist solely to retain their traditional supply
function (21%). Similar findings were shown between groups across time.
Conclusion
The exploration of patients’ expressed preferences regarding their visit
to the pharmacist covered a wide range of aspects that should be included in a
patient-centred approach to service re-design in primary care. A community
pharmacy-led medicines management service appears to meet the criteria required
by patients for their preferred service.
References
- http://www.rpsgb.org.uk/nhsplan/medsman.htm (01/12/04)
- http://www.managingmedicines.com (01/12/04)
- http://www.medicinesmanagement.org.uk (01/12/04)
