Background
Drug-related problems have been consistently identified as a cause of morbidity world-wide. Reducing preventable drug-related morbidity (PDRM) could potentially improve both the safety and the quality of health-care for patients, while reducing costs. A series of indicators for PDRM have been developed in the UK,¹ and translated into Portuguese.² Before attempting to apply them in a community pharmacy setting, we needed to explore pharmacists’ perceptions about whether they could be usefully applied in daily practice. This paper focuses on community pharmacists’ perceptions of the facilitators and barriers to their use in the Portuguese and English health-care systems.

Method
A pilot focus group (FG) was undertaken with practising pharmacists within the School of Pharmacy, University of Manchester. Four FGs were then conducted with community pharmacists (two in Portugal moderated by MPG; two in England moderated by CJM). Purposive sampling was used in both countries to achieve diversity within the groups. The FGs aimed in all cases to explore pharmacists’ views on the (i) usefulness of PDRM indicators as a working tool and (ii) potential facilitators and barriers to their routine use. The groups were audio-taped and transcribed verbatim. Transcripts were coded and analyzed using a framework approach.

Results
The Portuguese FGs had seven and ten participants; the English ones, six and seven participants. Analysis of the transcripts revealed some differences between the two countries as to the relative importance of some of the issues raised. Lack of remuneration and manpower were not perceived as a barrier for Portuguese pharmacists, while English pharmacists identified these as an obstacle to the potential use of PDRM indicators in community pharmacy. Time was also seen as less of a problem for Portuguese pharmacists. Although the Portuguese FGs identified a negative attitude from physicians towards the pharmacy profession as a barrier, Portuguese pharmacists felt more confident about the co-operation from patients to move the service forward than their English counterparts. Government support was seen as a more important facilitator for English pharmacists.

Discussion
Portuguese community pharmacists have implemented non-remunerated patient oriented services nationwide assisted by professional associations only and currently face no workforce shortage. These factors may help to explain why remuneration for services and manpower are not seen as problematic, and why Government support is not felt to be an issue. Community pharmacists in England practice differently, and, in many cases, face a high volume of prescriptions, which may explain why time is a more important consideration for them. The differences identified relating to physicians’ and patients’ attitudes may reflect the way in which pharmacists are perceived by each of these groups in the respective countries. Physicians may perceive pharmacists in a less positive way in Portugal due to the relative lack of recognition for extending the pharmacist’s role in health-care provision. For example, in contrast to Portuguese pharmacists, English pharmacists are now able to train to act as supplementary prescribers.

References

1. Morris CJ, Cantrill JA. Preventing drug-related morbidity - the development of quality indicators. J Clin Pharm Ther 2003; 28:295-305.

2. Guerreiro M, Cantrill J, Martins P. A method for international translation of preventable drug-related morbidity indicators in community pharmacy. 10th Health Services Research and Pharmacy Practice Conference. London. 2004 (www.hsrpp.org.uk)