Self-care of long-term conditions: patients’ perspectives and their (limited) use of community pharmacies

Abstract

Background Self-care support is an ‘inseparable’ component of quality healthcare for long-term conditions (LTCs). Evidence of how patients view and use community pharmacy (CP) to engage in self-care of LTCs is limited. Objective To explore patients’ perspectives of engaging in self-care and use of CP for self-care support. Setting England and Scotland. Method Qualitative design employing semi-structured interviews. LTCs patients were recruited via general practitioners (GPs) and CPs. Interviews were conducted between May 2013 and June 2014; they were audio-recorded, transcribed verbatim and analysed thematically. Results Twenty-four participants were interviewed. Three main themes emerged: engaging in self-care, resources for self-care support and (limited) use of community pharmacy. Participants’ LTC ‘lived experience’ showed that self-care was integral to daily living from being diagnosed to long-term maintenance of health/wellbeing; self-care engagement was very personal and diverse and was based on beliefs and experiences. Healthcare professionals were viewed as providing information which was considered passive and insufficient in helping behavioural change. Non-healthcare sources (family, carers, friends, internet) were important in filling active support gaps, particularly lifestyle management. Participants’ use of, and identified need for, community pharmacy as a resource for self-care support of LTCs was limited and primarily focussed on medicines supply. There was low awareness and visibility of CPs’ potential roles and capability. Conclusion CP needs to reflect on patients’ low awareness of its expertise and services to contribute to self-care support of LTCs. Rethinking how interventions are designed and ‘marketed’; incorporation of patients’ perspectives and collaboration with others, particularly GPs, could prove beneficial.

A qualitative synthesis of pharmacist, other health professional and lay perspectives on the role of community pharmacy in facilitating care for people with long-term conditions

“…28 "If the pharmacist just took it on himself I wouldn't be happy, but I would think if the doctor said go and see the pharmacist to discuss it, that would be good" (Lay, diabetes, primary; Twigg et al, 2013) However, the role of CPs in endorsing GP help-seeking was also valued 28 and CP services were more highly regarded when relationships with GPs were poor, access to other services difficult and satisfaction with other healthcare services was low. 40 CP was seen to occupy an isolated and subordinate position rather than one that is fully integrated with the rest of the primary care team. 39 This conflicted with patients' wish for care that is "joined up" i.e.…”

“…Patients were reported to hold primarily traditional views regarding the division of labour in healthcare [37][38][39] and the dominant perception of CP was seen to be responsibility for medicines supply and over the counter advice for self-limiting conditions. 36 38-40 There was evidence of a lack of clarity about the role of the pharmacist or purpose of CP services, 40 particularly when these contradicted expected and traditional perceptions of the pharmacist encounter. 31 The role of the pharmacist was usually conceptualized, not in isolation, but in relation to beliefs about other roles and responsibilities within the wider healthcare system, primarily those of the GP.…”

“…28 "I think probably also the psychological effect here that you can talk to somebody you know and even if you just get a confirmation of what the doctor has prescribed for you, it's a big help" (Lay, Heart Failure, primary; Lowrie et al, 2014) Patients who had not already experienced extended services within CP found it more difficult to identify the value of CP for supporting them with their LTCs beyond practical medicines support such as home delivery, pill boxes and medication supply. 40 Extended self-care was not commonly reported to be an area seen to be under the responsibility of the pharmacist. 36 40 9 "I know that they do offer a lot, but for me, my first port of call would be my doctor" (Lay, LTC primary;Ogunabayo et al, 2017) Concerns about conflict of interest due to the commercial setting and perceptions of pharmacists as "shop keepers" could influence the level of trust patients have in the advice they are provided by CPs and their perceptions of their role.…”

Patient and public perspectives of community pharmacies in the United Kingdom: A systematic review

“…Whilst evidence has demonstrated positive outcomes from community pharmacy services, uptake and awareness of some of these services have been low. A systematic review of uptake and patient outcomes of remunerated pharmacy services revealed low uptake despite improved clinical and financial outcomes, but this study did not explore patient perspectives.…”

Exploring medicines management by COPD patients and their social networks after hospital discharge

“…Efforts to preserve one’s self-image could also have explained the limited involvement of healthcare professionals in medication work [ 48 , 53 , 66 – 68 ]. There is some evidence that suggests patients perceive the role of pharmacists as limited to medicines supply [ 26 , 69 – 71 ].…”