The 18 interviews allowed for an in-depth exploration of the issue of VI in Belgian pharmacies from the pharmacists' perspective.
Community pharmacists' professional experience with visually impaired patients
Four themes emerged from the anc
The 18 interviews allowed for an in-depth exploration of the issue of VI in Belgian pharmacies from the pharmacists' perspective.
Community pharmacists' professional experience with visually impaired patients
Four themes emerged from the anchored data, and these were divided into 13 sub-themes (Table 2). The themes are presented individually and are illustrated with relevant verbatim excerpts.
Table 2
Main themes and sub-themes resulting from the analysis
Themes
|
Sub-themes
|
Training of community pharmacist
|
1. Lack of knowledge
|
2. Training needs
|
3. Types of training
|
4. University courses
|
Identification of visually impaired patients
|
1. Barriers to identification
|
2. Solutions to optimise identification
|
Communication with visually impaired patients and their proxies
|
1. Ideal communication
|
2. Barriers to communication
|
3. Inefficiency of transmission
|
Dispensing of appropriate pharmaceutical care
|
1. General care
|
2. Administration to others
|
3. Pharmaceutical forms
|
4. Solutions to address barriers to pharmaceutical care
|
Themes and sub-themes in italics were newly created during the analysis. |
Theme 1 Pharmacists report that there is no specific training for pharmacists regarding VI and technical aids. They believe that the development of training on this issue would be of interest to promote the dispensing of specific and adapted pharmaceutical care for visually impaired patients. For example, pharmacists would like to have information about VI itself, tips on how to improve the care of these patients, available materials, and useful links for finding more detailed information. In general, they felt that hands-on workshops and face-to-face courses would be the most appropriate way to integrate this new knowledge. Some pharmacists also advocated for the inclusion of seminars on this issue in the master’s degree program in Pharmaceutical Sciences.
"Learning more about visual impairment would be great, because it is actually something that is not covered at all in our courses", IPh1.
"What I like are little tricks. For example, special pill organisers or an app on their phone that would allow them to decipher notices, already knowing what exists and on my end having a list of things that I can suggest and where to find them as well," IPh16.
Theme 2 Most pharmacists report that they do not routinely ask a question to detect vision loss in their patients, that patients with VI do not always share their disability, and that access to their pharmacy is difficult. In addition, they are not familiar with all the signs to recognise a visually impaired patient and often deal with a proxy. To address this identification problem, pharmacists provided examples of accommodations that could improve access to their pharmacies. These included airy and spacious aisles, seating for waiting, automatic doors and no stairs at the entrance to the pharmacy. A few pharmacists also suggested the idea of putting markings on the floor to make it easier for these patients to find their way around the pharmacy. In addition, some pharmacists felt that the question about vision problems should be part of the medication history and that a notation in the patient's chart is needed to easily identify the patient each time they come to the counter.
"We need a path to the counter that is as clear as possible, to avoid having aisles that are too small, having stuff that is lying around everywhere", IPh3.
"Strips maybe to really direct them more easily to the counter, so they don't bump into this or that cabinet.", IPh8.
Theme 3 According to the pharmacists interviewed in the study, communication with visually impaired patients must be oral and requires time. However, they identified various barriers to this oral communication. First, the noise in the pharmacy during busy times could interfere with the quality of oral communication. In addition, pharmacists often use dual communication with their patients: they give oral advice about the proper use of medications and then write the dosage and essential information on the boxes. However, the inability to read due to visual impairment can make it difficult for patients to integrate the advice given by pharmacists, since they may only refer to their memory. Finally, in the case of communication with proxies, pharmacists claim that the transmission of information is inefficient. Indeed, the information given by proxies to visually impaired patients is not always complete and may have also been distorted.
"It is recognised that the patient does not really take in, or at least not entirely, the advice we give at the pharmacy when they come.", IPh8.
"I talk to a person at the counter, and they will come out having retained 80% of what I told them. That 80% will be given to someone else who will only retain 80%. So, in the end, only half of the message reaches the final recipient", IPh2.
Theme 4 The pharmacists began by suggesting solutions that could be implemented to improve the overall management of patients with VI. Writing in large letters, distinguishing boxes by colour or other distinctive elements, carrying out a box identification exercise at the counter, or writing a treatment plan were all considered to be interesting elements. Pharmacists also advocate for consistency of treatment to facilitate the identification of boxes daily.
"Writing the labels in large print and with a marker rather than small writing and with a pen, that I think is essential.", IPh15.
"I would ask them to bring in all their medications to see if they are actually able to recognise them.", IPh1.
"For example, to choose generic boxes with very distinct colours and avoid having boxes that look too similar to avoid confusion." IPh18.
In addition, they believe that the use of single-doses and the recording of the information dispensed would facilitate administration to others (for example, when a parent is visually impaired and must administer medication to their child). In this case, training could also be done with the visually impaired patient, or they could be assisted by a third party.
"Ideally, it would be a tablet or solid administration or in any case by unidose so in sachet, in ampoule or then make a system of unidose syrup", EPh14.
"I would eventually suggest that they record what I say on their smartphone, so they can listen to it again at home.", EPh6.
Finally, the different dosage forms (inhalation devices, insulins, eye drops, droppers, and syrups) require specific advice for each to promote optimal administration. For example, single-dose or tablet alternatives for syrups and droppers may be more appropriate. Similarly, the administration of inhaled medications could be optimised by watching an explanatory video and performing a demonstration in the presence of the dispensing pharmacist.
"You can really imagine pharmaceutical care with the pharmacist making sure that the patient is using their device properly and the patient has the opportunity to test it in front of them and it can be corrected." IPh9.
"For cough syrups, we can switch to solid forms where it's a dose that's appropriate for an adult in general," IPh10.
The model proposed in Fig. 2 represents a reflection of the themes described above. The analysis of this model has allowed us to identify the difficulties encountered by community pharmacists when dealing with visually impaired patients and to highlight different ingredients that are useful for improving this care.
Community pharmacists‘ professional experience with polymedicated elderly visually impaired patients
The results for the polymedicated elderly visually impaired patients were broadly similar to those obtained for the visually impaired population in general (Fig. 3). The main differences are in themes 3 and 4, which deal with communication and dispensing respectively. Therefore, only these two themes are described in the following results.
Theme 3 The main difference that pharmacists identified was the importance of effective doctors-pharmacist communication in providing appropriate pharmaceutical care to this patient group. However, many pharmacists found this communication difficult and offered suggestions for solutions. Some of them believe that a preferred communication channel should be selected, and specific time slots should be set aside to ensure optimal communication. They also advocate for medical-pharmaceutical consultations and the creation of a shared medical record.
"I would suggest to the doctors that we have a privileged channel of exchange: either that they give me their e-mail address or that they agree to give me their telephone number. I promise not to bother them for nothing, but that the day I need to, I can have someone to communicate with", IPh16.
Theme 4 A few things stand out in terms of pharmaceutical care and seem to be necessary when the patient is polymedicated. First, some pharmacists feel that conducting a medication review is relevant for this group of patients. In addition, most of the pharmacists interviewed felt that the use of a pill organiser was essential. Where appropriate, they suggested a method of storing boxes in different locations in the home according to when they are taken, or dispensing different generics so that patients can recognise boxes or tablets by their colours.
"I think they would be the first ones I would do a medication review on to see if we can't eliminate medications to minimise the number of times, they have to take.", IPh2.
"Pill organisers are essential given the number of medications they have to take to avoid as many errors as possible", IPh3.
ored data, and these were divided into 13 sub-themes (Table
2). The themes are presented individually and are illustrated with relevant verbatim excerpts.
Table 2
Main themes and sub-themes resulting from the analysis
Themes | Sub-themes |
Training of community pharmacist | 1. Lack of knowledge |
2. Training needs |
3. Types of training |
4. University courses |
Identification of visually impaired patients | 1. Barriers to identification |
2. Solutions to optimise identification |
Communication with visually impaired patients and their proxies | 1. Ideal communication |
2. Barriers to communication |
3. Inefficiency of transmission |
Dispensing of appropriate pharmaceutical care | 1. General care |
2. Administration to others |
3. Pharmaceutical forms |
4. Solutions to address barriers to pharmaceutical care |
Themes and sub-themes in italics were newly created during the analysis. |
FIGURES (black and white version for printed version) |
Theme 1 Pharmacists report that there is no specific training for pharmacists regarding VI and technical aids. They believe that the development of training on this issue would be of interest to promote the dispensing of specific and adapted pharmaceutical care for visually impaired patients. For example, pharmacists would like to have information about VI itself, tips on how to improve the care of these patients, available materials, and useful links for finding more detailed information. In general, they felt that hands-on workshops and face-to-face courses would be the most appropriate way to integrate this new knowledge. Some pharmacists also advocated for the inclusion of seminars on this issue in the master’s degree program in Pharmaceutical Sciences.
"Learning more about visual impairment would be great, because it is actually something that is not covered at all in our courses", IPh1.
"What I like are little tricks. For example, special pill organisers or an app on their phone that would allow them to decipher notices, already knowing what exists and on my end having a list of things that I can suggest and where to find them as well," IPh16.
Theme 2 Most pharmacists report that they do not routinely ask a question to detect vision loss in their patients, that patients with VI do not always share their disability, and that access to their pharmacy is difficult. In addition, they are not familiar with all the signs to recognise a visually impaired patient and often deal with a proxy. To address this identification problem, pharmacists provided examples of accommodations that could improve access to their pharmacies. These included airy and spacious aisles, seating for waiting, automatic doors and no stairs at the entrance to the pharmacy. A few pharmacists also suggested the idea of putting markings on the floor to make it easier for these patients to find their way around the pharmacy. In addition, some pharmacists felt that the question about vision problems should be part of the medication history and that a notation in the patient's chart is needed to easily identify the patient each time they come to the counter.
"We need a path to the counter that is as clear as possible, to avoid having aisles that are too small, having stuff that is lying around everywhere", IPh3.
"Strips maybe to really direct them more easily to the counter, so they don't bump into this or that cabinet.", IPh8.
Theme 3 According to the pharmacists interviewed in the study, communication with visually impaired patients must be oral and requires time. However, they identified various barriers to this oral communication. First, the noise in the pharmacy during busy times could interfere with the quality of oral communication. In addition, pharmacists often use dual communication with their patients: they give oral advice about the proper use of medications and then write the dosage and essential information on the boxes. However, the inability to read due to visual impairment can make it difficult for patients to integrate the advice given by pharmacists, since they may only refer to their memory. Finally, in the case of communication with proxies, pharmacists claim that the transmission of information is inefficient. Indeed, the information given by proxies to visually impaired patients is not always complete and may have also been distorted.
"It is recognised that the patient does not really take in, or at least not entirely, the advice we give at the pharmacy when they come.", IPh8.
"I talk to a person at the counter, and they will come out having retained 80% of what I told them. That 80% will be given to someone else who will only retain 80%. So, in the end, only half of the message reaches the final recipient", IPh2.
Theme 4 The pharmacists began by suggesting solutions that could be implemented to improve the overall management of patients with VI. Writing in large letters, distinguishing boxes by colour or other distinctive elements, carrying out a box identification exercise at the counter, or writing a treatment plan were all considered to be interesting elements. Pharmacists also advocate for consistency of treatment to facilitate the identification of boxes daily.
"Writing the labels in large print and with a marker rather than small writing and with a pen, that I think is essential.", IPh15.
"I would ask them to bring in all their medications to see if they are actually able to recognise them.", IPh1.
"For example, to choose generic boxes with very distinct colours and avoid having boxes that look too similar to avoid confusion." IPh18.
In addition, they believe that the use of single-doses and the recording of the information dispensed would facilitate administration to others (for example, when a parent is visually impaired and must administer medication to their child). In this case, training could also be done with the visually impaired patient, or they could be assisted by a third party.
"Ideally, it would be a tablet or solid administration or in any case by unidose so in sachet, in ampoule or then make a system of unidose syrup", EPh14.
"I would eventually suggest that they record what I say on their smartphone, so they can listen to it again at home.", EPh6.
Finally, the different dosage forms (inhalation devices, insulins, eye drops, droppers, and syrups) require specific advice for each to promote optimal administration. For example, single-dose or tablet alternatives for syrups and droppers may be more appropriate. Similarly, the administration of inhaled medications could be optimised by watching an explanatory video and performing a demonstration in the presence of the dispensing pharmacist.
"You can really imagine pharmaceutical care with the pharmacist making sure that the patient is using their device properly and the patient has the opportunity to test it in front of them and it can be corrected." IPh9.
"For cough syrups, we can switch to solid forms where it's a dose that's appropriate for an adult in general," IPh10.
The model proposed in Fig. 2 represents a reflection of the themes described above. The analysis of this model has allowed us to identify the difficulties encountered by community pharmacists when dealing with visually impaired patients and to highlight different ingredients that are useful for improving this care.