This study was conducted to explore the consumers’ awareness, perceptions, expectations and experiences with the community pharmacists’ services. In summary, the study illustrated that the consumers were satisfactorily aware about the roles of community pharmacists in the country. The consumers also have high levels of perception, expectations and experiences toward pharmacists.
Consumer Awareness of CPs’ Role in Healthcare Provision
Changes in the professional roles of the pharmacist such as the implementation of pharmaceutical care have resulted in a concentration of responsibilities within the pharmacist-patient collaborative relationship. If pharmacists and patients have the same opinion on the communicative relationship, then the usefulness and results of this relationship will be optimal . Here, the role of the pharmacy institutions and academics comes into play in propagating community consumer awareness of the roles and value of the pharmacist in guaranteeing optimal therapeutic outcomes . More than half of the consumers in this study were aware of the role of CPs in community pharmacies and healthcare settings, and they indicated this awareness by identifying the presence of the pharmacists during their visits to community pharmacies. Unfortunately, some consumers believed that personnel i.e. non-healthcare professionals who engage in dispensing tasks in GP clinics are pharmacists. This result is consistent with the finding of a study that identified 77.4% of the personnel who worked in medical clinics as pharmacists .
People must be aware of the need to treat OTC medicines with the same sense that they treat prescribed medicines since most pharmaceutical products can cause adverse events with low to moderate severities. The benefits of increasing the circulation OTC medicines include increased ease for patients, greater control of minor illnesses and reduced national medicine expenditures. Health providers should also focus on the obvious criteria of these OTC products and their evident safety . Our respondents indicated that they can obtain medicines from pharmacies without a prescription, they trust pharmacists to advise them regarding the use of medicines and other health issues and they feel comfortable when talking to a pharmacist regarding minor illnesses. Obtaining medicines without a prescription from a community pharmacy is influenced by the consumer’s locality of residence in this study. According to the locality of residence, consumers who live in the Penang city area were exceeding those from the suburbs and rural areas in obtaining medicines without a prescription from community pharmacies. This behavior may be due to the scarcity of private community pharmacies in rural areas where healthcare services are primarily delivered by the public sector.
Unless the healthcare system changes the way that it promotes trust in CPs, the public will not be expected to trust pharmacists to offer unfamiliar services that are perceived to have high risk. Public trust in this regard will be achieved by enhancing the pharmacist-patient relationship and by GPs supporting the pharmacists who are providing these services . Although the GPs in this study did not support the CPs in providing these services, consumers are satisfied with the services provided by the community pharmacies and the steps taken by the government to regulate extended services such as the health screening services provided by the community pharmacies, such as blood pressure monitoring and glucose and cholesterol level assessments.
The awareness of our respondents is significantly associated with the consumer age as an important determinant in accepting a pharmacist’s advice about medicines. Middle-aged consumers and older ones indicate more awareness of the advisory role of CPs regarding medicines than did younger consumers. This result is consistent with the findings from a study conducted in the Palestinian West Bank, in which older consumers (over 40 years old) were more likely to easily explain their opinions about asking a pharmacist for advice in comparison to younger consumers . This result may have been found because the older consumers visited the same pharmacy frequently and thus established a good relationship with the CP, more than the younger group . The ethnic background of consumers and their frequency in seeking information from the community pharmacy are the primary factors influencing consumer awareness of the CP’s roles in providing healthcare.
Consumer Perceptions of CPs’ Role in Providing Healthcare
When studying the expansion of professional roles in healthcare, it is imperative to think about consumer perceptions and the impact of consumerism on the demand for health services . Understanding how patients perceive and evaluate healthcare services should occur prior to measuring their satisfaction with these services . The professional role of the pharmacist will not be fully used unless it is fully understood and perceived by the public. There is a scarcity of studies about consumer perceptions and their needs from CPs in Malaysia. One study consumer preferred to go to clinics and hospitals for minor illnesses and screening tests. Our respondents disagree in their perceptions of CPs’ roles, which they believe to pertain to physicians only, such as suggesting the use of certain prescription medicines to patients, suggesting the use of certain prescription medicines to physicians, and diagnosing and treating minor illnesses . This finding was also consistent with the findings of a study conducted in Malta, where the respondents preferred to consult a doctor or treat themselves instead of consulting a pharmacist for their minor illnesses . Although some pharmacists can provide these services, perhaps due to the lack of awareness of most consumers about the availability of the service, they prefer to visit a clinic or a hospital . In Thailand, a country neighboring Malaysia, the situation is quite different in that consumers agree in their perception of the pharmacist’s role in consultation activities, which are considered to be a vital part for the success of the pharmacy trade in that country . On the other hand, a study conducted in Saudi Arabia found out that consumers perceived that there is lack of commitment from community pharmacists to dispense medications with prescriptions, and they do not give adequate counseling about medications. The professional performance in general is below expectation .
In the Malaysian study although the vast majority had heard the term “pharmacist”, some consumers believed that pharmacists were working on farms, and the majority believed that pharmacists work in doctors’ clinics . In addition, the majority sought advice about the use of medicines from doctors and few went to pharmacists for this purpose. At present, a great improvement in consumer perceptions of pharmacists has taken place. Consumers in this study agreed in their perceptions of the CPs’ roles regarding the educational and traditional roles of providing patient education and suggesting the use of nonprescription medications to patients. Certain clinical roles of CPs such as identifying and preventing prescription errors, designing and regulating medication regimens for patients, monitoring the outcomes of these regimens, and checking or preventing drug-related problems were also agreed upon by consumers. Trust in CPs was found to increase with age, and this is because the elderly are more extensive users of community pharmacies . In the present study, consumer age was found to be a determinant in perceiving CPs as having a clinical role in providing healthcare. The majority of older respondents disagreed about the ability of CPs to perform these roles, more than middle-aged and young individuals. This finding may be attributed to the fact that in the past, pharmacists were perceived negatively by consumers, and older people now recall that past and stand as witnesses for the present era by still having the same perceptions towards pharmacists.
In India, rural residents have higher perceptions of pharmacists than urban inhabitants . In this study, consumer perceptions of CPs’ roles in monitoring drug regimens and checking and preventing drug-related problems are correlated with the locality. The majority of the city inhabitants agreed that CPs monitor and prevent drug-related problems, more than those residing in the suburbs and rural areas. This finding may be attributed to the fact that there are no pharmacies and pharmacists in the rural areas of Malaysia, and nurses instead used to dispense medicines to patients . Consumer FSI behavior is considered to be another determinant of their perceptions of the CP conducting extended pharmacy roles such as diagnosing and treating minor illnesses. Ethnic background was found to play an important role in tailoring consumer perceptions that the CP would suggest the use of certain prescription medicines to physicians and assist in checking and preventing drug-related problems. The age, locality, ethnic background of consumers and FSI from CPs are the primary factors influencing consumer perceptions of the CPs’ roles in providing healthcare.
Consumer Expectations of CPs and Experience in Healthcare Provision
In the present study, unlike GPs, consumers have high levels of expectations of the CP as a healthcare provider. They expect CPs to take personal responsibility for resolving any drug-related problems they discover and to design any drug therapy treatment plans. CPs are considered to be knowledgeable drug therapy experts who are able to educate patients on the safe and appropriate use of medications. They also strongly anticipated that CPs will monitor responses to drug therapy and be more concerned with patients rather than being profit-oriented. In one study, consumers were interviewed had high expectations on community pharmacists to suggest the right medicines and advise them on the safe and effective use of medicines and recommend medicines with affordable price. The consumer’s previous experiences with community pharmacists were not satisfactory .
Pharmacists should know the reliability of information, its accessibility and their abilities to evaluate the literature to assist patients and providers . In their experiences with CPs, the consumers in this study also differed from the GP respondents in that they highly considered CPs as a reliable source of general drug information and as important professionals in healthcare provision. They also agreed that CPs always counsel them regarding the safe and appropriate use of medicines, and they denied the reversed statement that “Pharmacists appear reluctant to take personal responsibility for assisting them.” In general, consumer expectations of the CPs in healthcare matched their experiences.
Locality is an important determinant for consumer expectations of CPs taking personal responsibility for solving any drug-related problem, with CPs being a reliable source of general drug information and knowledgeable drug therapy experts who are more concerned about patients than being profit-oriented. The level of education of the consumer and his or her locality of residence also had important impacts on consumers’ experiences with the CP, especially urban citizens who utilized more educational and pharmaceutical services, to view the CP as an important healthcare provider and a counsellor of patients regarding the safe and appropriate use of medicines. Consumers who utilized the healthcare system expected to experience the highest quality of care services from confident and experienced providers .
The response rate (46%) of the study was low and it was study only in one state, hence the findings may or may not able to be generalized to the population. Secondly, due to the nature of the study, there is potential of social desirability bias i.e. there is tendency of the respondents to provide responses in a way to be more socially acceptable to the researchers.
In many countries, community pharmacies are more accessible to the general population. More evidence-based research related to the community pharmacists’ role and contribution to public health needs to be carried out. Outcomes research also need to be done to focus on the effectiveness of community pharmacists’ activities and practices versus general practitioners. From another perspective, research and practice model need be established to study the effectiveness of collaborative care between general practitioners and community pharmacists in disease management and outpatient patient care.