Thematic analysis of patient stories
Six core themes were identified from the analysis: staff attitudes, services, errors, supply, accessibility, and system, with each containing three sub-themes. Two hundred thirty-seven (237, 27.9%) stories were identified as containing pharmacy-related content from the initial 848 Care Opinion stories. Of the 237 stories, there were a total of 356 codes. One hundred and forty-eight (148) stories were single coded and grouped into one theme or subtheme. A further 89 stories were coded more than once and grouped into two or more themes or subthemes. Seventy-four patient stories (31.2%) were directly related to their experiences of pharmacy or of pharmacy staff, while the remaining 163 (68.8%) described patients’ overall healthcare experience with some reference to their experiences of pharmacy services or staff.
The stories were then categorised into one of three settings: community pharmacy (n = 155, 65.4%), hospital pharmacy (n = 67, 28.3%) and GP practice pharmacy (n= 15, 6.3%) for analysis. The entire process is illustrated in Figure 1.
Overall, supply was the most common theme of pharmacy related patient stories (104, 43.9%), followed, in decreasing frequency, by the themes of staff attitudes, services, accessibility, errors and systems, each receiving 93 (39.2%), 53 (22.4%), 40 (16.9%), 29 (12.2%) and 12 (5.1%) stories respectively, as shown in Table 1. However, the lack of GP pharmacy feedback hinders the allowance of meaningful analysis for this sector.
Sentiment analysis of patient stories
Among the 237 stories, a relatively equal number of were classified as positive (121, 51.1%) and negative (113, 47.7%). The remaining were mixed (3, 1.3%), where both positive and negative sentiment were expressed in the narrative. However, when the data was analysed according to pharmacy sector, a majority of patients reported negatively towards hospital pharmacy (51, 76.1 %). In contrast, community pharmacy had slightly more positive (86, 55.4%) than negative (68, 43.8 %) feedback. In GP practices, the majority of feedback was positive (13, 86.7 %). The overview of sentiment for the pharmacy themes and their respective subthemes are quantified and illustrated in Table 2.
Supply
The supply of pharmacy medication constituted the largest proportion of hospital feedback (53/67, 79.1%). Patient feedback was mainly negative (89/104, 85.6%) from both community (38/50, 76%) and hospital (51/53, 96.2%) patients with waiting times being the main reason for dissatisfaction (90/104, 86.5%). Stories relating to waiting times in hospitals predominantly concerned discharge delays typically ranging from two to eight hours and outpatient medication delays; these stories made up 49/67 (73.1%) of all hospital stories. Negative feedback towards community pharmacy related to long waits (hours to days) for prescriptions. In contrast, a smaller number of positive community pharmacy stories generally praised their speed of service.
Example (negative): ‘My experience at the pharmacy on the last four occasions have been horrendous waiting up to two hours for prescriptions to be dispensed seeing vulnerable people having to stand and wait…’ (Story 173, Hospital Pharmacy)
Several patients described a disruption in their supply of medication, affecting the amount of time they had to wait for their prescription to be dispensed. The only positive story was an expression of surprise when a pharmacy had medication in stock.
Example (negative): ‘...It is now Thursday night and in the unlikely event my prescription is even issued tomorrow, the pharmacy does not keep these tablets in stock, so we’re looking at next Monday, earliest.’ (Story 22, Community Pharmacy)
Staff Attitudes
Patient feedback relating to staff attitudes was positive overall (67/93, 72%). This theme made up the highest proportion of patient feedback relating to community pharmacy (65/155, 41.9%) with most feedback being positive (47/65, 72.3%). Helpfulness, professionalism, kindness, friendliness, politeness were common terms used to describe pharmacy staff across all settings.
Example (positive): ‘…the staff in the hospital pharmacy are some of the most patient pleasant caring people I have ever met…’ (Story 5, Community Pharmacy)
Negative patient stories described pharmacy staff in community pharmacy and in a general practice surgery as rude, hostile and condescending. Hospital pharmacy staff were described in a small number of stories as unprofessional.
Example (negative): ‘…Then the same pharmacy individual called my number…and from the outset seemed to find my two prescription items something highly amusing and started waving a box of laxative powders at me as if he were selling soap powder whilst at the same time almost giggling as if it were some joke…’ (Story 157, Hospital Pharmacy)
Services
Patient feedback was overall positive (38/53, 71.7%) regarding the services that pharmacies offer such as healthcare advice, clinical services (e.g. community pharmacy blood pressure checks, minor ailment services) as well as ordering repeat prescriptions and delivery services.
Example (positive):“ The pharmacist asked me a relevant question about my symptoms. Then only after this discussion did we realise that the prescription was incorrect and hugely insufficient for my needs… It's lucky the pharmacist asked the correct question, or I would have a wholly inadequate prescription.” (Story 175, Community Pharmacy)
Patient stories relating to Medicines Use Reviews (MURs) or the New Medicines Service (NMS) (English nationally agreed advanced services) were uncommon yet described positively:
Example (positive): “I saw a doctor about my asthma who prescribed me a new inhaler. Pharmacy were very helpful and rang me 2 times to check how I was getting on with it. The 2nd call I told them I wasn’t getting on with it very well so they advised me to get another appointment.” (Story 196, Community Pharmacy)
Patients’ stories relating to GP pharmacy described the exceptional care they received on their medicines use and the work pharmacy staff did to ensure patients received an appropriate alternative medication in light of medication shortages.
Example (positive): “…The Pharmacist was able to discuss an alternative with my GP and send a new electronic prescription to a different Pharmacy…” (Story 120, GP Pharmacy).
The patient story below highlighted the patient-centred care provided by a General Practice pharmacist leading to patient empowerment.
Example (positive) :“…Following on from a change of medication required when one item was withdrawn. This was followed up by the amount of tablets I could request being dropped. Following this medication review I felt more involved in my medical care.” (Story 183, GP Pharmacy)
Within the hospital setting, patients’ described positively the service they received and the information provided by hospital pharmacists to prevent medication side effects.
Example (positive): “…Pharmacist who came to the ward with prescriptions and eye drops so that one did not need to visit the pharmacy or queue, who then patiently explained to each person how the medications were to be used” (Story 178, Hospital Pharmacy)
The home delivery of medication, a service offered free of charge by community pharmacies in England, was associated with a small number of negative stories (4/5, 80%). Patients complained of failed medication deliveries from their community pharmacy that caused them to wait for their medication. However, a small number of patients (2/155, 1.29%) described how they appreciated reminders via text or call to collect their medication.
Accessibility
Patient stories often related to the accessibility of the pharmacy. Overall, accessibility was positively (28/40, 70%) described by patients. Several stories related to the convenience of community pharmacies attached to or within GP surgeries:
Example (positive): ‘…on-site pharmacy, accessible, can always park, staff helpful and friendly and very high standard of care and expertise…’ (Story 42, Community Pharmacy)
A minority of patient feedback related to the environment of the pharmacy (11/237, 4.64%) and these were mainly negative (9/11, 81.8%). Patients complained of crowding within some community pharmacies, whereas complaints regarding hospital pharmacy were directed at the outpatient pharmacy. Opening times of community pharmacies were appreciated in a small number of stories (2/155, 1.29%).
Systems
This theme refers to the organisation or processes of a company including company policies, electronic systems and pricing. The theme was largely related to negative (26/29, 89.7%) patient stories. All patients describing company polices felt negatively (19/19, 100%) towards them in both hospital and community pharmacy; patients described the lack of efficiency in handling administrative and procedural problems. The most common problem experienced by patients related to the systems for handling prescriptions and communicating these processes to patients. Other procedural problems were also described e.g. complaints policy, refund policy, etc. A lack of ownership of patients’ prescription problems was an issue described in some patient stories:
Example (negative): ‘Prescription ordering is a nightmare at this surgery for some inexplicable reason? The pharmacy blame the surgery and the surgery blame the pharmacy’. (Story 92, Community Pharmacy)
Complaints were also made relating to the reliability of Electronic Prescription Services (EPS), resulting in lost, as well as late, prescriptions. A lack of joined up working and information sharing between healthcare services was also evident.
Example (negative): “The pharmacy could not find anything on me again a week before I am due to go away even though I spoke with the pharmacist 2 weeks ago … Funny the pharmacist couldn’t find anything to do with me yet when I had my gastroscopy yesterday they had everything on computer…” (Story 144, Community Pharmacy)
Price was a concern for a minority of patients who were not exempt from prescription charges and the cost of private prescriptions was occasionally mentioned as being either expensive or cheap:
Example (negative): “I don't earn a lot of money so the £18 I was advised I would be refunded didn't happen and that lack of help was outrageous.” (Story 4, Community Pharmacy)
Errors
There were relatively few stories relating to errors (10/237 stories, 4.22%). Errors were unsurprisingly negative experiences (10/10, 100%) for patients. There were more non-medication related errors (7/237, 2.95%) described in patient stories than medication errors (3/237, 1.27%). Patients complained of administrative errors, such as erroneous prescription charges or non-medication related advice. Medication errors were only mentioned in community pharmacy related stories whereby medications were mistakenly dispensed.
Example (negative)“…Items are missing or you are given a completely different item that you did not order - which is potentially dangerous?” (Story 92, Community Pharmacy)