How to attract them and keep them: the pharmacy attributes that matter to Australian residents with chronic conditions

How to attract them and keep them: the pharmacy attributesthat matter to Australian residents with chronic conditionsSara S. McMillana, Adem Sava, Fiona Kellya,d, Michelle A. Kingc, Jennifer A. Whittyb andAmanda J. Wheelera,d

aSchool of Human Services and Social Work, bCentre for Applied Health Economics, Griffith Health Institute, Griffith University, Meadowbrook,cSchool of Pharmacy, Griffith University, Southport, Queensland, Australia and dSchool of Pharmacy, Faculty of Medical and Health Sciences,University of Auckland, Auckland, New Zealand

Keywordschronic disease; community pharmacy;patient-centred care; pharmacists

CorrespondenceMiss Sara S. McMillan, Griffith Health Institute,School of Human Services and Social Work,Griffith University, Room 2.15, Building L08,University Drive, Meadowbrook, Qld 4131,Australia.Email: [email protected]

Received February 15, 2013Accepted August 13, 2013

doi: 10.1111/ijpp.12075

Abstract

Objective To explore the attributes of pharmacy choice for people with chronicconditions.Methods Semi-structured interviews were conducted between May and October2012, across four regions in three Australian states. Purposive sampling was used torecruit participants with chronic conditions and unpaid carers. Interviews were ana-lysed via the constant comparison method.Key findings Ninety-seven interviews were conducted. The majority of partici-pants were regular patrons of one pharmacy and five attributes influenced thischoice: patient-centred care, convenience, price, personal trait or preference andservice/medication need. Patient-centred care, such as providing individualisedmedication counselling, continuity of care, development of relationships andrespectful advice, emerged as an important attribute. There was minimal discussionas to choosing a pharmacy based on the provision of professional services, under-scoring the limited consumer knowledge of such services and related standards ofcare.Conclusion Patient-centred care is an important attribute of quality care as per-ceived by people who are regular community pharmacy users. These findings high-light the need for pharmacy staff to implement a patient-centred approach to care,thus meeting the perceived needs of their customers.A greater effort is also necessaryto raise the profile of pharmacy as a healthcare destination.

Introduction

There is a global focus on implementing and evaluatinghealthcare services to better tackle health problems, such aschronic conditions, whilst meeting people’s needs and ensur-ing a quality healthcare experience.[1] This is best demon-strated by the increasing emphasis towards delivering apatient-centred approach to care, currently perceived as anintegral dimension of high quality healthcare worldwide.[2–4]

The pharmacy profession has increased its focus onpatient-centred services to address healthcare needs of peoplewith chronic conditions.[5] This is particularly importantgiven their increasing prevalence.[6] Community pharmacy isideally situated to assist people with managing the medica-tions commonly used in the treatment or management of

chronic conditions,[7] such as asthma and diabetes. In order tosupport this, the Australian government has introducedremuneration for community pharmacy to provide a range ofinitiatives,[8] such as disease management services and medi-cation use reviews.[9] These services enable community phar-macy to focus on prevention or management of chronicconditions or both, thus working with people to improvetheir health.

Despite recent changes, there is limited research on thequality of Australian pharmacy services[10] from a patient-centred perspective, even though patient-centred care canpromote beneficial outcomes, such as improved satisfactionand quality of care.[11] Historically, evaluations of community

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Research Paper

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pharmacy and its services have focused on patientsatisfaction.[12–16] Yet, there are methodological concernsabout using this outcome as an indicator of service quality,such as the lack of well-designed and validated satisfactioninstruments.[17,18] Other studies have investigated consumerperspectives of a specific professional service, without refer-ence to the entire pharmacy experience.[19–21] Whilst thesestudies provide significant contributions, it is also importantto explore the experiences of community pharmacy as awhole, from the perspectives of people living with chronicconditions and their carers. An exploration of the consumer’sexperiences (patient-centred perspective) is essential toensure and maintain a high quality healthcare service.

One approach to exploring pharmacy experiences is tofocus on assessing a person’s choice of pharmacy,[22–24] whichcan be viewed as a quality indicator. Arneson et al. discussedthat a person remains loyal to a pharmacy if their needs arebeing met and they are satisfied.[22] Both price[12,22] andconvenience[22–24] are acknowledged as factors influencingpharmacy choice, with people having a strong preference for apharmacy located near their home.[25] However, consideringthe evolution of Australian pharmacy practice, most of thisliterature is dated. Furthermore, these studies do not considerhow the attributes of patient-centred care influence phar-macy choice.

Given the current health climate and the evolving role ofcommunity pharmacy, it is more important to focus on phar-macy choice of people with chronic conditions and theircarers rather than people needing assistance for minor ail-ments. This is because the latter are less likely to require con-tinuing medication or pharmacy services. This study willprovide a framework for the pharmacy profession to identifythe quality features of patient-centred care or services thatthese consumers’ value. This will enable pharmacy staff tobuild on these positive experiences and assist in understand-ing, and preventing, any recurrent negative consumer experi-ences. Consequently, this study aims to explore the attributesof pharmacy choice from a large qualitative study of peoplewith a variety of chronic conditions and their carers.

Method

Study participants

Participants were purposively sampled[26] from four Austral-ian regions that represent diversity in geographical location,culture and socioeconomic status: Logan-Beaudesert andMount Isa (Queensland), Northern Rivers (New SouthWales) and greater Perth (Western Australia). Participantrecruitment was achieved using project information mail-outs via contacting peak consumer health and carer organisa-tions in the four project areas, and word of mouth fromparticipants, i.e. snowball sampling.[27] Community pharma-

cies were asked to distribute project information, and werecontacted either by direct canvassing or via key pharmacyorganisations. Eligibility criteria were established to promotediversity in the consumer sample and represent the Austral-ian population that might be living with a chronic condi-tion.[26] This ensured a range of people with varying healthconditions, age, and cultural background. Participants had tohave one or more chronic condition(s), or be an unpaid carer,or both.

Procedure

An interview guide was informed by previous stakeholderresearch on the same topic (Box 1),[28,29] and data were elicitedusing semi-structured, in-depth interviews. To ensure thatthe interview guide was culturally appropriate,[30] commentswere sought from a reference group comprised of culturallydiverse stakeholders with healthcare expertise. To promote astandardised interviewing method, the first 10 interviewswere conducted by two researchers with experience in quali-tative data collection (SM, AS), who then discussed theirapproach with the other interviewers (FK, CC, CM). The first20 interviews were transcribed by the researchers to enablefamiliarisation with the initial data and further refinementof the interview guide. Debriefs were conducted with theresearch team (via e-mail) after each interview, and feedbackwas obtained throughout the data collection process.

Individual interviews were conducted between May andOctober 2012, either via telephone or face to face. The inter-viewer and interview location were informed by the specificneeds of the participant and consideration of their personalcircumstances, such as cultural background or religiousbeliefs. Interviews were audio-recorded and ranged between15–91 min (average 50 min). Ethics approval was obtainedfrom Griffith University Human Research Ethics Committee(PHM/12/11/HREC).

Data analysis

Interviews were transcribed verbatim either by professionaltranscribers or by the researchers (except for two participantswho did not want the interview recorded; field notes were

Box 1 Interview questions related to pharmacychoice

Why do you mainly go into the pharmacy? (e.g. purpose)When you go to a pharmacy do you feel as though you aregoing there as a patient to get a health service or as a con-sumer to purchase a product?Can you describe a good and a bad pharmacy experience?Do you have a regular pharmacy?

Sara S. McMillan et al. 239


taken instead). A random sample of transcripts was checkedfor accuracy and a constant comparison method was used toanalyse the data.[31,32] This method involves returning to thetranscripts frequently during the analysis process to checkthat the data substantiates the insights and inferences.[33] Thedata were first openly coded into themes using the qualitativedata analysis package QSR NVIVO 9 (QSR International PtyLtd, Doncaster, Victoria, Australia). To assist data familiarisa-tion, researchers involved in coding did not code their owninterviews. After initial coding, further interviews wereexplored to develop sub-themes, leading to further categoryrefinement. A research team member (MK) checked thecoding for randomly selected transcripts to ensure data cred-ibility. The data analysis process was frequently discussed andreviewed between those researchers coding and also with theresearch team. Recruitment continued until data saturationwas established, e.g. when participants’ experiences and per-spectives became recurring and were in line with previouslycollected data.[34] To guide the analysis, two recent studies thatcategorised the attributes of patient-centred care differentlywere used: (1) a concept analysis by Morgan and Yoder,[35]

which identified four broad ranging attributes of patient-centred care, e.g. individualised, empowered, holistic andrespectful care; and (2) a qualitative study by Dancet et al.that defined 10 attributes as either humanistic, e.g. emotionalsupport and relationships, or organisational factors, e.g.accessibility and continuity of care.[36] Importantly, the attrib-utes identified by Dancet et al.[36] could further describeMorgan and Yoder’s[35] framework or, in the case of most ofthe organisational factors, facilitate its development.

Results

Participants

Ninety-seven interviews were undertaken (Table 1); themajority (n = 65) with female participants. Ages rangedfrom 16–85 years (mean = 57.2 years; standard deviation(SD) = 13.03). There was a diverse range of chronic condi-tions among participants, including: diabetes, mental illness,cardiovascular, respiratory and musculoskeletal conditions.Notably, almost 90% of participants had been diagnosed withtwo or more chronic conditions.

Participants could be classified according to one of threepatron categories: those who were a regular patron of onepharmacy, those with a regular pharmacy who utilised otherpharmacies for specific needs, or a casual visitor to variouspharmacies. A number of factors determined this choice:‘patient-centred care’, ‘convenience’, ‘price’, ‘personal trait orpreference’ and ‘service/medication need’. The following keywas used to identify participant characteristics: C – con-sumer; CA – carer; CC – consumer/carer; CALD – culturally

and linguistically diverse; IND – Aboriginal or Torres StraitIslander (see also Table 1).

Patient-centred care

A patient-centred approach was discussed widely amongstparticipants who patronised a regular pharmacy. A variety ofattributes of patient-centred care from both Mogan andYoder[35] and Dancet et al.[36] were identified, which is exem-plified in the following quote:

‘. . . she [pharmacist] makes a point to come over to me. . . she smiles, she’s just nice, she’s an educated phar-macist, she takes time to tell you when you’re changingyour drugs . . . she explained possible side effects . . .’[C_1150]

The above participant described both respectful and indi-vidualised care as defined by Morgan and Yoder.[35] Theencounter was respectful in terms of the pharmacist smilingand being nice, i.e. humanistic attributes, and being accessiblefor counselling purposes, i.e. organisational attributes.[36]

Furthermore, the participant appreciated being given medi-cation advice, an organisational attribute that is a componentof individualised care.

Individualised care

Taking the time to ensure that the person’s individual needswere met and not identifying people solely by their condi-tion(s) were exemplars of caring pharmacy staff. This was

Table 1 Participant data

Participant characteristics (n) (%)

Consumer/carer Consumer (C) 70 72.2Carer (CA) 8 8.2Consumer/carer (CC) 19 19.6

Race/culturalbackground

Aboriginal or Torres Strait Islander(IND)

23 23.7

Culturally and linguistically diverse(CALD), e.g. Asian, Middle Eastern,European and Pacific Islander

19 19.6

White 55 56.7Interview method Face-to-face 49 50.5

Telephone 48 49.5Location Logan/Beaudesert 41 42.3

Mount Isa/North West 15 15.5Northern Rivers 21 21.6Greater Perth 20 20.6

Chroniccondition(s)*

One 10 11.8Two 19 22.3Three or more 56 65.9

*Data from consumer and consumer/carer only.

240 Pharmacy choice for chronic conditions


highly valued by participants, as this increased approachabil-ity and fostered the development of a relationship, attributesidentified by Dancet et al.[36]

The provision of information[36] was viewed positively byparticipants and deemed essential when obtaining a newmedication:

‘. . . if I go up there with a script, she’ll [pharmacist]come out . . . to explain what it’s all for . . .’ [C_1053]

Continuity of care[36] was another reason for utilising aregular pharmacy, as this facilitated awareness of the person’smedical history:

‘. . . when you’re away from your pharmacy and you goto a new pharmacy, they don’t seem to have thatamount of personal care . . .’ [CC_016]

This enabled staff to apply this knowledge to the unique needsof the individual, e.g. providing tailored medication informa-tion.

For others, medication safety was a key priority for themand hence, using a regular pharmacy was seen as a way tooptimise this via continuity of care:

‘One chemist, all your pills are together. The chemistcan know what you’re on; look for drug interactions. . .’ [C_1072]

Alternatively, other participants viewed this primarily as amatter of convenience, as it could minimise the burden ofanswering questions or explaining personal circumstances.

Empowering care

Providing empowering care in terms of support and encour-agement was also important:

‘. . . because of being on the [opioid] . . . he always usedto say to me,“(name) you’re no junkie, you’re the onlyone who reduces, everybody else they go up.” And Iknew that he knew that I would one day be normalagain . . .’ [CC_1065]

Staff approachability facilitated a relaxed environment forconsumers to ask questions and seek advice, thus supportingpatient empowerment and resulting in continued use of thatpharmacy:

‘. . . he [pharmacist] is very approachable and all thestaff are too . . . you never feel as if you are stupid orasking a silly question . . .’ [C_005]

Holistic care

A holistic approach was being concerned about the person’soverall wellbeing:

‘She’s [pharmacist] a very caring person . . . who has aninterest in the whole picture and bothers to keep that inher memory bank and not just on the computer.’[C_015]

Furthermore, providing holistic care, where the pharmacystaff saw beyond the person’s medical history, e.g. a disabil-ity, respected their role as a carer and as a person knowl-edgeable in their condition(s), fostered a continuingrelationship.

Respectful care

When pharmacy staff acknowledged the associated difficul-ties in being a ‘perfect patient’, this enhanced perceived staffapproachability and respectful care:

‘. . . they [the pharmacist] were accepting of who youwere and you are not an angel and you had done thingswrong and that was okay you are human . . .’ [C_007]

One consumer with a disability articulated many reasons whyshe continued to go to a regular pharmacy; it was convenient,she was not judged, and the staff respected her knowledge ofher own condition(s). Furthermore, she described the stigmaand disrespect experienced elsewhere:

‘. . . there’s still a lot of pharmacists, and I’m talkingmainly about the young ones . . . think that thereforeyou must have an intellectual problem. Because you’vegot the physical disability and you can’t move . . .’[CC_1166]

The development of a relationship was particularly essentialfor participants of Aboriginal or Torres Strait Islander back-ground. A community elder expressed the need for his/herpeople to be able to trust healthcare professionals beforeengaging in conversation about health matters:

‘. . . if they go there on a regular basis to that one phar-macy I think that’s important . . .’cause Aboriginalpeople they need to trust people. And once they get thefeeling they can trust people then they’re more likely toopen up.’ [C(IND)_2001]

The significance of a humanistic approach was also men-tioned by two Aboriginal or Torres Strait Islander partici-pants. They described that the simple act of a healthprofessional placing a hand on their shoulder provided asense of care and safety, and that this was an important attrib-ute for optimal healthcare.

The preference for good, respectful customer service overconvenience was highlighted by a participant who stoppedpatronising the pharmacy located next to her doctor’ssurgery, because of the abrupt and arrogant manner of thepharmacist:



‘. . . Even if I’ve got to come out [of] the doctors andhop on the bus to go to [location name] . . . I will ratherthan go there and put up with that [behaviour].’[C(IND)_1097]

Convenience

The majority of participants selected a conveniently locatedpharmacy, e.g. close to their home or doctor, to use regularly,in order to reduce the time accessing care. Remarkably, someparticipants described a lack of individualised care with theirregular pharmacy, yet continued to utilise it because it wouldbe a greater burden and inconvenience to change pharmacies:

‘. . . when we got there they haven’t got it [medication]. . . It’s annoying and frustrating . . . We haven’t gotanother one [pharmacy] though. We go shopping at[location name] and we just stop over [at] the chemist,leave a script there . . .’ [C(CALD)_1085]

Participants without a regular pharmacy placed a highervalue on convenience than on individualised service, or usedpharmacies infrequently and accessed whatever one was openat the time:

‘. . . I don’t go to the same one each time, ’cause if I haveto go into one town for something. . . . I’ll go to thepharmacy while I’m there.’ [CC_1034]

Price

For some participants, particularly for low-income earners,price was an important factor influencing pharmacy choice.Participants were frustrated when they were charged variousprices for the same medication at different pharmacies. As aresult, they were more inclined to shop around for the bestprice and stay at that particular pharmacy.

Trade-offs between pharmacies were also evident withrespect to price and meeting different needs, and for someconsumers, this resulted in feelings of disloyalty:

‘We pretty much go to one pharmacy which is up theroad here. . . . The problem is it’s a small pharmacy andso therefore all their vitamins . . . are a lot dearer . . . sowe go to the other pharmacy which is I suppose rude onour behalf. But we’re pensioners.’ [C_1053]

Personal trait or preference

The choice of pharmacy was influenced to a lesser extent bythe personal trait or preference of the individual. Some con-sumers from culturally diverse backgrounds sought a phar-macy where a staff member spoke the same language or hadthe same cultural background. When asked about the pos-

sible impact of having a pharmacist of the same cultural back-ground, one Samoan participant explained:

‘. . . it would draw all the Samoans in . . . then they’llask questions and that’s the good thing about it . . .’[CC(CALD)_1124]

Service/medication need

Two or more pharmacies could be utilised by participants fora number of reasons: convenience, better medication price,or availability of different services such as medicationcompounding:

‘. . . The one we get the [compounded product] from isreally weird . . . we spend a fortune . . . but . . . there’sno interaction . . . they wouldn’t know who I am if Iwalked in there . . . I still go to the pharmacy near ourold house . . . they just know me . . .’ [CA_1013]

For some participants, an attribute of pharmacy choice waswhether the staff met their service expectations; it was impor-tant to obtain exactly what they wanted, when they needed it:

‘. . . you just tell them what you need and they’ll give itto you, or if you’re not really a 100% sure on what it is,they talk through whatever’s available . . .’ [C_1107]

Discussion

This study provides a greater understanding of patronagechoice for people with chronic conditions and carers. Partici-pants could be categorised into three patron groups: a regularpatron of one pharmacy, a casual visitor to various pharma-cies, or both, i.e. they have a regular pharmacy but utilisedother pharmacies to meet specific needs, such as better medi-cation pricing or service provision. Our findings corroborateexisting research indicating that people with complex condi-tions can place a higher importance on interpersonal skillswhen choosing a preferred healthcare provider,[37] and valuespecific humanistic aspects of patient-centred care, such assmiling and nice staff.[36] Furthermore, this study has identi-fied that patient-centred care can influence choice of phar-macy, which was to date a relatively unexplored attribute inthe pharmacy choice literature. Participants expressed theirgratitude to pharmacists that exceeded their personal expec-tations of the pharmacist’s professional role; which is alsodescribed as the ‘helping professional’ in the literature.[38]

Convenience was also important when choosing a pharmacyfor some participants. However, an unexpected finding washighlighted by those describing the inconvenience of chang-ing pharmacies, even if they were not entirely happy with thecare received.

A strength of this study was its large participant size withvarying chronic conditions and cultural backgrounds.



Further analysis to identify the relationships across the threepatron groups and participant demographics was not con-ducted and indeed would be challenging and inconclusivedue to the inherent lack of generalisability in the approach.[39]

Whilst we relied on self-reported data, which can be influ-enced by participant bias, a standardised interview guide wasused to ensure the key themes of interest were covered in asimilar order. There is the risk that consumers were also usersof hospital pharmacy services and talked about their experi-ences in this pharmacy sector. However, participants werespecifically asked about their community pharmacy experi-ence, and most people had at least one condition typicallymanaged by medicines sourced from community pharma-cies. To minimise the potential for interviewer bias, discus-sions were undertaken throughout the analysis betweeninterviewers who had different research experience and pro-fessional backgrounds. This study recruited consumers withone or more chronic condition(s); therefore the findings maynot translate to other pharmacy consumers, such as thosewith minor ailments. Further research to compare these twogroups is warranted, as there are likely to be differences in theattributes of pharmacy choice. Finally, we did not explore therelative importance of these attributes, an area for futureresearch.

The impact of convenience in influencing pharmacychoice is consistent with the literature.[12,22–24,40] However,what this study has identified is that some people continuedto use their regular pharmacy even after receiving what wouldbe perceived as a lack of patient-centred care. This findingunderscores the importance of subjective experiences indetermining a person’s choice. For example, the inconven-ience of going elsewhere may over-ride the importance ofpatient-centred care. Furthermore, convenience may be moreinfluential on pharmacy choice for consumers with chronicconditions and their carers due to the time or efforts neededto manage their conditions or roles; additional studies areneeded to confirm this importance relative to patient-centredcare for this population.

Alternatively, those consumers who patronise a conveni-ently located pharmacy with minimal patient-centred caremay not be aware of better health services elsewhere. Indeed,Victoor et al. elaborated on this by suggesting that peoplemay not have adequate information about different healthproviders to make a completely rational choice.[37] It has alsobeen suggested that if consumers have not experienced ahigher level of service, such as extensive drug informationconsultation, then they are likely to remain satisfied with theircurrent care.[23] This study highlights that people withchronic conditions and their carers seemed to be unaware ofthe range of higher level community pharmacy services avail-able to support them.[13,41] Apart from dose administrationaids and home medication deliveries, there was minimal dis-cussion about choosing a pharmacy based on the provision of

professional services. Therefore, more education about thestandard of care and professional services that consumersshould expect from their community pharmacy is needed;a recommendation identified previously in Australianpractice.[25]

Pharmacists need to consider that if a professional serviceor patient-centred care is not provided, then the consumermay not know about it and therefore may not expect it. Thisin turn may influence an individual pharmacist’s decision notto extend or improve their practice or service standards. Con-sidering that some professional services are relatively new toAustralian pharmacy practice,[8,9] further targeted promotionto facilitate their uptake is essential. This requires a collabora-tive approach between professional bodies and communitypharmacy staff (McMillan SS et al., unpublished data 2013.Given that a recent study has demonstrated that promotion ofpharmacy services does not necessarily result in an uptake ofuse,[42] this promotion should also aim to raise the profile ofpharmacy as a healthcare destination. Based on the impor-tance of patient-centred care for regular pharmacy users inthis study, an emphasis on providing this approach to care isneeded in community pharmacies. The public has ques-tioned whether pharmacists are trained in patient-centredcare.[43] Pharmacy educators should consider this given wehave identified patient-centred care as an important attrib-ute. Community pharmacy staff should reflect on these find-ings, as patient-centred care can promote the formation ofrelationships, which in turn can facilitate regular patronageand increase professional satisfaction.

A variety of consumer personal traits such as cultural back-ground and preferred spoken language could also influence aperson’s choice of pharmacy, suggesting that there is ‘no suchthing as the typical patient’.[37] The importance of price is con-sistent with the literature,[15,22] but is also subject to the indi-vidual consumer’s circumstances, e.g. low income level orpensioner. Overall, our findings confirm that selecting a phar-macy is a subjective experience for each individual; hencecommunity pharmacies need to meet the consumer’s specificneeds. The insights provided by participants can help informcommunity pharmacists as to what many people withchronic conditions and carers currently value from theirpharmacy. People also need to be able to differentiate betweenthe services that community pharmacies provide and matchthis to their priorities.

Conclusion

Patient-centred care, convenience, price, personal traits andspecific needs can all influence a person’s choice of pharmacy.As pricing and convenience in terms of location are more dif-ficult to change, pharmacy staff can turn their attentionto adopting a more patient-centred approach to care. Thiswas an important attribute for participants with a chronic



condition(s) when choosing a regular pharmacy. Consumersappreciated what they perceived to be quality service deliv-ered by approachable pharmacy staff providing individual-ised medication supply and advice. Regular pharmacypatrons also valued the formation of relationships and aholistic approach to care.

These are positive findings for the community pharmacysector. The profession is moving towards the implementationof more pharmacy services which can foster the developmentof, or enhance, relationships, an important influence on phar-macy patronage. As consumers with chronic conditions areoften on multiple medications and require ongoing treat-ment, they are valuable consumers for pharmacy. It is there-fore important that community pharmacy aims to meet theirindividual needs and provide the quality of care people want.

Declarations

Conflicts of interest

The Authors declare that they have no conflicts of interest todisclose.

Funding

This project is funded by the Australian Government Depart-ment of Health and Ageing as part of the Fifth Community

Pharmacy Agreement Research and Development Programmanaged by The Pharmacy Guild of Australia. The financialassistance provided must not be taken as endorsement of thecontents of this study.

Jennifer A. Whitty is supported by a research fellowshipfrom the Queensland Government Department of Employ-ment, Economic Development and Innovation, QueenslandHealth and Griffith University.

Acknowledgements

We thank all participants for sharing their personal storieswith us. We are grateful to Beth Hunter, Professor ElizabethKendall, Claire Campbell, Ciara McLennan and everyonewho supported us in recruiting participants.

Authors’ contributions

FK, MK, JW and AW contributed to the initial study design.SM, AS, FK and AW contributed to developing the interviewguide and study method. SM, AS and FK collected data, SM,AS and FK conducted data analysis, SM was the lead author ofthe manuscript, AS, FK, MK, JW and AW reviewed the manu-script, and AW, MK and FK are supervisors of SM.All Authorsstate that they had complete access to the study data thatsupport the publication.

References

1. Blendon RJ et al. Common concernsamid diverse systems: health careexperiences in five countries. Health Aff(Millwood) 2003; 22: 106–121.

2. Australian Commission on Safety andQuality in Health Care. Patient-CentredCare: Improving Quality and Safetythrough Partnerships with Patients andConsumers. Sydney, NSW: AustralianCommission on Safety and Quality inHealth Care, 2011.

3. Australian Commission on Safety andQuality in Health Care. Patient andConsumer Centred Care DiscussionPaper. Canberra, ACT: AustralianCommission on Safety and Qualityon Health Care, 2010. http://www.safetyandquality.gov.au/wp-content/uploads/2012/01/PCCC-DiscussPaper.pdf (accessed 10 January 2013).

4. Committee on Quality of HealthCare in America. Crossing the QualityChasm: A New Health System for the

21st Century. Washington, DC:National Academy Press, 2001. http://www.nap.edu/openbook.php?isbn=0309072808 (accessed 10 January2013).

5. George P et al. The evolving role of thecommunity pharmacist in chronicdisease management – a literaturereview. Ann Acad Med Singapore 2010;39: 861–867.

6. World Health Organization. Noncom-municable Diseases Country Profiles2011. Geneva: World Health Organiza-tion, 2011. http://www.who.int/nmh/publications/ncd_profiles2011/en/(accessed 10 January 2013).

7. Blalock SJ et al. The effect of commu-nity pharmacy based interventions onpatient health outcomes: a systematicreview. Med Care Res Rev 2013; 70:235–266.

8. Program Specific Guidelines. Phar-macy Practice Incentives (PPI). Can-berra, ACT; Australian Government,Department of Health and Ageing; The

Pharmacy Guild of Australia, 2012.http://www.5cpa.com.au/docs/librariesprovider5/public-documents/initiatives-and-programs/ppi/primary-health-care/ppi-program-specific-guidelines-november-2012.pdf?sfvrsn=2 (accessed 10 January 2013).

9. The Pharmacy Guild of Australia.Initatives and Programs. Adelaide, SA:The Pharmacy Guild of Australia, 2010.

10. White L, Klinner C. Service quality incommunity pharmacy: an explorationof determinants. Res Soc Admin Pharm2012; 8: 122–132.

11. McMillan SS et al. Patient centredapproaches to health care: a systematicreview of randomized controlled trials.Med Care Res Rev 2013 (accessed 1August 2013, epub ahead of print). doi:10.1177/1077558713496318

12. Villako P, Raal A. A survey of Estonianconsumer expectations from the phar-macy service and a comparison withthe opinions of pharmacists. PharmWorld Sci 2007; 29: 546–550.



13. Gastelurrutia MA et al. Customers’expectations and satisfaction with apharmacy not providing advanced cog-nitive services. Pharm World Sci 2006;28: 374–376.

14. Oparah AC, Kikanme LC. Consumersatisfaction with community pharma-cies in Warri, Nigeria. Res Social AdmPharm 2006; 2: 499–511.

15. KT X. Choice of and overall satisfactionwith pharmacies among a community-dwelling elderly population. Med Care2002; 40: 1283–1293.

16. Chen Y-C et al. Public views of com-munity pharmacists in Taiwan. Int JPharm Pract 2012; 20: 203–206.

17. Attree M. Patients’ and relatives’experiences and perspectives of ‘Good’and ‘Not so Good’ quality care. J AdvNurs 2001; 33: 456–466.

18. Naik Panvelkar P et al. Measurement ofpatient satisfaction with communitypharmacy services: a review. PharmWorld Sci 2009; 31: 525–537.

19. Um IS et al. Consumer perspectivesabout weight management services in acommunity pharmacy setting in NSW,Australia. Health Expect 2012 (accessed10 January 2013, epub ahead of print).doi: 10.1111/j.1369-7625.2012.00788.x

20. Teh R et al. Consumer perspectives ofpharmacist-delivered healtn informa-tion and screening services. Int J PharmPract 2001; 9: 261–267.

21. Taylor J et al. A community pharmacy-based cardiovascular screening service:views of service users and the public.Int J Pharm Pract 2012; 20: 277–284.

22. Arneson DL et al. Patronage motivesof community pharmacy patrons. JPharm Mark Manag 1989; 4: 3–22.

23. Whitehead P et al. Patient drug infor-mation and consumer choice of phar-macy. Int J Pharm Pract 1999; 7: 71–79.

24. Phul S et al. Pharmacy services andpatient choice: insights into differences

between patient groups. Int J PharmPract 2003; 11: 233–242.

25. The Pharmacy Guild of Australia.Final Report: Consumer Experiences,Needs and Expectations of Commu-nity Pharmacy. Canberra, ACT: Aus-tralian Government, Department ofHealth and Ageing, 2005. http://guild.org.au/docs/default-source/public-documents/services-and-programs/research-and-development/Third-Agreement-R-and-D/2005-501/final-report.pdf?sfvrsn=0 (accessed 10January 2013).

26. Lawrence Neuman W. Social ResearchMethods: Qualitative and QuantitativeApporaches. Boston, MA: Pearson Edu-cation, Inc., 2011.

27. Liamputtong P. Research Methods inHealth: Foundations for Evidence-BasedPractice. Sydney, NSW: Oxford Univer-sity Press, 2010.

28. Sav A et al. Treatment burden amongpeople with chronic illness: what areconsumer health organisations saying?Chronic Illn 2013; 9: 220–232.

29. McMillan S et al. Community phar-macy in Australia: the health hub desti-nation of the future. Res Soc AdminPharm 2012 (accessed 10 January 2013,epub ahead of print). doi: 10.1016/j.sapharm.2012.11.003

30. Roulston K. Considering quality inqualitative interviewing. Qual Res 2010;10: 199–228.

31. Boeije H. A purposeful approach to theconstant comparative method in theanalysis of qualitative interviews. QualQuant 2002; 36: 391–409.

32. Glaser BG. The constant comparativemethod of qualitative analysis. SocProbl 1965; 12: 436–445.

33. Sim J, Wright C. Research in HealthCare: Concepts, Designs and Methods.London: Stanley Thornes (Publishers)Ltd, 2000.

34. Bowen GA. Naturalistic inquiry and thesaturation concept: a research note.Qual Res 2008; 8: 137–152.

35. Morgan S, Yoder LH. A concept analysisof person-centered care. J Holist Nurs2012; 30: 6–15.

36. Dancet EA et al. Patients from acrossEurope have similar views on patient-centred care: an international multilin-gual qualitative study in infertility care.Hum Reprod 2012; 27: 1702–1711.

37. Victoor A et al. Determinants ofpatient choice of healthcare providers:a scoping review. BMC Health Serv Res2012; 12: 272.

38. Denhov A, Topor A. The componentsof helping relationships with profes-sionals in psychiatry: users’ perspec-tive. Int J Soc Psychiatry 2012; 58: 417–424.

39. Lincoln YS, Guba EG. NaturalisticInquiry. Newberry Park, CA: Sage Pub-lications, Inc., 1985.

40. Peterson GM et al. Public perceptionsof the role of Australian pharmacists incardiovascular disease. J Clin PharmTher 2010; 35: 671–677.

41. Worley MM et al. Pharmacists’ andpatients’ roles in the pharmacist-patient relationship: are pharmacistsand patients reading from the samerelationship script? Res Soc AdminPharm 2007; 3: 47–69.

42. Gidman W et al. Understanding publictrust in services provided by commu-nity pharmacists relative to thoseprovided by general practitioners: aqualitative study. BMJ Open 2012; 2:e000939. doi: 10.1136/bmjopen-2012-000939

43. Rapport F et al. Through the lookingglass: public and professional perspec-tives on patient-centred professional-ism in modern-day communitypharmacy. Forum Qual Soc Res 2010;11: article 7.



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How to attract them and keep them: the pharmacy attributes that matter to Australian residents with chronic conditions