Online pharmacies are no replacement for face-to-face pharmacist interaction, UK study finds
General practice staff, including GPs, in the UK have responded to a survey to explore their views of the increasing availability of distance-selling pharmacies.
Researchers from the University of Sunderland in north-east England surveyed 97 practice staff. The sample included 19 GPs, 25 practice managers, 16 reception staff, eight pharmacists/pharmacy technicians, six prescription clerks, four dispensing managers, five nurses, and five ‘other’ staff, plus nine respondents who were missing role information.
They also held a small set of focus groups that included a total of eight GP participants.
Concerns were raised in both focus groups that an increased reliance on remote dispensing could result in potential loss of valued elements of local community pharmacy provision.
“Continuity of care, community pharmacists’ local knowledge of patients and relationships with GPs were perceived to be essential for enabling a valued alert system of compliance problems and prescribing errors, and of the efficient resolution of problems,” said the researchers in the International Journal of Pharmacy Practice.
For example, one GP and focus group participant said: “There’s a big issue around continuity of care generally … I think if you take out yet another community-based resource or you denigrate it … by challenging their financial viability … you could very readily lose that immediate contact with patients”.
Dealing with medicines dispensing and supply issues was not perceived to be a legitimate responsibility of the GP, unless it impacted directly on patient care.
“It’s when it doesn’t work that I become more interested,” said another focus group GP participant.
Required changes to electronic repeat prescriptions and remotely dispensed multi-compartment compliance aids were reported to be complex and time-consuming to resolve.
Meanwhile the majority of survey respondents reported that they dealt with local independent or small chain pharmacies on a daily or weekly basis (68%) and less frequently with large multiple or supermarket pharmacies, or distance-selling pharmacies that trade only online or by mail order.
In line with focus group findings, interaction with community pharmacy was highly valued among survey respondents.
Most respondents (76.3%) reported that they would prefer to deal with a local pharmacist they knew well when dealing with medicine supply and dispensing queries (47.4% strongly agreed, 28.9% agreed).
When asked to rate the most important things related to safe and efficient supply of medicines, the most highly rated item was “effective communication between pharmacy and general practice”, with 97.9% citing this as very important.
This was followed by good relationships between general practice and pharmacy (88.7%); alerts about medicines compliance (81.4%), supply issues (77.3%); and safety issues (75.3%); the opportunity for patients (and/or carers) to have direct face-to-face contact with their pharmacist responsible for dispensing their medicines (67%); and dispensing pharmacist knowing local patients well (63.9%).
Most respondents agreed or strongly agreed that where and how prescriptions are dispensed has an impact on their practice and patients (81.4%).
More respondents rated home deliveries of medications by local community pharmacies as an important service (92.6%) than postal delivery by distance-selling pharmacy (26%).
Meanwhile respondents shared concerns about distance-selling pharmacies including the unreliability of delivery of medicines, and lack of direct patient contact, for example the loss of personal service and social interaction, especially for the elderly and housebound.
The findings “highlight that community pharmacy is seen by family practice staff to provide a valued ‘safety net’ that can help to identify and resolve compliance issues and prescribing errors more efficiently,” write the authors.
“Reported concerns suggest that some staff believe that an increased reliance on distance-selling pharmacies and other forms of centralised dispensing may denigrate valued elements of community pharmacy and dispensing practices by threatening their long-term sustainability.”
The authors acknowledge the limitations of their small sample size and say the findings should be interpreted with caution.
See the full study here