Price versus service: the patient impact

tug of war

Patients who attend a discount pharmacy are more likely to have a poorer perception of its service standards and are less likely to adhere to their medicines, new research suggests

Researchers from the School of Pharmacy, University of Sydney, surveyed 319 patients recruited from eight Sydney pharmacies.

They found that “attending pharmacies with a price promotion business strategy” was predictive of lower “perceived service quality” (pSQ) – a patient’s judgement of, or impression about, the overall excellence of the service provided by the community pharmacy – when compared to regularly attending a pharmacy with a high service business strategy.

Attending these pharmacies was also linked to poor medication adherence, said the researchers, led by former NSW PSA president Stephen Carter.

They called for policy-makers to consider whether incentive/disincentive mechanisms could be built into remuneration systems for the supply of medicines.

“This study explored the impact of the regular day-to-day service that community pharmacies provide in supporting medication adherence,” the authors said.

“While it is clear that pharmacies aiming to provide high levels of service tend to have patients who report better patient experience and who are more adherent than patients attending discount stores, there was a high degree of variability in adherence both within and between pharmacy types.

Perhaps not surprisingly, patient experience (as reported by pSQ) was the best predictor of adherence and this should focus community pharmacy owners, managers and practitioners on the important role of communication and patient support,” they said.

Given the importance of improving medication adherence, and the negative impact on this when patients experience low service quality, community pharmacies need to be designed and managed to allow pharmacists to provide high levels of patient-centred care, the authors said.

“Each and every patient deserves the opportunity to have meaningful contact with their pharmacist, while obtaining their medicines. Regular ongoing support can allow for therapeutic relationships to develop and which allows for pharmacists to intervene to improve patient safety and provide adherence support,” they said.

“Designing and managing pharmacies without the specific intent of providing patient-centred care appears to be associated with poor adherence and this is likely to compromise therapeutic outcomes”.

There were more female (68.5%) participants in this study and approximately half (53.6%) of the participants were aged 35–54 years old.

Just over 84% of the patients lived within 5 km of the pharmacy. Most participants (91.8%) visited the pharmacy at least every month and used medicine at least once every day (92.1%), while 83.4% were
prescribed between 1 and 4 regular medicines and only 2.8% were prescribed more than 7.

The study was published in the journal Patient Education and Counselling.

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  1. Philip Smith

    There are obviously some variables here.
    I suspect the wage of the pharmacist and the workload they are under at the time is more of a cause, but the discount models is supported by those factors resulting in a poor outcome.
    7CPA changed nothing in regards to this.

    • Paul Sapardanis

      Correct Philip its that simple. The more time you have then the more time you can give. Equals better service. I’m disappointed that the 7cpa promotes this kind of practice as well. It should have been the more you do the less you get paid. But here we are now

      • Ex-Pharmacist

        The Guild has never been able to find a way to limit the mega-profits from ‘script factory’ sweat-shop type dispensaries (perhaps similar to the ones described in this story) without hurting their own members businesses. Chemist Warehouse owners becoming billionaires is a side-effect of this failure, but a lesser evil than inflicting any financial pain on their members. The government remains blinded as ever by the Guild’s smokescreen on “professional” (cough…) CPA services while owners fill their bank accounts with overly generous dispensing & CPA fees. The losers are the overworked, deskilled & underpaid staff on the pharmacy floor, and the users of these Pharmacy services. The biggest loser is the tax payers of Australia (remember them?) who end up grossly overpaying for these dispensing fees + CPA services for very little actual benefit.

  2. disillusioned

    @sue_dunlevy 😬

  3. Steven J

    How about we make the owner, within reason of course, work in the pharmacy?

    Maybe, at least half the hours or hours reflecting their ownership percentage.

    Maybe we should stop letting people own mints that print them money that they don’t ever step foot in.

    • Paul Sapardanis

      A condition of ownership should be a minimum amount of work in store each fortnight. It would give said owner a greater understanding of the work involved for the pharmacist in that store. Why have ownership rules if the pharmacist doesn’t work there?

  4. Sean Gannon

    The pubmed ID for the article referenced here is

    32788130 for anyone who wants to read it themselves.

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