Ensuring patient-centred care beyond compliance

Abstract

Background: Pharmacists base safe practice on regulatory compliance, yet evolving patient needs increasingly require the exercise of professional judgement beyond these standards

Objective: To identify patient needs and develop strategies to overcome challenges in meeting these needs.

Method: An anonymised online questionnaire to gather pharmacist insights was developed. Focus group discussions involving two community pharmacists, one hospital pharmacist, one academic pharmacist, one regulatory pharmacist and one layperson were conducted to validate the questionnaire and clarify concepts such as ‘going beyond the call of duty’ in pharmacy practice. Thematic analysis was performed on qualitative data gathered. The ‘Pharmacist Perspective on Patient Needs Questionnaire’ was disseminated online to pharmacists. The questionnaire gathered quantitative and qualitative insights into the regulatory, professional, and service-related barriers faced. Ten case studies and relevant patient-centred strategies were designed based on questionnaire and focus group insights. Validation of these cases was done through a focus group session.

Results: Thematic analysis identified four main themes with corresponding sub-themes: Going Beyond the Call of Duty, Barriers to Going Beyond the Call of Duty, Regulations and Sustainability. Among the pharmacists surveyed (N=39), the three most frequently encountered patient needs were: polypharmacy (n=30), low health literacy (n=27) and care coordination (n=24). Frequency ratings across the 14 identified patient needs differed significantly (Friedman Test, p<0.001). Kruskal Wallis tests revealed that professional role was found to significantly influence the frequency of encountering low health literacy (p = 0.030), financial constraints (p = 0.013), and post discharge support (p = 0.024). Years of experience significantly affected frequency ratings for financial constraints (p = 0.018) and care coordination (p = 0.021). When describing actions that ‘go beyond the call of duty’ four pharmacists provided no specific examples, characterising such efforts as either too frequent to recall or a fundamental part of practice. Inductive content analysis of the remaining responses (n=35) identified five categories of support: medication access (n=11), medication management support (n=9), emotional support (n=9), practical support (n=2), and patient advocacy (n=3).The ten case studies were organised into four sections: Scenario outlining the patient need, Practice Challenges describing the pharmacist’s difficulties, Thematic Links connecting the case to the study’s themes, and Resolutions detailing both immediate pharmacist actions and broader systemic actions. The cases addressed continuity of care gaps, adherence support for patients with literacy barriers, non-formulary prescription that a patient cannot afford, emotional distress, conflicting prescriber instructions, medication shortages, extended opening hours, support for foreigners, prescription support following bereavement and financial constraints.

Conclusion: Pharmacists go beyond their duties by providing care that extends past regulatory expectations and centres on the patient’s wellbeing. The cases illustrate the challenges of sustaining this approach by presenting realistic, practice-based scenarios in which pharmacists navigate complex patient needs within routine constraints.