Characterizing healthcare quality in the community pharmacy setting: Insights from a focus group study

Background: There is currently no common frame of reference defining community pharmacy quality. It can therefore be difficult to know whether the provision of care meets minimum standards and how to improve quality of care. Objective: The aim of this research was to develop a conceptual framework characterizing healthcare quality in the community pharmacy setting. Methods: Ten focus group discussions with 47 participants were conducted across the northwest of England, United Kingdom. All participants had experiences of health care provided by community pharmacies and included patients and their carers, pharmacists and pharmacy staff, and National Health Service staff who commissioned pharmacy services. Constant comparative analysis was used to analyze the verbatim transcripts. Results: Community pharmacy quality can be conceptualized as dynamic with 3 interdependent dimensions. Each dimension was associated with structures, processes, and outcomes. The first dimension (accessibility) emphasized that in addition to patients requiring access to the available services, medicines, and health care advice, it was equally important for pharmacy personnel to have access to adequate structures to provide quality health care. The second dimension (effectiveness) highlighted a shift away from simply supplying medicines to supplying medicines appropriately, from passively providing services and information to individualizing advice to achieve intended outcomes, and from having structures available to using them purposefully to achieve outcomes. The third dimension (positive perceptions of the experience) enabled patients and carers to better care for themselves and for others, and it influenced future access. At the same time, when pharmacy personnel believed themselves to be valued and that they had done a good job, they felt motivated to continue to provide high-quality care. Conclusions: All 3 dimensions should be considered when the term quality is used in the context of community pharmacy. This research can be used as a springboard for similar studies in other sectors or jurisdictions wishing to characterize quality for their health care services. In particular, this research provides a common frame of reference for those interested in the provision and assessment of quality health care from community pharmacies. (C) 2012 Elsevier Inc. All rights reserved.