Community pharmacists, medication monitoring, and the routine nature of refills: A qualitative study

Objective: To describe the attitudes, contextual factors, and behaviors associated with medication monitoring in the dispensing process by community pharmacists. Design: Descriptive qualitative research with semistructured interviews. Setting: Midwestern community pharmacies or telephone. Participants: 12 licensed community pharmacists from chain, independent, and grocery pharmacies. Intervention: 45-minute, semistructured interviews were conducted to gather detailed live experiences and perspectives pertinent to the study objective. Main outcome measures: Transcripts were coded descriptively and inter-pretively, originating with the input and monitoring process domains of the Health Collaboration Model. Results: A thematic dichotomy was interpreted in the analysis. All participants discussed both (1) the technical and routine nature of their work, and (2) the problem-solving and relational aspects of practice. More specifically, medication monitoring was constrained by busyness, lack of patient interest, and the routine nature of refills, although to varying extents. Some predominantly responded to unique circumstances such as patient question-asking, prior memory of a patient interaction or service utilization, or technical issues such as medication cost. Others added unprompted questions of varying specificity when handing off the prescription to understand patient medication experiences. Pharmacists felt challenged by nonadherence monitoring because workflows made this information difficult to access and late refills were prevalent. Conclusion: Community pharmacies seeking to increase medication monitoring in the dispensing process may target the routine nature of refills and the availability of monitoring information.