PHARMACISTS INTEGRATION INTO PRIVATE PRIMARY HEALTHCARE CLINICS: THE PERSPECTIVES OF PRIVATE GENERAL PRACTITIONERS, PHARMACISTS AND HEALTHCARE CONSUMERS IN URBAN AREAS IN MALAYSIA

Abstract

Pharmacists are considered medication experts but are underutilised and exist mainly at the periphery of the Malaysian primary healthcare team. Private General Practitioners (GPs) in Malaysia are granted rights under Poison Act 1952 to prescribe and dispense medications at their clinics, thus limiting community pharmacists’ involvement in ensuring safe use of medications as most patients obtain their medications from their GPs. The integration of a pharmacist into private primary healthcare clinics has the potential to contribute to quality use of medications and is a novel approach in Malaysia. However evidence supporting this role in the Malaysian context is currently limited. This thesis explored the perspectives of private GPs, pharmacists and healthcare consumers on the integration of pharmacists within private primary healthcare clinics in Malaysia. Five focus groups and twenty semi-structured interviews were conducted with a purposive sample of private GPs (n=13), pharmacists (n=19) and consumers (n=24) until data saturation was achieved. All sessions were audio-recorded and transcribed verbatim and thematically analysed using NVivo 10 (QSR, Melbourne). The themes which emerged from private GP participants were; (1) poor understanding of pharmacists’ roles, (2) readiness to accept pharmacists in private primary healthcare clinics, (3) lack of confidence and trust in pharmacists, and (4) perceived increased costs with pharmacist integration. Themes which emerged from pharmacist participants were; (1) pharmacists envisioned main role in private primary healthcare clinics as dispensing medications, (2) difficulty envisioning roles beyond dispensing medication, (3) lack of support and recognition by consumers and private GPs, and (4) cost implications from pharmacist integration. Themes which emerged from consumer participants were; (1) pharmacists’ role viewed mainly as supply of medications, (2) readiness to accept pharmacists in private primary healthcare clinics, (3) willingness to pay for pharmacy services, and (4) concerns about GPs’ resistance to pharmacist integration. The results of this study demonstrated that participants generally supported the integration of pharmacists into private primary healthcare clinics but were concerned with the implementation of the model in Malaysia. These concerns were greatly associated with remuneration and pharmacists’ skills for successful integration. The findings of this project will help form basis of a new primary care delivery model for Malaysia.