"What counts can't always be measured": a qualitative exploration of general practitioners' conceptualisation of quality for community pharmacy services.

ABSTRACT

BACKGROUND: The expansion of community pharmacy services is one solution to relieve pressure on general practice in the United Kingdom (UK). There is a paucity of research of general practitioners' (GPs') perspectives of quality of care in the community pharmacy sector. The purpose of this study was to explore GPs' Conceptualisation of quality for community pharmacy services, including the management of acute (low acuity) conditions and defining indispensable aspects of the patient experience ('always events') Opinions regarding whether and how to measure quality in the community pharmacy sector METHOD: Semi-structured interviews were conducted with GPs in the UK. GPs were recruited using the snowballing technique and professional networks. Interviews were audio-recorded, transcribed and analysed using an interpretive approach. RESULTS: Interviews were completed with 20 GPs from Scotland (n = 8) and England (n = 12). Multidimensional and inter-related concepts of quality were identified; most dimensions related to patient benefit, as well as impact on GP workload or other health service provision. Interviewees cautioned that "what counts can't always be measured". GPs' expectations of quality often mirrored those of their own sector, but were ambivalent about the adoption of a quality outcome framework-type approach. Pharmacist involvement was expected to ensure quality in the management of 'acute consultations', however, GPs lacked awareness of community pharmacy personnel type, roles and training. Interviewees' perceptions of quality varied by pharmacy type; independent pharmacies were sometimes associated with higher quality service delivery than larger chain organisations. CONCLUSIONS: Quality frameworks for community pharmacy services could be partly informed by GP experience and expectations, but need to be contextual to reflect differences between both settings. The importance of person-centred care, consistency and continuity was emphasised together with the need for competent personnel and privacy of interactions.