Abstract
Globally, media reports exist of pharmacies providing patient focused services for free in order to meet the healthcare needs of their communities. These services do not receive remuneration from the government, insurance companies, or payments from patients. Services include the management of minor and common ailments and, screening and monitoring tests related to the management of chronic conditions. Budgetary cuts and funding reductions for the pharmacy sector have introduced uncertainty for the community pharmacy business model, putting the financial sustainability of these free services into question. More importantly this means that patients could be losing access to services that might otherwise lead to improvements in health.
The aims of this thesis are to identify (1) what unfunded services are provided in community pharmacies, (2) their impact on patient health outcomes, and (3) the costs associated with the provision of these services. It consists of three studies, with each informing the next.
The first study (scoping study) utilises focus group discussions with practising pharmacists across New Zealand to ascertain the types of unfunded services they provide. The second study (feasibility study) utilises a mixed model study design consisting of a real time continuous observation time-motion study, short on-site patient interviews, and one-on-one semi-structured interviews with pharmacy managers and owners. The main aim of this study is to ascertain if the study method is suitable before launching a nationwide study. The final study (nationwide study) investigates the provision of pharmacy services in real-time at a national level.
Unfunded services were found to belong to three categories namely (1) standalone unfunded services, (2) services funded elsewhere, and (3) leakages from the funding model. Some services belonged to more than one category.
It was found that pharmacies do indeed offer unfunded services. Pharmacists were found to offer the majority of unfunded services, however despite self-reports of higher proportions, they were found to utilise 6.4 ± 4.9% of their average working day providing unfunded services. Twenty-three unfunded service types were found to exist where the management of common and minor ailments was the most frequently provided. Variability in labour costs were also found where the majority of unfunded services cost below $10 (New Zealand). Patients cited convenience, trusting the pharmacist, and affordability of pharmacy services as reasons they access services from the pharmacy. Sixty-six percent of patients followed up after a pharmacy intervention confirmed that their symptoms had resolved after obtaining the service from the pharmacy and no further healthcare was sought from other healthcare providers.
This thesis informs the health sector about unfunded services provided, their health outcomes for patients and costs associated with provision.