Hospital clinical pharmacists’ perspectives on suboptimal pharmaceutical care: a qualitative study.

Abstract

Abstract Background While clinical pharmacists are responsible for medicines optimisation and provision of pharmaceutical care, there is a lack of literature focusing on what constitutes ‘suboptimal’ pharmaceutical care. Aim To explore the perceptions and experiences of hospital clinical pharmacists of the delivery of suboptimal pharmaceutical care, and the determinants influencing their behaviours. Method This study adopted a phenomenological qualitative design. Participants from one health board in Scotland were recruited purposively, and interviewed until data saturation was reached. The semi-structured interview schedule focused on behaviours associated with participant’s experiences and perceptions of suboptimal pharmaceutical care. Behavioural determinant items were derived from the Theoretical Domains Framework (TDF). Transcripts were analysed using a thematic approach. Results Ten participants were interviewed to achieve data saturation. Behaviours were observed in different phases of the process: identifying, responding to, reporting and reflecting on suboptimal pharmaceutical care. The themes from the analysed data showed potential influences from environmental context and resource factors such as time management and prioritisation which influenced both the identification and reporting of suboptimal pharmaceutical care, and social and professional role and identity factors including professional embarrassment and hierarchical barriers which influenced reporting on suboptimal pharmaceutical care. Conclusion This study suggests that the concept of suboptimal pharmaceutical care can be used to describe events and episodes that pharmacists perceived as being less than the desired standard of care for patients. Factors such as time management, prioritisation and system related barriers often prevented pharmacists reporting suboptimal pharmaceutical care.