Table 3

Barriers to using CP post-discharge services

Type of barriersExamplesRepresentative quotes
Barriers related to the healthcare system and the ToC process
  • The different services provided locally which confuse patients about what is available

  • The lack of a national standard ToC service*

  • Privacy and confidentiality issues related to sharing information with the CP; as some patients see community pharmacists as non-healthcare professionals or because they feel their personal information is too sensitive to be shared with their CP

‘We are bombarded with many new systems, and there is another system on top of another system. There is that much confusion.’ (02P, with LTC)
‘It might have been operating in some areas for years, but it has not been operating in the areas where I have lived.’ (07P, with no LTC)
Barriers related to the accessibility and availability of the resources at the CP
  • Transport accessibility issues to the CP where patients are too ill or housebound

  • Some CPs are not accessible for the elderly or for patients with disabilities

  • Community pharmacists have time pressure and therefore unable to provide post-discharge care

  • Community pharmacists cannot provide home visits because of their shortage of staff

‘Pharmacies that I have been out to, the local ones, they do not have ramps or disability access.’ (01P, healthy individual)
‘There is very little time for pharmacists to communicate with the person.’ (02P, with LTC)
Barriers related to patients’ understanding of CP post-discharge services
  • The lack of awareness of CP post-discharge services

  • The lack of appreciation of the benefits of CP post-discharge services, for example, some participants believed that CPs do not provide cognitive services/advices; access of care from other healthcare professionals was preferred such as GPs, practice nurses or the hospital doctor

  • Patients’ low acceptability of seeing a community pharmacist post-discharge may be due to a long hospital stay so they do not want any additional care, or they would be reluctant to change from seeing their GPs as the first port-of-call, or they do not have trust/good relationship with their community pharmacists

  • Patients perceive that community pharmacists have no knowledge of the patient’s medical history and no full access to the medical records; therefore, they might not provide the required support to hospital-discharged patients

‘There is still a massive gap in terms of understanding what the community pharmacist can do. Many people think of it as just a chemist’s shop.’ (04P, carer)
‘Diabetes affects people in different ways. It would be wrong to expect the pharmacist to be fully aware of exactly how diabetes affects that person.’ (10P, with LTC)
‘Older people might find it difficult not to see their GP whom they know, like, and trust. They might feel cast off and just castaway to go and see the pharmacist instead.’ (07P, with no LTC)
  • *At the time of conducting the interviews, there was no national standard ToC service. However, DMS will be an essential national service for hospital-discharged patients on a new medicine.

  • CP, community pharmacy; DMS, Discharge Medicines Service; GP, general practitioner; LTC, long-term condition; ToC, transfer of care.