Table 3

Themes identified with narrative examples

ThemesNarrative examples
Indicator characteristicsPositive: ‘I liked that a large number of items (for some diseases) were included. Pharmacists should know all QI statements’. (P5)
Negative: ‘My patients are well. I think it is not always necessary to measure QIs’. (P22)
Barriers: ‘I hesitate to recommend the clinician to prescribe an additional medicine to patients who are already taking a lot of medications regardless of the reason’. (P3)
Facilitators: ‘I realised that once I became familiar with QI statements, I was able to check QIs so efficiently. I think continuity is a key to success’. (P4)
Web applicationPositive: ‘The application was easy to use and access the data’. (P7)
Negative: ‘When a QI had a small number of patients in the denominator, the graph was fluctuating and not interesting at all’. (P7)
Barriers: ‘There were visualisations that I did not understand. However, those were not important for me because I was only interested in my pharmacy score’. (P2)
Facilitators: ‘It would be nice if the application was a bit simpler and linked to pharmacy record system so that we work efficiently’. (P23)
PolicyNegative: ‘One of my achievements in this project was that my patient stopped routinely taking a pain killer. But I was disappointed with the current policy because my service was not adjusted to financial incentives’. (P3)
Barriers: ‘I first worked hard on the QI project. But I realized that there was no financial merit to our pharmacy’. (P1)
Facilitators: ‘I want policymakers or pharmacist’s organizations to use QIs to increase transparency and accountability about our services. I guess that QIs might be adjusted to local policy as well’. (P18)
PatientPositive: ‘By spending more time on patient counselling, my patient remembers my name. She is now happy to talk to me about their condition and lifestyle’. (P2)
Negative: ‘my patient told me ‘was there something wrong?’ when I asked her about her health and the blood test result. I might have asked too many questions to her’. (P9)
Barriers: ‘When I ask patients themselves, sometimes they do not know even know how they feel. I need to talk to their family or carers, but not always a success’. (P15)
Facilitators: ‘My patients have sufficient education on warfarin therapy (I educated them). They usually show their international normalised ratio (INR) values to me after INR testing was performed by their doctors’. (P10)
TimeNegative: ‘I spent a lot of time on patient counselling to explain deprescribing more than I thought. It was frustrating’. (P9)
Barriers: ‘I think that time is the critical issue. I was being asked to spend more time on the patients’ counselling and report QI items in addition to a regular workload’. (P23)
Facilitators: ‘Pharmacists participated in the QI project, but now I realised that all staff, such as registered dieticians and pharmacy staff, should have worked. I think they are capable of reporting QI items and information they have is sometimes important to understand patients’. (P15)
CompetencePositive: ‘I have never checked the vaccination status of my patients before. Now we check their vaccine status and recommend a flu shot if necessary’. (P22)
Negative: ‘That was boring because QI score was rarely changed’. (P16)
Barriers: ‘I am not sure if I can provide my patients with proper advice based on their blood test result’. (P19)
Facilitators: ‘There are opportunities to learn pharmacotherapy for pharmacists, but those do not focus on guidelines’. (P21)
Pharmacy administrationPositive: ‘I was worried about my staff before. According to QI score, my staff were working well, so I was happy to see their work using QIs’. (P18)
Negative: ‘I felt more responsibility for improving the score as a manager’. (P25)
Barriers: ‘As a manager, I wanted to discuss QI score with my staff. But I hesitated to do so because they were always busy’. (P24)
Facilitators: ‘I think it would be different if we had a quality control expert in our pharmacy’. (P21)
CollaborationPositive: ‘I liked that we (care manager and I) work together to detect PIMs’. (P1)
Negative: ‘Doctor did not accept my recommendation of changing sulfonylureas because following the medication guideline or guidance was not mandatory’. (P4)
Barriers: ‘When we communicate with doctors in the hospital, we usually make online reports to suggest PIMs. But the clinics do not have such a convenient system. We have to make a call, which is time-consuming’. (P26)
Facilitators: ‘I think pharmacists should actively collaborate with care managers in addition to doctors. I know some patients who do not have home care, but they start to communicate with care managers’. (P1)
  • Each theme is presented with indicative verbatim quotes from participants, anonymised by alphanumeric codes (eg, P1=Pharmacist 1).