Pharmacists' perceptual systems regarding their role in medication adherence in South Africa : an interactive qualitative analysis approach

Abstract

The major purpose of this exploratory study was to understand what the perceptions are of pharmacists in South Africa regarding their role in the medication adherence of a patient. The WHO (World Health Organization) referred to medication non-adherence as a “worldwide problem of striking magnitude” and improving adherence to medication has become a priority to health care researchers and policy makers (WHO, 2003:xiii). Research suggests that 30% to 50% of patients do not take their medicine for chronic conditions as prescribed (Horne et al., 2005:10). The costs of medication non-adherence to patients are considered to be a missed opportunity for treatment gain and, if their condition worsens, a possible decline in their quality of life (Clifford et al., 2010:78). Medication adherence also had emerged as a multi-faceted phenomenon where the best results are obtained if more than one facet can be addressed simultaneously. The importance of the pharmacist as a factor in medication adherence cannot be negated because the pharmacist fulfils an essential link in the chain of health-care to the patient The general research objective of this study was to use the Interactive Qualitative Analysis (IQA) approach to construct and describe the pharmacists’ cognitive mind map regarding the perceptual views of their roles in South Africa in terms of medication adherence of patients. IQA data were collected during three processes. A focus group with pharmacists, selected from a constituency representing pharmacists from as many as possible parts of the pharmaceutical sector in South Africa, identified the components (affinities) of the pharmacists’ perceptual systems (Northcutt & McCoy, 2004:47). An analysis revealed six main categories, named affinities, in IQA are External Barriers, Disposition, Communication Skills, Professionalism, Information Role and Motivational Role Individual semi-structured IQA interviews with pharmacists served to add richness and in-depth descriptions of the meaning of the affinities. A web-based questionnaire was developed with the purpose of capturing the responses of South African pharmacists in terms of their perceived relationships of the affinities as generated by the focus group. External Barriers were identified as the primary driver of the system with Communication Skills in the modulator role. The participants indicated the Motivational Role as the primary outcome (primary role) regarding their roles in medication adherence. The system produced two identifiable loops or cycles namely The Turmoil loop and The Pharmacists Portrayal Loop. Communication Skills modulated both loops, preventing them from becoming vicious cycles spinning out of control to detrimentally affect the medication adherence role of the pharmacist. Pharmacists experience External Barriers very negatively as they cannot escape them or have limited power or authority over them. External Barriers are a reality in the practice of pharmacists in South Africa and ultimately determine the interaction and relationship with the patient. The respondents considered Communication Skills as very important. The perceptual system might not yet be a true representation of medication adherence but rather a system reflecting compliance with medication. However, it shows a significant but unknowing shift in terms of the principles of a formalised medication adherence structure. The respondents perceived that they as pharmacists have a role to play in the medication adherence of their patients and willingly accepted the role, as they really do care for their patients and do want to help patients to the best of their ability. This study was the first to be done on the perception of South African pharmacists on their role in the medication adherence of their patients and provide new and previously unknown information in the format of a system and model to benefit all pharmacists in South Africa