Challenges in the management of community pharmacies in Malaysia
Background: The provision of professional pharmacy services by community pharmacists continues to be limited, particularly in low and middle income countries. It was postulated that multiple management challenges faced by community pharmacists contribute to this situation.
Objective: The primary aim of the research was to determine the challenges faced in the management of community pharmacies in Sarawak (the largest state in Malaysia), and practical strategies to cope and overcome the challenges.
Methods: Semi-structured interviews were carried out with community pharmacists practising in Sarawak. Purposive and snowball sampling were employed to ensure a diverse group of informants. The interviews were audio-recorded and transcribed verbatim, with the resultant data analysed using thematic analysis. Data collection, coding, interpretation were carried out iteratively until theoretical saturation.
Results: Twenty respondents from different demographic characteristics were recruited. Six major themes were identified. Management challenges faced by community pharmacists traverse five major domains: market competition, legislative issues, customers’ knowledge and expectations, macroeconomic impacts and operational challenges. Most of these challenges require government intervention to be resolved. In the meantime, improving customer service and expanding the range of professional services were seen as the most viable strategies to cope with existing challenges. The main concern is that current legislative and economic landscape may hinder these strategies. Enactment of dispensing separation and more protective measures against market competition were suggested to alleviate the challenges faced.
Conclusion: Numerous management challenges faced by community pharmacists that distract them from delivering professional pharmacy services have been highlighted. Urgent affirmative actions by the government are warranted in supporting community pharmacists to realise and maximise their potentials.
2. Ram S, Jensen M, Blucher C, Lilly R, Kim R, Scahill S. Pharmacists as Managers: what is being looked for by the sector in New Zealand community pharmacy? Asia Pac J Health Manag. 2015;10(1):36-45.
3. Ottewill R, Jennings PL, Magirr P. Management competence development for professional service SMEs: the case of community pharmacy. Education and Training 2000;42(4/5):246-255. doi: 10.1108/00400910010373697
4. Woods P, Gapp R, King MA. A grounded exploration of the dimensions of managerial capability: A preliminary study of top Australian pharmacist owner-managers. Res Social Adm Pharm. 2015;11(5):623-638. doi: 10.1016/j.sapharm.2014.11.008
5. Duckett K. Community, autonomy and bespoke services: Independent community pharmacy practice in hyperdiverse, London communities. Res Social Adm Pharm. 2015;11(4):531-544. doi: 10.1016/j.sapharm.2014.10.009
6. Chappell NL, Barnes GE. Professional and business role orientations among practicing pharmacists. Soc Sci Med. 1984;18(2):103-10. doi: 10.1016/0277-9536(84)90030-3
7. Bissell P, Traulsen M. Sociology and Pharmacy Practice. United Kingdom: Pharmaceutical Press; 2005.
8. Bader LR, McGrath S, Rouse MJ, Anderson C. A conceptual framework toward identifying and analyzing challenges to the advancement of pharmacy. Res Social Adm Pharm. 2017;13(2):321-331. doi: 10.1016/j.sapharm.2016.03.001
9. Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47(3):533-543.
10. Mossialos E, Naci H, Courtin E. Expanding the role of community pharmacists: Policymaking in the absence of policy-relevant evidence? Health Policy. 2013;111(2):135-148. doi: 10.1016/j.healthpol.2013.04.003
11. Smith J, Picton C, Dayan M. Now or never: Shaping pharmacy for the future. London: Royal Pharmaceutical Society; 2013.
12. Aburuz S, Al-Ghazawi M, Snyder A. Pharmaceutical care in a community-based practice setting in Jordan: where are we now with our attitudes and perceived barriers? Int J Pharm Pract. 2012;20(2):71-79. doi: 10.1111/j.2042-7174.2011.00164.x
13. Laliberté MC, Perreault S, Damestoy N, Lalonde L. Ideal and actual involvement of community pharmacists in health promotion and prevention: a cross-sectional study in Quebec, Canada. BMC Public Health 2012;12:192. doi: 10.1186/1471-2458-12-192
14. Roberts AS, Benrimoj SI, Chen TF, Williams, KA, Aslani P. Implementing cognitive services in community pharmacy: A review of facilitators used in practice change. Int J Pharm Pract. 2006;14(3):163-170. doi: 10.1211/ijpp.14.3.0002
15. Gastelurrutia MA, Benrimoj SI, Castrillon CC, de Amezua MJC, Fernandez-Llimos F, Faus MJ. Facilitators for practice change in Spanish community pharmacy. Pharm World Sci. 2009;31(1):32-39. doi: 10.1007/s11096-008-9261-0
16. Eades CE, Ferguson JS, O'Carroll RE. Public health in community pharmacy: A systematic review of pharmacist and consumer views. BMC Public Health. 2011;11(1):582-594. doi: 10.1186/1471-2458-11-582
17. Berbatis CG, Sunderland VB, Joyce A, Bulsura M, Mills C. Enhanced pharmacy services, barriers and facilitators in Australia's community pharmacies: Australia's National Pharmacy Database Project. Int J Pharm Pract. 2007;15(3):185-191. doi: 10.1211/ijpp.15.3.0005
18. Mak VSL, Clark A, Poulsen JH, Udengaard KU, Gilbert AL. Pharmacists' awareness of Australia's health care reforms and their beliefs and attitudes about their current and future roles. Int J Pharm Pract. 2012;20(1):33-40. doi: 10.1111/j.2042-7174.2011.00160.x
19. Smith F. The quality of private pharmacy services in low and middle income countries: A systematic review. Pharm World Sci. 2009;31(3):351-361. doi: 10.1007/s11096-009-9294-z
20. Hermansyah A, Sainsbury E, Krass I. Community pharmacy and emerging public health initiatives in developing Southeast Asian countries: a systematic review. Health Soc Care Community 2016;24(5):e11-22. doi: 10.1111/hsc.12289
21. Miller R, Goodman C. Performance of retail pharmacies in low- and middle-income Asian settings: a systematic review. Health Policy Plan. 2016;31(7):940-953. doi: 10.1093/heapol/czw007
22. Azhar S, Hassali MA, Ibrahim MIM, Ahmad M, Masood I, Shafie AA. The role of pharmacists in developing countries: the current scenario in Pakistan. Human Resour Health. 2009;7:54. doi: 10.1186/1478-4491-7-54
23. Hassali MA, Ooi GS, Shafie AA, Alrasheedy AAF, Ho RY. Assessment of Malaysian community Pharmacists' involvement in extended pharmacy services. Malaysia: School of Pharmaceutical Sciences, Univeriti Sains Malaysia; 2014.
24. Alabid AHM, Ibrahim MIM, Hassali MA. Dispensing practices of general practitioners and community pharmacists in Malaysia: A pilot study. J Pharm Pract Res. 2013;43(3):187-189. doi: 10.1002/j.2055-2335.2013.tb00251.x
25. Hassali MA, Tan CS, Saleem F, Aljadhey H. A qualitative exploration of perceptions toward pharmaceutical price war among community pharmacists in the state of Penang, Malaysia. J Med Mark. 2013;13(1):44-53. doi: 10.1177/1745790413477648
26. Pharmaceutical Services Division, MoH Malaysia. Community Pharmacy Benchmarking Guideline 2nd Edition. Malaysia 2015.
27. Brooks JM, Klepser DG, Urmie JM, Farris K, Doucette WR. Effect of local competition on the willingness of community pharmacies to supply medication therapy management services. J Health Hum Serv Adm. 2007;30(1):4-27.
28. Martins L, Queiros S. Competition among pharmacies and the typology of services delivered: the Portuguese case. Health Policy. 2015;119(5):640-647. doi: 10.1016/j.healthpol.2015.03.001
29. Hassali MA, Saleem F, Alrasheedy AA, Aljadhey H, Verma AK. Challenges in managing a retail pharmacy: Views from community pharmacists in the state of Penang, Malaysia. J Med Mark. 2014;14(4):244-249. doi: 10.1177/1745790415586326
30. Rangchian M, Mehralian G, Salamzadeh J, Vatanpour H. Underlying factors influencing community pharmacies business in low-to medium-developed markets: a societal perspective. J Pharm Health Serv Res. 2016;7(3):129-139. doi: 10.1111/jphs.12134
31. Hassali MA, Shafie AA, Ooi GS, Wong ZY. Pharmacy Practice in Malaysia. In: Fathelrahman AI, Ibrahim MIM, Wertheimer AI, eds. Pharmacy practice in developing countries: Achievements and challenges. United Kingdom: Elservier; 2016.
32. Britnell M. Malaysia: Reform some time, soon? In: In search of the perfect health system. United Kingdom: Palgrave; 2015.
33. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101. doi: 10.1191/1478088706qp063oa
34. Pharmaceutical Services Division, MoH Malaysia. Good Pharmaceutical Trade Practice for Private Sector. Malaysia 2015.
35. Zieman, Cooperative alliance signs MoU to develop chain of pharmacies. Malaysia: The Star Online; 14 October 2013. Available at: http://www.thestar.com.my/business/sme/2013/10/14/on-track-to-be-the- biggest-cooperative-alliance-signs-mou-to-develop-chain-of-pharmacies/ (accessed 8 April 2016).
36. Bong K. Setting up community pharmacy in hospitals, Sarawak: Borneo Post Online; 29 March 2014: Available at: http://www.theborneopost.com/2014/03/29/setting-up- community-pharmacy-in-hospitals/ (accessed 16 March 2016).
37. Nga do TT, Chuc NT, Hoa NP, Hoa NQ, Nguyen NT, Loan HT, Toan TK, Phuc HD, Horby P, Van Yen N, Van Kinh N, Wertheim HF. Antibiotic sales in rural and urban pharmacies in northern Vietnam: an observational study. BMC Pharmacol Toxicol. 2014;15(1):1-10. doi: 10.1186/2050-6511-15-6
38. Bahnassi A. Do no harm: the role of community pharmacists in regulating public access to prescription drugs in Saudi Arabia. Int J Pharm Pract. 2016;24(2):142-145. doi: 10.1111/ijpp.12224
39. Martins F, van Mil JWF, Costa FA. The organizational framework of community pharmacies in Europe. Int J Clin Pharm. 2015;37(5):896-905. doi: 10.1007/s11096-015-0140-1
40. Mehralian G, Rangchian M, Javadi A, Peiravian F. Investigation on barriers to pharmaceutical care in community pharmacies: a structural equation model. Int J Clin Pharm. 2014;36(5):1087-1094. doi: 10.1007/s11096-014-9998-6
41. Basak S, van Mil JWF, Sathyanarayana D. The changing roles of pharmacists in community pharmacies: perception of reality in India. Pharm World Sci. 2009;31(6):612-618. doi:10.1007/s11096-009-9307-y
42. Vogler S, Habimana K, Arts D. Does deregulation in community pharmacy impact accessibility of medicines, quality of pharmacy services and costs? Evidence from nine European countries. Health Policy 2014;117(3):311-327. doi: 10.1016/j.healthpol.2014.06.001
43. Hassali MA, Mak VSL, Ooi GS. Pharmacy Practice in Malaysia. J Pharm Pract Res. 2014;44(3):125-128. doi: 10.1002/jppr.1024
44. Lee KS, Lim YW, Long CM. The fate of the new pharmacy bill: going backwards or forwards? J Pharm Policy Pract. 2016;9:25. doi: 10.1186/s40545-016-0081-7
45. Salmasi S, Long CM, Khan TM. Interplay of medication errors and the separation of dispensing. Res Social Adm Pharm. 2016;12(1):171-172. doi: 10.1016/j.sapharm.2015.07.004
46. Pharmaceutical Services Division, MoH Malaysia. A national survey on the use of medicines (NSUM) by Malaysian Consumers 2012. Malaysia 2013.
47. Ting CY, Lee KS, Tan RTH, Ang WC, Long CM. An exploratory study on the consumers use of medicine in the state of Sarawak, Malaysia. J Young Pharm. 2016;8(4):477-482. doi: 10.5530/jyp.2016.4.26
48. Neoh CF, Hassali MA, Shafie AA, Awaisu A. Nature and adequacy of information on dispensed medications delivered to patients in community pharmacies: a pilot study from Penang, Malaysia. J Pharm Health Serv Res. 2010;2(1):41-46. doi: 10.1111/j.1759-8893.2010.00026.x
49. Shann P, Hassell K. Flexible working: Understanding the locum pharmacist in Great Britain. Res Social Adm Pharm. 2006;2(3):388-407. doi: 10.1016/j.sapharm.2006.03.002
50. MOH Malaysia. Health Facts. Malaysia 2015. Available from: http://vlib.moh.gov.my/cms/documentstorage/com.tms.cms.document.Document_2e8efe25a0188549d5315d00e9ca9560/KKM_HEALTH_FACTS_2015.pdf (accessed 11 June 2016).
51. Doucette WR, Nevins JC, Gaither C, Kreling DH, Mott DA, Pedersen CA, Schommer JC. Organizational factors influencing pharmacy practice change. Res Social Adm Pharm. 2012;8(4):274-284. doi: 10.1016/j.sapharm.2011.07.002
52. Hatah E, Braund R, Tordoff J, Duffull SB. A systematic review and meta-analysis of pharmacist-led fee-for-services medication review. Br J Clin Pharmacol. 2014;77(1):102-115. doi: 10.1111/bcp.12140
53. Chua SS, Lim KP, Lee HG. Utilisation of community pharmacists by the general public in Malaysia. Int J Pharm Pract. 2013;21(1):66-69. doi: 10.1111/j.2042-7174.2012.00219.x
54. Svensberg K, Kälvemark Sporrong S, Håkonsen H, Toverud EL. Because of the circumstances, we cannot develop our role: Norwegian community pharmacists’ perceived responsibility in role development. Int J Pharm Pract. 2015;23(4):256-265. doi: 10.1111/ijpp.12154
The authors hereby transfer, assign, or otherwise convey to Pharmacy Practice: (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print pr epublish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to Pharmacy Practice with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Author Self-Archiving Policy
Pharmacy Practice permits and encourages authors to post and archive the final pdf of the articles submitted to the journal on personal websites or institutional repositories after publication, while providing bibliographic details that credit its publication in this journal.