RESEARCH ARTICLE Open Access
A new model o pha macies? Insigh s om
a quan i a i e s udy ega ding he public’s
pe cep ions
Ve ónica Polica po
1
, Sónia Romano
2*
, João H. C. An ónio
3
, Tânia So ia Co eia
3
and Suze e Cos a
4
Abs ac
Backg ound: Wo ldwide communi y pha macies a e shi ing hei ole in he heal hca e sys em om simple
medica ion dispense s o heal h ca e p o ide s. High le els o sa is ac ion wi h pha macy se ices we e ound in
p e ious s udies. This s udy has wo main goals. The p ima y goal is o desc ibe he le els o sa is ac ion and
knowledge ega ding pha macy se ices in Po ugal. The seconda y goal is o explo e he pe cep ions and he
u ilisa ion o pha macy se ices by he Po uguese. This s a emen includes explo ing he impac o a se o
a iables on bo h pe cep ions and uses o pha macies in ega d o se ices ha a e cu en ly o e ed as well as o
new se ices ha may be p o ided in he u u e.
Me hods: A ace- o- ace su ey o closed-ended ques ions was applied o a na ionwide ep esen a i e sample o
he Po uguese popula ion in Sep embe 2015. The sample was weigh ed based on popula ion dis ibu ion ac oss
egions, habi a , age and gende . Da a analysis comp ises desc ip i e s a is ics and Mul iple Co espondence
Analysis o explo e di e en ypologies o esponden ’s o ien a ion owa d communi y pha macy.
Resul s: A o al o 1114 in e iews comp ised he s udy. O he esponden s, 36% used he pha macy as a i s
esou ce when seeking o ea a mino ailmen , and 54% epo ed ha hey use he pha macy as a i s esou ce
when seeking answe s abou medicines. O hose who isi ed hei pha macy a leas once in he p e ious yea ,
94% we e ei he globally sa is ied o e y sa is ied. The le el o acknowledgemen o pha macy se ices’was also
high among he Po uguese. O he pa icipan s, 29% conside ed he e could be mo e se ices a ailable in
pha macies ha a e cu en ly p o ided by o he heal h ca e acili ies. The cons uc ion o a ypology o o ien a ions
owa ds communi y pha macy p ac ice esul ed in h ee ou come g oups: “Mo i a ed”(63%), hose wi h a
connec ion o a pha macy; “Se led”(23%), mainly hose who had a pha macy nea by; and “Demobilised”(14%),
hose who a e weakly ied o a pha macy.
Conclusions: The as majo i y o he Po uguese popula ion has a s ong posi i e a i ude owa ds hei
communi y pha macy, as exp essed by he high le els o sa is ac ion wi h, and posi i e e alua ion o , he
pha macy’s se ices.
Keywo ds: Communi y pha macy, Sa is ac ion, Pha macy se ices, E alua ion o pha macy se ices, Po ugal
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* Co espondence: sonia. omano@an .p
2
Cen e o Heal h E alua ion & Resea ch (CEFAR), Associação Nacional das
Fa mácias (ANF), Rua Ma echal Saldanha 1, 1249-069 Lisbon, Po ugal
Full lis o au ho in o ma ion is a ailable a he end o he a icle
Polica po e al. BMC Heal h Se ices Resea ch (2019) 19:186
h ps://doi.o g/10.1186/s12913-019-3987-3
Backg ound
Wo ldwide communi y pha macies a e shi ing hei ole
in he heal hca e sys em om simple medica ion dis-
pense s o heal h ca e p o ide s [1]. Wi h his pa adigm
shi , i is ele an o unde s and he ollowing: wha pha -
macy use s wan mo e o om hei pha macies; wha a e
hei expec a ions ega ding a new se o ad anced se -
ices ha pha macies may o e in he nea u u e and;
how do such expec a ions ela e o he le el o sa is ac ion
ega ding he se ices ha a e cu en ly being p o ided.
This pape a emp s o answe hese ques ions, u ilising
quan i a i e da a om a s udy conduc ed in Po ugal in
2015, based on a na ionwide s a is ically ep esen a i e
sample o he Po uguese popula ion.
The opic is app oached om he pe spec i e o he
main challenges ha public heal h con on s in he
wen y- i s cen u y, including economic c ises, widen-
ing inequali ies, he ageing popula ion, inc easing le els
o ch onic disease, mig a ion and u banisa ion, en i on-
men al damage and clima e change [2]. Add essing
heal h ela ed ma e s equi es he join ac ion o heal h
and non-heal h sec o s, public and p i a e sec o s and
ci izens [3]. Consequen ly, he enhancemen o he ole
o communi y pha macies in he heal hca e sys em is a
new app oach ha is highligh ed by he poli ical
p og amme o he XXI Go e nmen o Po ugal [4].
These issues a e discussed in his pape , in he con ex
o Po uguese communi y pha macy p ac ice, which
cons i u es an in e es ing case s udy o obse e he
ans o ma ion o he ole o communi y pha macies in
he heal h ca e sys em, including he means by which
pha macy use s e alua e hei se ices and he expec a-
ions hey de elop owa ds new ones.
The Po uguese heal h sys em is o ganised a ound a Na-
ional Heal h Se ice (NHS) ha is p ima ily unded
h ough ans e s om he go e nmen budge , meaning
ha gene al axa ion is he main sou ce o unding o he
NHS. The Po uguese NHS de i es om he Be e idge
model and is uni e sal in co e age, gene al in p o ision
and enden ially ee o i s use s. The heal h ca e deli e y
sys em consis s o a ne wo k o public and p i a e heal h
ca e p o ide s; each is connec ed o he Minis y o Heal h
and o he pa ien s in i s own way [5].
Po uguese communi y pha macies a e p i a ely
owned, and each has a echnical di ec o wi h a deg ee
in pha maceu ical sciences [5]. By he end o 2015, he e
we e 2936 pha macies dis ibu ed all o e he coun y
wi h an a e age o se en ull- ime employees pe pha -
macy [6,7]. The u al a eas a e he egions whe e he
numbe o pha macies pe capi a is highe [7], p o iding
p oximi y suppo o his popula ion wi h lowe di ec
access o o he heal h ca e p o ide s.
The se ices p o ided by Po uguese communi y pha -
macies include, among o he s, hesaleo p esc ip ion-only
medicines (POM) and non-p esc ip ion medicines (NPM)
and se e al o he heal h- ela ed p oduc s (e.g., cosme ics
and i amins). Al hough pha macis s ha e always had in-
ol emen in p o iding heal h se ices, his end has in-
c eased in ecen yea s [8,9]. In 2007, wi h ecen upda es,
a new legisla ion de ined he scope o se ices allowed in
pha macies, including: home ca e suppo , i s aid, medi-
cines adminis a ion, immunisa ion ( accines no included
in he Na ional Vaccina ion Plan), lab es s, diagnos ic and
he apeu ic se ices, disease managemen p og ammes,
heal h campaigns and collabo a ion in na ional heal h edu-
ca ion p og ammes [10,11]. The e o e, as a se ing o pub-
lic heal h ac i i ies, communi y pha macies p esen se e al
bene i s o i s use s. Wi h ex ended business hou s and no
appoin men needed in ad ance, hese pha macies can be
mo e accessible han o he heal h ca e p o ide s [12].
Con e sely, a e iew conduc ed in 2008 iden i ied high
le els o pa ien sa is ac ion wi h pha macy se ices and
highligh ed he need o unde s and expec a ions and
p e e ences o pa ien s, explo ing and ma ching hese o
he se ices p o ided [13]. Such high le els o sa is ac-
ion wi h he communi y pha macy se ices ha e also
been epo ed by he Po uguese popula ion in p e ious
s udies [14]. Fo many yea s, pha macis s ha e been in
he op 5 o he mos us ed p o essions acco ding o
consume su eys [15,16]. Dua e e al. [17] showed
how pha macy clien s e alua e e y posi i ely he quali y
o he se ices p o ided ( a ed as 4 o mo e, in a scale o
1 o 5), as well as he quali y o con ac and in e pe -
sonal ela ionship be ween clien s and p o essionals. The
highes sco e is us (4.4), ollowed by pe sonalisa ion
(4.1) and he an icipa ion o needs (3.6). In hei quali a-
i e s udy abou communi y pha macy in Po ugal,
Ca aco e al. [18] ound ha he Po uguese appea ed o
asc ibe a pa icula social ole o he pha macis , as pa
o a suppo i e ne wo k ha con ibu es, among o he
issues, o sol e p oblems o access o he heal h sys em.
Howe e , his ole appea s o be mo e associa ed o he
pe cei ed de iciencies o o he communi y heal h ca e
p o ide s (such as doc o s) han o he pe cei ed p o es-
sional du ies o pha macis s. Ca aco e al
.
[18] also ob-
se ed ha he in e pe sonal ela ionship o each
clien wi h he pha macy s a was a he co e o a
gene al posi i e expe ience o he pha macy, namely,
a sense o secu i y in ela ion o he adequacy and
quali y o dispensed p oduc s.
As such, pha macis s a e conside ed o be
knowledgeable, eliable, us ul and conside a e, which is
a esul ha has also been ound in coun ies such as I an
[19], Canada [20], Thailand [21] and Aus alia [22,23].
Mo eo e , he gene al le el o sa is ac ion owa ds pha -
macies is highe han owa ds o he heal h ca e p o ide s,
such as clinical labs, p i a e medical p ac ices, o p i a e
hospi als. Simila esul s we e ound in Canada [20],
Polica po e al. BMC Heal h Se ices Resea ch (2019) 19:186 Page 2 o 11
whe e pha macis s we e iewed posi i ely and conside ed
o play a cen al ole in he heal h sys em o hei p o -
inces by a la ge majo i y o he popula ion, mainly by
women, hose o e 60, and egula isi o s o he pha -
macy. A wide majo i y also ag eed ha expanding he ole
o pha macis s in heal h ca e deli e y would posi i ely im-
pac he pa ien s’quali y o li e, educe o e c owding in
eme gency ooms and walk-in clinics and educe o e all
heal h ca e cos s [20].
While his s udy a ge s explo ing simila dimensions,
such as sa is ac ion, o he ela ionship be ween pha -
macy p o ide s and use s, i also a ge s add essing his
ela ionship om a di e en angle. Namely, his s udy
elucida es how pha macy use s pe cei e he exis en
model o communi y pha macy in Po ugal, de ined
h ough he se ices o e ed, and hei a i udes owa ds
new se ices and he e o e owa ds eme gen new
models o communi y pha macy p ac ices. In addi ion,
based on hese aspec s, his s udy p oposes a ypology o
communi y use s, acco ding o hei a i udes owa ds
bo h exis ing and eme gen pha macy models.
Main goals and esea ch ques ions
This s udy epo s he esul s o a na ionwide su ey
whe e he iews o he Po uguese popula ion ega ding
he exis ing pha macy model and a p oposed model o
be o e ed in he u u e we e explo ed.
Ou objec i e is o assess he iabili y o possible
eme ging models o communi y pha macy p ac ice in
Po ugal. Finally, we in end o do he ollowing: build a
ypology o pha macy use s owa ds communi y pha -
macy p ac ice; o cha ac e ise each clus e in e ms o
hei composi ion (who a e he pe sons ha a e mainly
con ibu ing o each clus e ); and o iden i y explana o y
ac o s o he clus e i .
We in end o answe he ques ion “wha a e he ex-
pec a ions o pha macy clien s in ela ion o a se o new
se ices ha would expand he ole o pha macies as
heal h ca e p o ide s?”In addi ion o his main ques ion,
a ew o he s will be add essed: how do clien s a e he
impo ance o he se ices ha a e cu en ly p o ided by
he pha macies? In addi ion, how sa is ied a e hey wi h
hose se ices? To wha ex en a e hese le els o sa is-
ac ion ela ed o he equency o isi s o he pha macy
and o he expec a ions owa ds enla ging hei ole as
heal h ca e p o ide s? The objec i es o his pape a e o
explo e possible eme ging models o communi y pha -
macy p ac ice in Po ugal and o cha ac e ise he opin-
ions o he Po uguese popula ion in ela ion o hese
eme gen models.
Me hods
The s udy u ilised a quan i a i e design, and da a
we e collec ed h ough a su ey o closed-ended
ques ions (English ansla ed e sion p o ided in Add-
i ional ile 1).Thesu eywasdesignedandcon-
duc ed by CESOP (Resea ch Cen e o Public Opinion
o he Ca holic Uni e si y o Po ugal), wi h he col-
labo a ion o CEFAR (Cen e o Heal h E alua ion &
Resea ch o he Po uguese Associa ion o Pha ma-
cies). The da a we e collec ed by 88 in e iewe s
unde he supe ision o 22 ield-wo k coo dina o s.
A p e- es was conduc ed o e alua e he ques ion-
nai e unde s anding and easibili y. As one o he
goals was o measu e he pe cep ions o communi y
pha macy se ices in he gene al Po uguese popula-
ion and no exclusi ely on pha macies’usual cus-
ome s, a ep esen a i e na ional sample was u ilised,
in acco dance wi h a s a i ied mul i-s ep me hod.
Fi s ly, he locali ies we e chosen andomly om each
o he 10 s a a g oups ob ained h ough combining
he 5 NUTSII (Nomencla u e o Te i o ial Uni s o
S a is ics) egions in Po ugal mainland wi h hei
habi a ( u al/u ban). The numbe o locali ies se-
lec ed om each s a um was p opo ional o he
numbe o adul s li ing in each s a um, based on he
elec o al egis e da abase. In Po ugal, e e y ci izen
o e 18 is immedia ely included in he elec o al egis-
e . Ce ain esiden s wi hou Po uguese na ionally,
namely, immig an s om ou side he E.U., whom a e
app oxima ely 3% o he o al popula ion, a e no in-
cluded in his da abase. Ne e heless, hese indi id-
uals could ye be selec ed as esponden as hei
dis ibu ion in he coun y is simila o he
Po uguese dis ibu ion. Secondly, o each chosen lo-
cali y, he household was selec ed h ough a andom
ou e pa h. Thi dly, in each household, he espon-
den s we e chosen acco ding o he me hod o he
las /nex pe son o ha e his/he bi hday o 18 yea s
old o mo e. U ilising a doo - o-doo me hodology,
he su ey was applied ace- o- ace by skilled in e -
iewe s wi h special aining o his p ojec . A o al
o 1114 in e iewees comp ised he inal sample (ma -
gin o e o o app oxima ely 3% o a 95% con i-
dence in e al). The sample was weigh ed based on
popula ion dis ibu ion ac oss egions and habi a
(u ban/ u al a eas), age and gende , acco ding o he
popula ion es ima es p o ided by S a is ics Po ugal
[24] ( he o icial s a is ics ins i u ion in Po ugal,
www.ine.p ). This pos -sampling weigh ing p ocess al-
lows he co ec ion o de ia ions esul ing om he
sampling p ocess, making he wo king da abase as
nea as possible o he uni e se unde analysis.
Desc ip i e s a is ics, bo h uni a ia e and mul i a i-
a e, and s a is ical es s comp ised me hods o analysis
o measu e possible di e ences be ween g oups and
es he esea ch hypo hesis. A e a desc ip i e ana-
lysis o he main a iables, c oss abs enabled es ing
Polica po e al. BMC Heal h Se ices Resea ch (2019) 19:186 Page 3 o 11
o di e ences acco ding o he main cha ac e isa ion
a iables (gende , age coho , and egion o esi-
dence), as well as o he ele an a iables conside ing
he objec o s udy (e.g., equency o pha macy use,
o ha ing a ch onic disease). Se e al echniques and
s eps comp ised mul i a ia e explo a ion o da a. Fi s ,
Fac o Componen Analysis o he a iables ha mea-
su ed he deg ee o impo ance gi en o pha macy
se ices ( a imax o a ion; KMO = 0.838; Ba le ’s
Sphe ici y Tes p<0.001. N= 754) was conduc ed.
Th ee componen s we e ound, and he a iables wi h
sco es abo e 0.4 we e e ained o cons uc he new
a iables (α> 0.6): suppo wi h he apy and medical
p esc ip ion; p e en ion o a heal hy li e; and home
and o he p oximi y se ices. Fu he clus e analysis
showed ha he mos nume ous g oup was he i s
one(56%), ollowedbyhomeando he p oximi yse -
ices (34%) and p e en ion (10%). These g oups we e
hen used as inpu a iables o a Mul iple Co es-
pondence Analysis (MCA), oge he wi h wo o he
a iables: heopinion owa d headequacyo he
pha macy se ices o he esponden s’needs; and how
likely hey we e o isi he pha macy in he u u e,
in case i p o ides a pa icula se o new se ices.
The analysis p o ided wo main dimensions and sug-
ges ed he o ganisa ion o esponses in o h ee
g oups, which we e u he alida ed h ough a
K-Means Clus e Analysis. The g oups a e p esen ed
in he nex sec ion.
Resul s
A o al o 1114 people pa icipa ed in he s udy. Be o e
weighing, 64 % we e women, and pa icipan s’age anged
widely, be ween 18 and 95 yea s old (Mean 52.70, SD =
17.19). Pa icipan s’dis ibu ion ac oss he i e main e-
gions o Po ugal mainland was he ollowing: No h 40%;
Cen e 18%; Lisbon 30%; Alen ejo 6%; and Alga e 6%
(Table 1). All analysis was pe o med a e weigh ing he
sample on he basis o he popula ion dis ibu ion ac oss
egions and habi a (u ban/ u al a eas), age and gende .
Use o pha macies o mino ailmen s
When he pa icipan s we e asked abou he i s place
hey consul when a mino ailmen a ises, mo e han
one- hi d o he esponden s (36%) answe ed ‘ he pha -
macy’, ollowed by p ima y heal h cen es (27%). The
majo i y o he esponden s (54%) s a ed he pha macy
was also he i s esou ce hey seek when hey ha e
ques ions abou medicines. O he pa icipan s, 17% (n
= 185) epo ed “o he ”sou ces, o which 48 indi iduals
e e ed o he medicine lea le , while 42 indi iduals e-
e ed o he in e ne . The pha macy is a equen op ion
o he Po uguese popula ion: he o e whelming majo -
i y o esponden s (95%, n= 1057) epo ed o ha e
isi ed he pha macy a leas once o e he pas yea .
Among hese esponden s, app oxima ely hal (51%, n=
538) isi he pha macy 6 o mo e imes, and 81% (n=
850) isi a leas 3 imes o e he pas 6 mon hs. This e-
quency is highe among women (p< 0.001), he elde ly (p
< 0.001), he e i ed, pensione s and widowe s (p<0.001).
Sa is ac ion wi h pha macy se ice
The pa icipan s appea o ha e a high sense o sa is ac-
ion wi h hei Pha macy. Among hose who isi ed hei
local pha macy a leas once in he pas yea , he o e -
whelming majo i y epo ed o be ei he sa is ied o e y
sa is ied (94%, n= 995). App oxima ely one in ou e-
sponden s (26%, n= 274) s a ed ha he/she is e y sa is-
ied. The sa is ac ion le el is also e y high when he
a ious dimensions o pha macy se ices we e conside ed
sepa a ely (Fig. 1). Mo e han 90% o esponden s decla ed
hemsel es sa is ied o e y sa is ied in ela ion o six o
he eigh dimensions o which he sa is ac ion le el was
measu ed. Examples included he compe ence o p o-
ide s, he in o ma ion o e ed, he loca ion, o he
amoun and quali y o se ices p o ided by he Pha macy.
The dimension wi h he lowes sco e was he one e-
la ed o access du ing he nigh and on weekends,
ollowed by he cus ome p i acy dimension. Howe e ,
app oxima ely wo in e e y h ee esponden s decla ed
hemsel es ei he sa is ied o e y sa is ied wi h his
dimension.
Familia i y wi h pha macy se ices
Se ices p o ided by pha macies appea o i he exis ing
needs o 69% o he esponden s (n= 729). Howe e , 29%
(n= 306) o he pa icipan s belie e he e could be mo e
se ices a ailable in pha macies ha a e cu en ly p o-
ided in o he heal h ca e acili ies. Fu he mo e, he pa -
icipan s show a high le el o acknowledgemen o he
pha macy’sse ices(Fig.2). The bes -known se ice is he
“suppo in he choice o non-p esc ip ion medicines”.
App oxima ely 4 in 5 esponden s (79%) epo ed know-
ing his se ice. Ne e heless, he e a e ce ain se ices
ha emain unknown o he majo i y o he pa icipan s,
namely, hose ha a e no a ailable in Po uguese Pha -
macies. The leas known se ice is “scheduling a medical
appoin men ”wi h he gene al p ac i ione ia pha macy,
e e ed o by only one in e e y en indi iduals (11%). Al-
hough he e a e se ices ha a e mo e amilia han
o he s, he pa icipan s’opinion is nea ly unanimous in
hei impo ance; he as majo i y o esponden s a e
hem as ei he impo an o e y impo an , e en o se -
ices leas known by esponden s (Fig. 3). The mos im-
po an se ices a e “poin -o -ca e es s and medical
sc eening”(93% a ed his se ice as “impo an ”o “ e y
impo an ”), “suppo in keeping ch onic disease pa ien s
unde con ol”(92%), “suppo in he choice o
Polica po e al. BMC Heal h Se ices Resea ch (2019) 19:186 Page 4 o 11
non-p esc ibed medica ion”(92%) and “ex ended
heal h ca e in pha macies”(91%). When p omp ed
o ank he i e mos impo an se ices, despi e
hei cu en a ailabili y a he pha macies, he e-
sponden s chose: 1) au oma ic enewal o p esc ip-
ions o ch onic disease pa ien s (chosen as one o
he 5 mos impo an se ices by 50% o he espon-
den s and a ed as he mos impo an se ice by
30%); 2) suppo in main aining ch onic disease
unde con ol ( op5: 48%; 1s : 20%); 3) home deli -
e y o medicines ( op5: 48%; 1s : 12%); 4) ex ended
heal h ca e in pha macies (e.g., ea men o small
wounds, and i s aid) ( op5: 39%; 1s : 14%); and 5)
p o ision o ce ain medicines exclusi ely dispensed
a he hospi al pha macy and ollow-up o ea men
( op5: 38%; 1s : 14%).
Table 1 Cha ac e is ics o su ey esponden s
Cha ac e is ics To al (n=1114)
Non-weigh ed ( alid) Weigh ed ( alid)
n%n%
Region
No h 443 39.8 422 37.9
Cen e 197 17.7 270 24.3
Lisbon 336 30.2 295 26.5
Alen ejo 70 6.3 80 7.2
Alga e 68 6.1 46 4.1
Gende
Male 394 35.5 536 48.1
Female 715 64.5 578 51.9
Communi y pha macy equency
Visi pha macy a leas once in he las yea 1055 94.7 1057 94.9
≥6 isi s in he las six mon hs 576 54.8 538 51.1
Age g oup (yea s)
18-24 55 4.9 99 8.9
25-34 116 10.4 177 15.9
35-44 228 20.5 208 18.7
45-54 218 19.6 201 18
55-64 171 15.4 172 15.4
≥65 325 29.2 257 23.1
Ma i al s a us
Has a pa ne (ma ied o de ac o) 680 62 645 58.8
Single 205 18.7 281 25.6
Widow / di o ced / sepa a ed 211 19.3 172 15.6
Educa ion
No educa ion 33 3 24 2.2
P ima y educa ion (4
h
o 6
h
yea ) 376 34.7 337 31.1
P ima y educa ion (9
h
yea ) 171 15.8 169 15.5
Seconda y educa ion (12
h
yea ) 238 21.9 254 23.4
Highe educa ion (uni e si y) 267 24.6 301 27.8
Occupa ion
Employed 551 49.7 591 53.3
Unemployed 116 10.5 115 10.3
Pensione 329 29.7 278 25.1
O he 113 10.2 127 11.3
Polica po e al. BMC Heal h Se ices Resea ch (2019) 19:186 Page 5 o 11

Building a ypology o o ien a ions owa ds communi y
pha macy p ac ice
Oneo hemaingoalso hiss udywas oexplo e
possible eme ging models o communi y pha macy
p ac ice in Po ugal and o cha ac e ise he Po u-
guese popula ion in ela ion o hose eme gen
models. To accomplish his goal, an MCA was con-
duc ed, ha ing he ollowing ac i e a iables: he
opinion owa ds he adequacy o he pha macy se -
ices o gene al needs; how likely esponden s a e o
conside isi ing he pha macy in he u u e, in case
i p o ides a pa icula se o new se ices; and a new
Fig. 2 Le el o knowledge o pha macy se ices
Fig. 1 Le el o sa is ac ion wi h pha macy se ices
Polica po e al. BMC Heal h Se ices Resea ch (2019) 19:186 Page 6 o 11
a iable classi ying indi iduals acco ding o how hey
a e he impo ance o pha macy se ices (clus e s).
MCA allowed he iden i ica ion o wo dimensions,
esul ing in h ee ou come g oups (Fig. 4). These
g oups a e named acco ding o he main idea ha
c oss-cu s he a iables ha a e mos ele an o hei
o ma ion. Thus, quali a i ely naming he g oups was
a means o be e cap u ing and communica ing he
main ai s o each g oup.
The “Mo i a ed”
People who e eal a connec ion wi h he Pha macy. These
people a e egula cus ome s, and we an icipa e hey will
seek pha macy se ices mo e o en i hey inc ease and di-
e si y. These people wan pha macies o suppo ch onic
disease pa ien s h ough ex ended heal h ca e, ollow-up,
and au oma ic enewal o p esc ip ions. The “Mo i a ed”
cons i u e he la ges g oup in he sample (63%, n=699).
Women p ima ily comp ise his g oup, as do he younges
and egula pha macy cus ome s.
The “Se led”
Mainly cha ac e ised by a ou ing se ices “coming o
hem”(23%). Pha macy cus ome s occasionally comp ise
his g oup; his g oup is unlikely o inc ease i s demand
o he Pha macy. These indi iduals belie e pha macy
se ices a e adjus ed o hei needs. This g oup high-
ligh s he impo ance o se ices such as home deli e y
o medicines o p o ision o ce ain medicines exclu-
si ely dispensed a he hospi al pha macy. The “Se led”
a e p ima ily men, o en olde han younge , e i ed/pen-
sione s, and mainly ha e a pha macy nea by.
The “Demobilised”
This is a mino i y g oup (14% o he sample), weakly ied
o he Pha macy. Membe s o his g oup a ely isi he
pha macy and do no belie e hey may need o isi mo e
o en in he nea u u e. This g oup is p ima ily composed
by men, unemployed, hose who a e a e pha macy cus-
ome s, and people wi h no easy access o a pha macy.
Discussion
Resul s sugges ha he as majo i y o he Po uguese
popula ion has a s ong posi i e a i ude owa ds he
communi y pha macy. These esul s a e in acco dance
wi h wha o he s udies ound in di e en coun ies
[19–21,23,25–27], emphasising he c oss-coun y ele-
ance o communi y pha macies as gene al heal h ca e
p o ide s [1,28].
This posi i e a i ude is h ee- old. Fi s , his a i ude
is exp essed by he high le els o sa is ac ion wi h he
pha macy in gene al and wi h i s pa icula se ices; he
compe ence o pha macis s and he quali y o se ices
ob ained he highes le els o sa is ac ion, con i ming e-
sul s om p e ious s udies de eloped in Aus alia [22],
I an [19], Canada [20], I eland [25], o Po ugal [18].
Second, he in e iewees a e as impo an o e y im-
po an he majo i y o se ices cu en ly p o ided by
communi y pha macies. Finally, he Po uguese also
posi i ely e alua e he possibili y o pha macies p o id-
ing a new se o se ices in he nea u u e. E alua ing
Fig. 3 Le el o impo ance o pha macy se ices
Polica po e al. BMC Heal h Se ices Resea ch (2019) 19:186 Page 7 o 11
pa ien s’sa is ac ion and a ached impo ance wi h di -
e en pha macy se ices plays an impo an ole ha
can suppo and help o design and de elop inno a i e
pha macy se ices o be e se e pa ien s’needs and
p e e ences and o maximise he p o essional capaci y o
communi y pha macies a local and na ional le els.
These esul s encompass an endo semen by he Po -
uguese o an enla ged ole o pha macis s and commu-
ni y pha macies in he p o ision o ex ended heal h ca e
se ices. A simila esul was ound in one s udied con-
duc ed in Canada [20], which showed ha 72% o Cana-
dians conside ed pha macis s o be heal h ca e
p o ide s; mo e han hal a ed hem as cen al playe s
in he heal hca e sys em. Simila ly, p e ious esea ch e-
ga ding he Po uguese con ex had p e iously
highligh ed ha he Po uguese iden i y di e en oles
o pha macis s, such as medicines supplie , ad ice p o-
ide and communi y heal h p omo e ; hese a e oles
ha we e posi i ely ela ed o pa ien s’sa is ac ion and
loyal y, explaining 50% o pa ien s’sa is ac ion and 61%
o loyal y [29]. The communi y heal h p omo e ole
equally ela ed o bo h o hese dimensions. Howe e ,
in hei quali a i e s udy ega ding he consume s’pe -
cep ions o communi y pha macy in Po ugal, Ca aco
e al. iden i ied di e gen unde s andings o he pha -
macis ’s ole, wi h he main pe cep ions poin ing o a
p oduc -supplying ole and associa ed o low le els o
knowledge and awa eness o he pha macis s’ esponsi-
bili ies [18]. The esea che s hypo hesise ha such poo
knowledge and low expec a ions can jus i y a educed
desi e o an ex ended ole o he pha macis in he
communi y. By con as , ou da a sugges ha he
Po uguese popula ion would welcome new se ices, i
hey a e o ien ed o enhance be e access o gene al
heal h ca e. Howe e , he “cus ome p i acy”dimension
needs o be add essed and po en ially imp o ed o u-
u e pha macy se ice de elopmen . Ou indings a e
mos in acco dance wi h p e ious s udies ha sugges
pa ien s’conce ns ega ding p i acy and con iden iali y
[12,30].
As pa ien sa is ac ion eme ges as a c i e ion o im-
p o e pa ien s’ us [31] and heal h ou comes [32], his
a icle a emp s o build a ypology o pha macy’s e ec -
i e and po en ial use s, in ega d o hei a i udes o-
wa ds a new model o communi y pha macies,
composed o bo h old se ices, which a e mo e a ached
o POM and NPM counselling and dispensing, and new
ones, which a e be e desc ibed as ex ended heal h ca e
p o isions (e.g., p o iding POM ha a e cu en ly only
a ailable h ough hospi als, o au oma ic enewal o p e-
sc ip ions o pa ien s wi h ch onic diseases ha a e
unde con ol). The h ee g oups iden i ied sugges wo
di e en lines o ac ion. On he one hand, pha macies
a e challenged o co espond o he cu en ly high ex-
pec a ions and posi i e a achmen o hei egula cus-
ome s, mainly women and he younges . The expansion
o he pha macies’ ole as a gene al heal h ca e p o ide
appea s o i he expec a ions o hese “mo i a ed”indi-
iduals, which cu en ly appea o ha e a connec ion o
he pha macy; he challenge is o e ain hem in he
Fig. 4 A ypology o o ien a ions owa ds communi y pha macy p ac ice
Polica po e al. BMC Heal h Se ices Resea ch (2019) 19:186 Page 8 o 11
changing dynamics o he pha macies. On he o he
hand, pha macies a e challenged o add ess he needs o
bo h he “se led”(23%) and he “demobilised”(14%);
he i s has easy access o a pha macy, which is con a y
o he second.
Ta ge ing hese g oups wi h new and mo e sophis i-
ca ed pha macy se ices ha ul il di e en p e e ences
and needs can be an oppo uni y o expand he
pa ien -cen ed p o essional ole o communi y pha ma-
cis s and o enhance he managemen o ch onic condi-
ions in he communi y wi h lowe cos s o he pa ien s
and he go e nmen [33].
A ecen s udy es ima ed ha he communi y pha macy
se ices p o ided in Po ugal in he las 25 yea s p o ide a
gain o 8.3% in he Quali y o Li e (QoL) o pa ien s and
an annual economic alue o 879.6 M€, including 342.1 M
€in se ices o he han dispensing and 448.1 M€in
a oided expenses ela ed o heal h ca e esou ce use.
These se ices included: adhe ence in e en ions; ch onic
disease in e en ions; and non-p esc ip ion selec ion and
counselling. Po en ial u u e communi y pha macy se -
ices we e also es ima ed wi h an addi ional inc ease o
6.9% in QoL and an economic alue o 144.8 M€[34].
Al hough his s udy does no explo e he consume s’
willingness o pay (WTP) o pha macy se ices, which
may dic a e he easibili y o hei implemen a ion, se -
e al s udies epo ha he e a e many consume s will-
ing o pay o speci ic communi y pha macy se ices.
The willingness o pay appea s o be sensi i e o pe -
cei ed u ili y and heal h imp o emen s [35–37].
De eloping and expanding he ole o communi y
pha macis s can be a means o enew he ocus on p e-
en i e heal h ca e and o ex end he co e age o p i-
ma y heal h ca e. Fo example, in Finland, communi y
pha macis s a e ac i ely in ol ed in he ea men and
p e en ion o majo ch onic diseases. In he Uni ed
S a es, communi y pha macies p o ide in luenza immu-
nisa ions in communi ies designa ed as medically unde -
se ed [38], and in England, he New Medicine Se ice
(NMS), a complex medicine managemen in e en ion,
suppo s pa ien s’adhe ence o newly p esc ibed medi-
cines o long- e m condi ions [39]. B oadening he
scope o communi y pha macis s’may be an impo an
policy le e ha coun ies could pu sue o p o ide less
cos ly and mo e p e en i e heal h ca e and be e man-
agemen o long- e m condi ions [40], as pa ien s show
s ong a i udes, connec ion and sa is ac ion wi h hese
p o essionals and se ices p o ided.
Conclusion
This s udy explo ed a new app oach in ol ing an unde -
s anding o he expec a ions and p e e ences o pa ien s
owa ds communi y pha macies, leading o an
explo a o y ypology o (po en ial) pha macy cus ome s.
One con ibu ion o his a icle is ha i p o ides insigh
ega ding he basis o a s a is ically ep esen a i e sam-
ple o he Po uguese popula ion. In a ace- o- ace in e -
iew conduc ed doo - o-doo , 1114 esponden s
answe ed a closed-ques ion su ey ha measu ed hei
a i udes in ela ion o he se ices ha communi y
pha macies cu en ly p o ide, as well as hose ha could
be p o ided in he nea u u e. This ace- o- ace me h-
odology, which is known o ha e an ad an age in ob ain-
ing quali y da a, also has i s disad an ages, as is he case
when in e iewees diligen ly a emp o mee he (imag-
ined) expec a ions o he in e iewe s and he e o e ad-
he e mo e easily o socially accep able no ms and
discou ses. This beha iou may ha e in luenced he e y
high le els o sa is ac ion owa ds communi y pha macy
se ices and may be one o he limi a ions o he s udy.
Ne e heless, his me hodology o ace- o- ace in e -
iewees is a ed as one o he bes o ensu ing us
among in e iewees and he e o e he eliabili y o he
in o ma ion and da a p oduced.
The esul s sugges ha he majo i y o he Po uguese
ha e a connec ion o a pha macy, in acco dance wi h
he esul s om p e ious s udies on communi y pha -
macy ac oss he wo ld and in Po ugal. The le els o sa -
is ac ion a e high, and he se ices p o ided a e a ed as
impo an and e y impo an by he majo i y o he
popula ion. On he one hand, he impo ance assigned
o se ices is associa ed wi h he knowledge ha cus-
ome s cu en ly ha e abou hem ( he mo e knowledge,
he mo e impo ance). On he o he hand, esponden s
a e open o new se ices ha ha e no ye been imple-
men ed, which hey also pe cei ed as impo an . These
esul s sugges ha he e is a gene al ag eemen among
he popula ion ega ding he ole o pha macies in he
heal h sys em and a posi i e a i ude owa d he ex en-
sion o hei ole as public heal h p o ide s.
Addi ional in es iga ions o de e mine consume s’
willingness o pay o di e en pha macy se ices should
be explo ed.
This s udy highligh s ce ain u u e di ec ions ha can
be pu sued by pa ien s, heal h p o essionals and policy
make s o expand he heal h ca e ole o Po uguese
communi y pha macies.
Addi ional ile
Addi ional ile 1: Su ey empla e. English ansla ed e sion o he
Po uguese su ey. (PDF 349 kb)
Abb e ia ions
CEFAR: Cen e o Heal h Resea ch & E alua ion; CESOP: Resea ch Cen e o
Public Opinion o he Ca holic Uni e si y o Po ugal; M€: Million eu os;
MCA: Mul iple Co espondence Analysis; NHS: Na ional Heal h Se ice;
NMD: New Medicine Se ice; NPM: Non-p esc ip ion medicines;
Polica po e al. BMC Heal h Se ices Resea ch (2019) 19:186 Page 9 o 11