Abstract
Background: Comparing healthcare services for patients with minor ailments between pharmacies and hospital outpatient departments is crucial for understanding public behavior and factors influencing healthcare service selection decisions. Data from this comparison serves as an important foundation for developing efficient and accessible service guidelines in diverse contexts.
Methods: This study employed a qualitative research approach to compare healthcare services for patients with minor ailments between pharmacies and hospital outpatient departments. The research was conducted in three main phases: 1) Literature review of minor ailment care services and policies from countries with notable programs, including Canada, United Kingdom, Australia, Taiwan, South Korea, and South Africa; 2) Data collection through in-depth interviews with patients and pharmacists, along with surveys on expectations and satisfaction of minor ailment patients using services at pharmacies and hospital outpatient departments, using qualitative survey methods in 6 provinces: Bangkok and surrounding areas, Chiang Mai, Udon Thani, Sukhothai, Sa Kaeo, and Yala, with 48 informants; and 3) Expert and stakeholder meetings with 25 participants to perform content analysis of the collected data.
Results: (1) Literature review revealed that pharmacy-based minor ailment programs vary across countries according to health insurance systems and pharmacist roles. Countries with universal health coverage support pharmacist roles through specific programs, such as the UK and Taiwan, while South Korea and South Africa face legal constraints and pharmacy distribution issues. Compensation systems affect program sustainability, with countries having good reimbursement systems like the UK and Canada showing high program participation rates, while countries using co-payment systems like Australia and Taiwan may have service access limitations. (2) Service pathway findings showed patients chose pharmacies for convenience and speed, while hospitals had complex procedures and time-consuming processes. Program barriers included unclear communication, unstable reimbursement systems, and patient misunderstandings about pharmacy roles, such as self-medication without health history taking. Additionally, data linkage systems between pharmacies and hospitals remained inefficient. (3) Comparison of expectations and satisfaction revealed service users had high expectations for both pharmacies and hospitals, particularly in accessibility (pharmacy x ̅ = 4.7, SD = 0.5, 95.0%; hospital x ̅ = 4.8, SD = 0.4, 96.0%) and staff service (pharmacy x ̅ = 4.9, SD = 0.4, 97.2%; hospital x ̅ = 5.0, SD = 0.0, 100.0%). However, hospitals scored higher in facility size (pharmacy x ̅ = 4.5, SD = 0.7, 90.7%; hospital x ̅ = 4.6, SD = 0.6, 91.8%) and medication completeness (pharmacy x ̅ = 4.7, SD = 0.6, 93.7%; hospital x ̅ = 4.8, SD = 0.4, 95.6%), while pharmacies scored higher in service speed (pharmacy x ̅ = 4.7, SD = 0.6, 94.0%; hospital x ̅ = 4.7, SD = 0.7, 93.9%). Satisfaction findings showed high scores for both settings, with pharmacies receiving higher scores for value for money (pharmacy x ̅ = 9.2, SD = 1.8, 92.0%; hospital x ̅ = 4.7, SD = 2.6, 46.7%) and accessibility, while hospitals scored higher in service quality (pharmacy x ̅ = 9.3, SD = 1.5, 92.7%; hospital x ̅ = 9.3, SD = 1.2, 93.2%) and treatment process standards. Service loyalty showed users were more likely to use pharmacy services in the future than return to hospitals (pharmacy x ̅ = 9.6, SD = 1.2, 95.6%; hospital x ̅ = 5.8, SD = 1.6, 58.3%) and more likely to recommend pharmacies than hospitals (pharmacy x ̅ = 9.6, SD = 1.2, 95.6%; hospital x ̅ = 6.1, SD = 2.1, 61.1%).
Conclusion: The positive reception from both patients and pharmacists demonstrates the program's potential for addressing primary healthcare needs while reducing the burden on hospital outpatient departments. However, identified challenges, particularly regarding patient understanding and technical infrastructure, indicate areas requiring development to enhance program efficiency. Pharmacists' emphasis on honesty as a sustainability factor underscores the importance of maintaining program integrity. Future policy considerations should focus on expanding health insurance coverage, strengthening management systems, and developing technological infrastructure to support this community-based healthcare initiative. These findings provide valuable insights for policymakers and healthcare administrators in refining and scaling similar primary care pharmacy services.
Recommendations: 1) Service systems should develop integrated data linkage between pharmacies and healthcare units, establish standardized practice guidelines, and expand programs to cover all treatment rights; 2) Reimbursement systems should be improved for speed and transparency, with consideration of co-payment systems to reduce government budget burden; 3) Public relations should emphasize easily understood communication and increase promotional channels to reach all population groups; and 4) Governance should ensure transparency in program operations and implement rigorous pharmacy monitoring systems. These measures will enable program expansion and increase public confidence.
