A qualitative study on pharmacists’ perception on integrating pharmacists into private general practitioner’s clinics in Malaysia

Main Article Content


Pharmacists, Physicians, Primary Health Care, Delivery of Health Care, Integrated, Interprofessional Relations, Qualitative Research, Malaysia


Background: Private general practitioners in Malaysia largely operates as solo practices – prescribing and supplying medications to patients directly from their clinics, thus posing risk of medication-related problems to consumers. A pharmacy practice reform that integrates pharmacists into primary healthcare clinics can be a potential initiative to promote quality use of medication. This model of care is a novel approach in Malaysia and research in the local context is required, especially from the perspectives of pharmacists.

Objective: To explore pharmacists’ views in integrating pharmacists into private GP clinics in Malaysia.

Methods: A combination of purposive and snowballing sampling was used to recruit community and hospital pharmacists from urban areas in Malaysia to participate either in focus groups or semi-structured interviews. A total of 2 focus groups and 4 semi-structured interviews were conducted. Sessions were audio recorded, transcribed verbatim and thematically analysed using NVivo 10.

Results: Four major themes were identified: (1) Limited potential to expand pharmacists’ roles, (2) Concerns about non-pharmacists dispensing medicines in private GP clinics, (3) Lack of trust from consumers and private GPs, (4) Cost implications. Participants felt that there was a limited role for pharmacists in private GP clinics. This was because the medication supply role is currently undertaken in private GP clinics without the need of pharmacists. The perceived lack of trust from consumers and private GPs towards pharmacists arises from the belief that healthcare is the GPs’ responsibility. This suggests that there is a need for increased public and GP awareness towards the capabilities of pharmacists’ in medication management. Participants were concerned about an increase in cost to private GP visits if pharmacists were to be integrated. Nevertheless, some participants perceived the integration as a means to reduce medical costs through improved quality use of medicines.

Conclusion: Findings from the study provided a better understanding to help ascertain pharmacists’ views on their readiness and acceptance in a potential new model of practice.

Abstract 1847 | PDF Downloads 1190 online appendix Downloads 577


1. Jaafar S, Mohd Noh K, Abdul Muttalib K, Othman N, Healy J. Malaysia Health System Review. Health Systems in Transition 2013;3(1):1-103.

2 Ramli A, Taher S. Managing chronic diseases in the Malaysian primary health care – a need for change. Malays Fam Physician. 2008;3(1):7-13.

3 Wong SS. Pharmacy practice in Malaysia. Malaysian Journal of Pharmacy 2001;1(1):2-8.

4 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

5 Chee HL. Ownership, control, and contention: challenges for the future of healthcare in Malaysia. Soc Sci Med. 2008;66(10):2145-2156. doi: 10.1016/j.socscimed.2008.01.036

6 Aljunid S. The role of private medical practitioners and their interactions with public health services in Asian countries. Health Policy Plan. 1995;10(4):333-349.

7 Ministry of Health Malaysia. Country Health Plan: 10th Malaysia Plan 2011-2015. Available at: http://www.moh.gov.my/images/gallery/Report/Country_ health.pdf (accesed 29 December 2014).

8 Fialová D, Onder G. Medication errors in elderly people: contributing factors and future perspectives. Br J Clin Pharmacol. 2009;67(6):641-645. doi: 10.1111/j.1365-2125.2009.03419.x

9 Junius-Walker U, Theile G, Hummers-Pradier E. Prevalence and predictors of polypharmacy among older primary care patients in Germany. Fam Pract. 2007;24(1):14-19. doi: 10.1093/fampra/cml067

10 Freeman CR, Cottrell WN, Kyle G, Williams ID, Nissen L. An evaluation of medication review reports across different settings. Int J Clin Pharm. 2013;35(1):5-13. doi: 10.1007/s11096-012-9701-8

11 Chua SS, Kok LC, Md Yusof FA, Tang GH, Lee SWH, Efendie B, Paraidathathu T. Pharmaceutical care issues identified by pharmacists in patients with diabetes, hypertension or hyperlipidaemia in primary care settings. BMC Health Serv Res. 2012;12:388. doi: 10.1186/1472-6963-12-388

12 Dolovich L, Pottie K, Kaczorowski J, Farrell B, Austin Z, Rodriguez C, Gaebel K, Sellors C. Integrating family medicine and pharmacy to advance primary care therapeutics. Clin Pharmacol Ther. 2008;83(6):913-917. doi: 10.1038/clpt.2008.29

13 Fish A, Watson MC, Bond CM. Practice-based pharmaceutical services: a systematic review. Int J Pharm Pract. 2002;10(4):225–233. doi: 10.1211/096176702776868451

14 Ables AZ, Baughman OL 3rd. The clinical pharmacist as a preceptor in a family practice residency training program. Fam Med. 2002;34(9):658-662.

15 Cone SM, Brown MC, Stambaugh RL. Characteristics of ambulatory care clinics and pharmacists in Veterans Affairs medical centers: an update. Am J Health Syst Pharm. 2008;65(7):631-635. doi: 10.2146/ajhp070198

16 Martin RM, Lunec SG, Rink E. UK postal survey of pharmacists working with general practices on prescribing issues: characteristics, roles and working arrangements. Int J Pharm Pract. 1998;6(3):133-139.

17 Carter BL, Malone DC, Billups SJ, Valuck RJ, Barnette DJ, Sintek CD, Ellis S, Covey D, Mason B, Jue S, Carmichael J, Guthrie K, Dombrowski R, Geraets DR, Amato M; Impact of Managed Pharmaceutical care on resource utilization and Outcomes in Veterans affairs medical centers. Interpreting the findings of the IMPROVE study. Am J Health Syst Pharm. 2001;58(14):1330-1337.

18 Lowe CJ, Raynor DK, Purvis J, Farrin A, Hudson J. Effects of a medicine review and education programme for older people in general practice. Br J Clin Pharmacol. 2000;50(2):172-175.

19 Farrell B, Ward N, Dore N, Russell G, Geneau R, Evans S. Working in interprofessional primary health care teams: What do pharmacists do? Res Social Adm Pharm. 2013;9(3):288-301. doi: 10.1016/j.sapharm.2012.05.005

20 Low WH, Seet W, Ramli AS, Ng KK, Jamaiyah H, Dan SP, Teng CL, Lee VK, Chua SS, Md Yusof FA, Karupaiah T, Chee WS, Goh PP, Zaki M, Lim TO. Community-based cardiovascular Risk Factors Intervention Strategies (CORFIS) in managing hypertension: A pragmatic non-randomised controlled trial. Med J Malaysia. 2013;68(2):129-135.

21 Frankel GE, Austin Z. Responsibility and confidence: identifying barriers to advanced pharmacy practice. Can Pharm J (Ott). 2013;146(3):155-161. doi: 10.1177/1715163513487309

22 Rosenthal M, Austin Z, Tsuyuki RT. Are pharmacists the ultimate barrier to pharmacy practice change? Can Pharm J (Ott) 2010;143:37-42.

23 Hassali M, Awaisu A, Shafie A. Professional Training and Roles of Community Pharmacists in Malaysia: Views from General Medical Practitioners. Malays Fam Physician. 2009;4(2-3):71-76.

24 Sarriff A, Nordin N, Hassali MA. Extending the Roles of Community Pharmacists: Views from General Medical Practitioners. Med J Malaysia. 2012;67(6):577-581.

25 Saw PS, Nissen L, Freeman C, Wong PS, Mak V. A new role of pharmacists in private primary healthcare clinics in Malaysia: the views of general practitioners. J Pharm Pract Res 2017;47(1):27-33.

26 Saw PS, Nissen LM, Freeman C, Wong PS, Mak V. Health care consumers' perspectives on pharmacist integration into private general practitioner clinics in Malaysia: a qualitative study. Patient Prefer Adherence. 2015;9:467-477. doi: 10.2147/PPA.S73953

27 Freeman C, Cottrell WN, Kyle G, Williams I, Nissen L. Integrating a pharmacist into the general practice environment: opinions of pharmacist's, general practitioner's, health care consumer's, and practice manager's. BMC Health Serv Res. 2012;12:229. doi: 10.1186/1472-6963-12-229

28 Jorgenson D, Laubscher T, Lyons B, Palmer R. Integrating pharmacists into primary care teams: barriers and facilitators. Int J Pharm Pract. 2014;22(4):292-299. doi: 10.1111/ijpp.12080

29 Tan EC, Stewart K, Elliott RA, George J. Integration of pharmacists into general practice clinics in Australia: the views of general practitioners and pharmacists. Int J Pharm Pract. 2014;22(1):28-37. doi: 10.1111/ijpp.12047

30 Houle SK, Grindrod KA, Chatterley T, Tsuyuki RT. Paying pharmacists for patient care: A systematic review of remunerated pharmacy clinical care services. Can Pharm J (Ott). 2014;147(4):209-232. doi: 10.1177/1715163514536678

31 Isetts BJ, Schondelmeyer SW, Artz MB, Lenarz LA, Heaton AH, Wadd WB, Brown LM, Cipolle RJ. Clinical and economic outcomes of medication therapy management services: the Minnesota experience. J Am Pharm Assoc (2003). 2008 Mar-Apr;48(2):203-211. doi: 10.1331/JAPhA.2008.07108

32 Thompson CA. State-paid medication therapy management services succeed. Am J Health Syst Pharm. 2008;65(6):490- 498. doi: 10.2146/news080022

33 Lee E, Braund R, Tordoff J. Examining the first year of Medicines Use Review services provided by pharmacists in New Zealand: 2008. N Z Med J. 2009;122(1293):3566.

34 Jackson M, Gaspic-Piskovic M, Cimino S. Description of a Canadian employer-sponsored smoking cessation program utilizing community pharmacy-based cognitive services. Can Pharm J (Ott) 2008;141(4):234-240.

35 Look KA, Mott DA, Leedham RK, Kreling DH, Hermansen-Kobulnicky CJ. Pharmacy participation and claim characteristics in the Wisconsin Medicaid Pharmaceutical Care Program from 1996 to 2007. J Manag Care Pharm. 2012 Mar;18(2):116-128. doi: 10.18553/jmcp.2012.18.2.116

36 Pope C, Mays N. Reaching the parts other methods cannot reach: an introduction to qualitative methods in health and health services research. BMJ. 1995;311(6996):42-45.

37 Thomas D. A General Inductive Approach for Analyzing Qualitative Evaluation Data. Am J Eval 2006;27(2):237-246.

38 Jorgenson D, Gubbels-Smith A, Farrell B, Ward N, Dolovich L, Jennings B. Characteristics of pharmacists who enrolled in the pilot ADAPT Education Program: Implications for practice change. Can Pharm J (Ott). 2012;145(6):260-263. doi: 10.3821/145.6.cpj260

39 Hassali MA, Shafie AA, Awaisu A, Mohamed Ibrahim MI, Ahmed SI. A public health pharmacy course at a Malaysian pharmacy school. Am J Pharm Educ. 2009;73(7):136.

40 Ting KN, Wong KT, Thang SM. Contributions of Early Work-Based Learning: A Case Study of First Year Pharmacy Students. International Journal of Teaching and Learning in Higher Education 2009;22(3):326-335.

41 Olsson E, Tuyet LT, Nguyen HA, Stalsby Lundborg C. Health professionals' and consumers' views on the role of the pharmacy personnel and the pharmacy service in Hanoi, Vietnam: a qualitative study. J Clin Pharm Ther. 2002;27(4):273-280.

42 Kamei M, Teshima K, Fukushima N, Nakamura T. Investigation of patients' demand for community pharmacies: relationship between pharmacy services and patient satisfaction. Yakugaku Zasshi. 2001;121(3):215-220.

43 Kamat VR, Nichter M. Pharmacies, self-medication and pharmaceutical marketing in Bombay, India. Soc Sci Med. 1998;47(6):779-794.

44 Wen MF, Lin SJ, Yang YH, Huang YM, Wang HP, Chen CS, Wu FL. Effects of a national medication education program in Taiwan to change the public's perceptions of the roles and functions of pharmacists. Patient Educ Couns. 2007;65(3):303-310. doi: 10.1016/j.pec.2006.08.011

45 Sarriff A. A survey of patient-oriented services in community pharmacy practice in Malaysia. J Clin Pharm Ther. 1994;19(1):57-60.

46 Hassali MA, Subish P, Shafie AA, Ibrahim MIM. Perceptions and Barriers towards Provision of Health Promotion Activities among Community Pharmacists in the State of Penang, Malaysia. J Clin Diagn Res 2009;3(3):1562-1568.

47 Amzan K. Pharmacists vs doctors: The ongoing 'debate'. The Malay Mail Online 2015. Available at: http://www.themalaymailonline.com/opinion/kamal-amzan/article/pharmacists-vs-doctors-the-ongoing-debate (accessed 17 June 2015).

48 McDonough RP, Rovers JP, Currie JD, Hagel H, Vallandinghanl J, Sobotka J. Obstacles to the implementation of pharmaceutical care in the community setting. J Am Pharm Assoc 1998;38(1):87-95. doi: 10.1016/S1086-5802(16)30296-0

49 Kucukarslan S, Lai S, Dong Y, Al-Bassam N, Kim K. Physician beliefs and attitudes toward collaboration with community pharmacists. Res Social Adm Pharm. 2011;7(3):224-232. doi: 10.1016/j.sapharm.2010.07.003

50 Hughes CM, McCann S. Perceived interprofessional barriers between community pharmacists and general practitioners: a qualitative assessment. Br J Gen Pract. 2003;53(493):600-606.

51 Bradley F, Elvey R, Ashcroft DM, Hassell K, Kendall J, Sibbald B, Noyce P. The challenge of integrating community pharmacists into the primary health care team: a case study of local pharmaceutical services (LPS) pilots and interprofessional collaboration. J Interprof Care. 2008;22(4):387-98. doi: 10.1080/13561820802137005

52 Van C, Costa D, Abbott P, Mitchell B, Krass I. Community pharmacist attitudes towards collaboration with general practitioners: development and validation of a measure and a model. BMC Health Serv Res. 2012;12:320. doi: 10.1186/1472-6963-12-320

53 Ramalho de Oliveira D, Brummel AR, Miller DB. Medication therapy management: 10 years of experience in a large integrated health care system. J Manag Care Pharm. 2010;16(3):185-195. doi: 10.18553/jmcp.2010.16.3.185

54 Jacob S, Sarriff A. An explorative study of pharmacy-based bone mineral density testing. Malaysian J Pharm Sci. 2006;4(2):1-14.

55 Swan M, Zwi A. Private practitioners and public health: close the gap or increase the distance. Department of Public Health and Policy, London School of Hygiene and Tropical Medicine;1997.