Views of visually impaired adults on the quality of care provided by community pharmacies in Ireland: A qualitative interview study
According to the 2022 Census, approximately 297,000 people in Ireland experience blindness or a Visual Impairment (VI). It is well documented that people with VI typically experience a higher incidence of negative health outcomes. Significantly, the World Health Organisation have attributed this in part to unfair conditions experienced within the health system.
“A tailored approach to community pharmacy care for this cohort can be achieved through minor adjustments to our usual practice”
As community pharmacists we are the health system’s first point of contact for many patients. As VI poses various challenges to individuals in how they obtain and take medications, more needs to be understood regarding how we, as pharmacists, can optimally assist these patients. Given the current landscape of expanding responsibilities within community pharmacy in Ireland, we in the School of Pharmacy, University College Cork, believed this was the right time to investigate visually impaired patient experiences of community pharmacy care in Ireland.
Aims and Methods
This work aimed to seek opinions of patients with VI, regarding the level of care provided by community pharmacies in Ireland, to explore their personal experiences and recommendations. Our work focused on adults over the age of 18, with a VI, i.e., reduction in visual acuity and/or visual field of any severity and duration. Vision Ireland assisted in recruiting interviewees and eighteen interviews took place between October and December 2023.
Main Results
Interviewees highlighted how disability awareness amongst pharmacy staff should be improved and how previous interactions, involving staff members not identifying their VI, had led to misunderstandings. It was felt that in some instances staff were unaware and lacked confidence of how to best communicate with patients with VI. Patients reiterated their happiness to explain communication preferences if asked and stressed the importance of speaking directly to the patient rather than a fully sight representative who may accompany them.
‘They literally handed me a pen and went tick the ones that you use regularly, and I was like ‘ahh…’ So, I asked them ‘could you actually read them out’. So, just a bit more awareness maybe, awareness is huge thing.
(Interviewee 2, Female)(Interviewee 2, Female)
Furthermore, interviewees emphasised the importance of not covering braille instructions on medication packaging which facilitates their identification of different products. Most reported that the braille instructions on their medicines have previously been covered by a dispensing label. The importance of consistent medicines packaging, such as keeping products in original containers was also highlighted.
‘You have the packet and then they’re put into the Ziplock bags. You can’t distinguish which is which, whereas if they’re in the box, you can say yeah, these are paracetamol.’
(Interviewee 3, Male)
Interviewees also provided insights into how the internal layouts of pharmacies could be adjusted to improve accessibility. Currently, depending on the layout of certain pharmacies, particularly in larger premises, locating the correct counter is often difficult. In smaller premises, navigating narrow aisles is sometimes a challenge, particularly with guide dogs. Poor lighting and presence of various physical obstacles, more prevalent around Christmas time, also causes problems.
‘Steps and narrow aisleways, or stuff in the aisleways, like boxes on the ground or the bargain basin at the end, those kinds of things give you bad access.’
(Interviewee 1, Male)
However, it was clear that there are lots of supportive measures currently being implemented by pharmacy staff to support these patients. Examples of aids to help with medication management included blister packs, measured syringes, cutting tablets in half and placing medications in different sized packaging or separate containers. The potential to use mobile applications as assistive technologies were also highlighted. Applications highlighted included NaviLens, SeeingAI and Be My Eyes. Throughout our interviews the strong correlation between close patient-staff relationships and improved service was clear, with these patients usually preferring to attend one pharmacy. A small but significant recommendation was that staff should learn the names of patients with VI and to use them frequently to avoid unnecessary confusion.
‘If you do know the customer’s name, use it. There is nothing more embarrassing if they say ’what can I do for you?’ and you answer, and they’re talking to the person next to you.’
(Interviewee 8, Male)
Conclusions
Overall, our work suggests that a tailored approach to community pharmacy care for this cohort can be achieved through minor adjustments to our usual practice. Even as small as learning someone’s name! This study identified the importance of communication, collaboration and relationship building with these patients to achieve positive community pharmacy experiences and health outcomes for patients with VI across Ireland.
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