The Nature and Meaning of Patient Focused Records in Community Pharmacy

For community pharmacy in England, National Health Service policy is driving an integrated care agenda which aims to make increasing use of community pharmacists to support the wellbeing of communities, refocusing their professional role as providers of care. This will inevitably impact health records use by community pharmacists. This research aims to understand community pharmacists’ record keeping practices and the meanings they ascribe to health records. A two-phase qualitative study was employed, aligned to a constructionist interpretivist philosophy. Phase one involved depth interviews with eighteen community pharmacists in the Midlands to explore their experiences of using records. Phase two involved depth interviews with three patient representatives and fifteen members of a multidisciplinary team who interface with community pharmacies to explore their experiences and expectations of community pharmacists’ record keeping practice. Data were analysed thematically. Viewing the data through the theoretical lens of institutional logics revealed that community pharmacists navigate discrepant state, market, corporate and professional logics as they deliver state mediated healthcare from a retail setting. Their relationship with the hybrid patient-consumer-customer informs record keeping practices that balance professional and corporate logics with consumer and market logics. State, market, and professional logics combine to influence fragmented and incomplete records, requiring duplication of information. State and professional logics inform pervasive medico-legally defensive record keeping practices. The policy-driven formalised integration of community pharmacy into primary care presents an opportunity for community pharmacists to demonstrate the value that they bring to patient care. This research has highlighted that community pharmacy patient focused records have developed to meet the organisational and commercial needs of community pharmacies, driven by records systems that privilege income and service delivery. A shift in the values that are ascribed to patient focused records may be required if community pharmacy is to achieve its full potential.