PHARMACY CONSUMER RESEARCH Pharmacy usage and communications mapping Executive Summary June 2009

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PHARMACY CONSUMER RESEARCH Pharmacy usage and communications mapping Executive Summary Audience segmentation

Annexe B

Four key audience segments emerged from the research, based on a qualitative analysis of audience attitudes/behaviour. The segments were: Traditionalists Enthusiasts Indulgers Avoiders. The two key drivers underlying the segments emerged as: The frequency of contact people already had with staff in pharmacies and how much focus individuals put on their relationship with staff in pharmacies (including pharmacists and their teams) The frequency with which people were already going into pharmacies and how much focus individuals put on the pharmacy environment/experience (or, more broadly, chemists/health and beauty stores which housed a pharmacy). The people with LTCs talked to across the sample tended to fall into a segment which was primarily determined by their demographic characteristics, most notably age and gender, rather than their LTC. This meant that they were likely to respond to the same kinds of overarching messages and communication channels as others in their segment. People with LTCs (and their carers) across the sample, unsurprisingly, tended to be using their pharmacy team and visiting their pharmacy more than others in their segment. They were also likely to have a particular interest in services focused on their LTC, such as a form of Medicine Use Review (MUR) and ongoing support/care. A key learning from the research was, however, that these LTC-specific services should be communicated in a way that is relevant and meaningful for the segment in question rather than purely as a LTC service. These segments, and the positioning of the various demographic groups and LTCs, as well as different types of pharmacy, are illustrated on the map below:

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High
People: current frequency of contact with the team/focus on relationship

Specialist pharmacy chains People with severe health Women with COPD/ conditions, including CHD/COPD/ Local independent emphysema/CHD who are emphysema/who are not mobile pharmacies mobile

Traditionalists
Place: current frequency of usage/ focus on environment and experience

Older people with mild/ moderate health conditions

Enthusiasts

Older men 55-70 (separated/divorced) Older men 55-70 (cohabiting)

Parents of children with diabetes/asthma Women with diabetes/ asthma/less severe LTCs Mothers/women/carers 35+

Low

High
Younger women with diabetes/asthma/less severe LTCs

Men with diabetes/ asthma/less severe LTCs

Avoiders
Men 16-24, including black African & Caribbean men Men 25-55 15-17s

Indulgers
Supermarket pharmacies

Women 18-35

Pharmacy-led health & beauty retailers

Low

The individual segments can be summarised as follows. Traditionalists Medium-high usage of the pharmacy team, low-medium frequency of pharmacy usage Often older people and people with severe/multiple LTCs may or may not be mobile Focused on the personal service given by the pharmacy team; less focused on the pharmacy environment Prefer local independent pharmacies, tend to use the same one Key opportunity is to build and develop current relationships with the pharmacist/pharmacy team endorsement from other healthcare professionals is likely to be critical to this Key challenge comes from overcoming the established/entrenched nature of their relationships with other healthcare providers Enthusiasts Medium-high frequency of pharmacy usage, medium-high usage of the pharmacy team Often women 35+ with responsibility for others (husband/partner, children, elderly relatives), older women with LTCs and parents of children with LTCs This segment is most enthusiastic about/aware of/open to pharmacy services Likely to use a range of types of pharmacy due to the busy nature of their lifestyle but often claim to prefer specialist pharmacy chains, which offer the combined benefits of an enjoyable environment, a wide range of services and tailored support/advice from the pharmacy team Key opportunity is to consolidate and widen their understanding/ awareness of and receptivity to the full range of services available
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Main challenge relates to Enthusiasts instinct to take children to the GP rather than use pharmacy services

Indulgers Medium-high frequency of pharmacy usage, low-medium usage of the pharmacy team Often younger women, including women with LTCs Focus on the beauty offer and the environment, may feel embarrassed about talking to the pharmacist Prefer pharmacy-led health and beauty retailers, which offer a more enjoyable shopping environment and greater choice Key opportunity is to trigger browsing of the pharmacy and contact with the pharmacy team via the health and beauty area of the store Key challenge is to build confidence amongst Indulgers and to encourage them to truly engage with the pharmacy team/services and environment Avoiders Low-medium frequency pharmacy usage, low-medium usage of the pharmacy team Encompasses teenagers, younger men including black African and Caribbean men and middle aged/older men who rely on others to go to the pharmacist for them Actively avoid going to pharmacies, feel uncomfortable in the pharmacy environment as it currently stands due to perceptions of the environment as feminised/for older people/lacking privacy and of customer service being indiscreet Some claim to prefer supermarket pharmacies for the provision of anonymity Key opportunity is to provide environments, customer service and services that are more youth-/male-friendly, for example sport and fitness-focused services, as well as putting more emphasis on privacy and discretion Key barriers relate to current negative perceptions of staff, the environments and the relevance of services to them.

Overview of responses to pharmacies increasing their role in healthcare provision

Participants across the sample welcomed the idea of pharmacies playing a greater role not only in providing advice relating to medication but also in preventative areas of health, including testing/screening and supporting health improvement behaviours. The key potential benefits of pharmacies offering these services were felt to be: Quicker/easier and more flexible access to healthcare Less formal/structured access to healthcare (able to drop in) and therefore increased likelihood that individuals will visit on a spontaneous basis Earlier/more frequent visits to pharmacies than current healthcare providers and therefore more focus on preventative healthcare. A further benefit participants talked about was that of a redistribution of workloads, which it was believed would have the positive effect of relieving NHS services. More
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specifically, participants felt that providing more services in pharmacies could reduce pressure on GPs, and allow them to focus on their key areas of specialism and expertise. A minority of participants were cynical about the increasing role of pharmacies and interpreted the change as a way of the government preventing them from accessing the services they wanted from GPs. Some also felt the change could signal a move towards getting people to pay for services delivered through pharmacies that would otherwise be free on the NHS in other settings. Finally, a significant proportion of participants, including many who were positive about the idea of an increased role for pharmacies, were concerned about how the plan would be implemented. They anticipated that significant levels of additional investment in pharmacy training/staffing levels and skills, as well as enhanced environments, would be needed in order to deliver the services effectively. There was a particular concern that the pharmacy initiative did not merely shift queues and waiting times from GPs to pharmacies.

Responses to services
Details of the current/potential pharmacy services looked at in the research can be found in section 4.4.1 of the appendix. Generally participants felt that all of the services explored in this research had relevance to themselves and/or others. Discussion around the issue of price was not specifically prompted as part of this research. However, participants tended to view the services as being beneficial to the NHS in the long run by improving health and therefore reducing overall pressure on services and so they tended to assume that this would save the government money. This led people to believe that these services should therefore be provided free of charge or, if not, then cheaper than private sector alternatives. The issue of who would be offering these services was also not explicitly explored in this research. However, it frequently emerged as an issue, with many participants wanting clarification around who exactly was offering the services the NHS or individual pharmacies. Participants frequently commented that making services feel relevant to them was as much about communicating all of the services appropriately for each segment rather than targeting different services at different segments. However, individual segments did express more interest in some services than others, often due to the increased relevance of some services resulting from their age/gender.
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Equally, people with LTCs were more likely to express interest in services with some relevance to their condition. Having said this, individuals with LTCs did not always recognise the relevance of some of the services to them as they are currently expressed, most notably MURs, due to fact that they were not perceived to be tailored to them or their specific needs as defined by the segment they fell into. Key overall preferences by segment were:
Traditionalists Medicine Usage Review/support for people with LTCs Stop smoking support Treatment for minor ailments Pharmacies in GPs surgeries Dispensing services support amongst some Enthusiasts Advice on keeping well Heart MOT Testing for people at risk of high blood pressure and diabetes (adults not children) Treatment for minor ailments Dispensing services support amongst some

Avoiders All Treatment for minor ailments Teenagers Teenage pregnancy and sexually transmitted infections advice service Testing for and treating Chlamydia

Indulgers Dispensing services Contraception dispensing services in pharmacies Optimisation of health (advice on keeping well focused on diet) Treatment for minor ailments Testing for and treating Chlamydia support amongst some

18-24 men Optimisation of health (advice on keeping well focusing on optimising health and fitness) 25-55 men Heart MOT (plus advice on keeping well as a follow-up) Testing for people at risk of high blood pressure and diabetes

Summary of pharmacy attributes/challenges in relation to uptake of pharmacy services

The attributes that are likely to enhance uptake of services and the challenges that need to be tackled in order to ensure uptake are listed in the table below: Key attributes Key challenges
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Accessibility Accessibility Easy to reach/no need to drive/easy Friendly/approachable more could be done to invite Avoiders/ parking Indulgers in Open at convenient times (within this, extended hours)/drop in/no need for an appointment Contactable through a range of channels Large network/choice of different pharmacies/anonymity Environment Provision of uncluttered, easy to navigate, tidy environments (smaller independents) Provision of masculine/youthfriendly environments Provision of privacy at all points in the experience Provision of clinical conditions Access to evidence-based information Keep records of medicines dispensed Access to evidence-based information Lack of ability to share medication records Lack of access to medical records Range of clinical services available Lack of qualified staff/appropriate environments within all pharmacies Joined up working Need more evidence that healthcare professionals will refer to pharmacists and that pharmacists/ qualified staff working in pharmacies will refer to other professionals Need to communicate explicitly the use of pharmacies to host clinical/ other services offered by specialist healthcare professionals Professionalism, skills and knowledge Not all know that pharmacists are highly qualified Other pharmacy staff need to deliver suitable and accurate advice
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Range of clinical services available Increased speed/ease/convenience

Joined up working Some evidence of positive relations and good two-way communication between pharmacists/GPs

Professionalism, skills and knowledge Pharmacists are highly qualified

too Pharmacists and their teams need to develop soft skills, for example better front of house approach, sensitivity, listening skills, ability to build relationships

One stop shop for healthy living/health improvement Good opportunity to provide this within larger pharmacies

One stop shop for healthy living/health improvement Some concern that smaller pharmacies would not be able to deliver this (and may close down over time, thus reducing accessibility) Good to communicate partnership working with other public/private healthy living/health improvement providers explicitly esp. good as a means of drawing Avoiders/ Indulgers into pharmacies

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Differences by type of pharmacy

Local independent pharmacies Local independent pharmacies emerged as having most appeal to Traditionalists/ Enthusiasts who were very focused on personal service and having an ongoing relationship with the pharmacy team. The perceived disadvantages of local independents related to the environments, which were often criticised as being difficult to navigate, cluttered and lacking anonymity. Many also had doubts that local independents would be able to deliver the level of privacy and clinical conditions necessary for the delivery of some of the new services. There were, however, strong calls to retain local independent pharmacies going forward and a concern that if these pharmacies were lost in the future, a key strength of pharmacies in terms of accessibility especially for those in deprived and rural communities would be lost. Specialist pharmacy chains Specialist pharmacy chains were felt to offer a good combination of personal service and efficient environments, although there was some feeling that continuity of service was sometimes not as good as for local independents. Overall, however, these chains were felt to be well placed to deliver a broader range of services going forward. Pharmacy-led health and beauty retailers The pharmacy-led health and beauty retailers were felt to have the distinct advantage of appealing to younger people as well as being able to offer appropriate levels of privacy and clinical conditions for the new services. However a key challenge for these chains was felt to be around delivery of personal service and the development of ongoing relationships that will be essential for maximum uptake and use of the services. Supermarket pharmacies Supermarket pharmacies were felt to be less established and relatively unknown. Avoiders, in particular, were attracted to this kind of pharmacy because it does not constitute a traditional medical/health context and offers the potential for maximum anonymity.

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However there were also strong concerns about pharmacy team expertise, how personal/ongoing relationships could be developed and the provision of privacy/clinical conditions within this environment.

Communication insight
Overview The research revealed peoples strong desire for a national communication campaign which: Presents pharmacies as facilitating access to better health for all Consolidates and clearly establishes pharmacists core areas of expertise and what they can offer Communicates the other services on offer, who is offering them and their credentials to do so. Key messages A range of potential messages were exposed in the research. A full list of these can be found in section of 4.4.3 of the appendix. The following key messages emerged from the research as most important to include (listed in broad order of importance): Go to your pharmacy for on the spot advice, testing for and treatment of minor ailments like coughs, colds, indigestion or minor injuries Pharmacists are experts at dispensing medicines and understanding how different medicines affect each other, including prescription and nonprescription drugs Pharmacists are not just there for prescriptions, they offer more than you think, they are expert in delivering a range of other services Pharmacies can provide a private place if you want to talk about something personal (clarifying privacy is provided at different levels, according the needs of different services and at different points in the process of accessing them) Pharmacists work in partnership with your GP and other local health services (although not as a first port of call). Additional messages not explicitly exposed in the research but which emerged as important included: Pharmacies can provide the clinical conditions necessary to provide screening services Pharmacies work in partnership with other local public/private service providers to offer the best keeping well services. Beyond this, the key messages to emerge by segment were:
Traditionalists Pharmacists can offer you a Medicine Use Review Enthusiasts Your local pharmacy can be a very convenient way of getting medical

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Did you know that up to 50% of people take their medicines incorrectly Pharmacies can provide support and advice for you if you have a LTC

Avoiders Your local pharmacy is friendly and approachable Your pharmacy helps you to keep and optimise your health Your local pharmacy can be a very convenient way of getting medical advice because pharmacies can be open longer hours

advice because pharmacies can be open longer hours Prescriptions can be ready by the time you get to the pharmacist or they could be sent to your home (not work) (For people with LTCs) Did you know that up to 50% people take their medicines incorrectly Indulgers Your pharmacy helps you to keep and optimise your health Your local pharmacy is friendly and approachable Your local pharmacy can be a very convenient way of getting medical advice because pharmacies can be open longer hours

Executional guidance Additional learning from the research for the future communication campaign included: Use simple, straightforward messages that do not assume prior knowledge or understanding of pharmacies, staff skills and the services on offer The tone needs to be down to earth, friendly and empathetic Explicitly show/allude to the friendliness and approachability of staff If specific services are to be included, clarify who is providing the service, what their skills are, and how the environment supports service delivery Where possible, develop a way to help people to navigate pharmacy services, for example via a set of visual identifiers Use healthcare professionals especially GPs to endorse pharmacy services Use testimonials to show how pharmacy services are relevant to everyday people, possibly including pharmacist/pharmacy team testimonials to help develop a positioning/positive image for them Link the campaign to other relevant health campaigns, for example promoting pharmacies as a destination for keeping well advice within the Know your limits campaign or using the pharmacy campaign as a foundation on which to further build the Ask your pharmacist campaign Work with others in the health and beauty/keeping well sectors (both public and private) to communicate (and deliver) services. Channel guidance There were requests for a national mass media campaign, encompassing national TV.

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People also felt that a strong local aspect would be beneficial, to allow for specific targeting of populations and pharmacy profiles. They imagined this might involve local media, local stakeholders and NHS services. Beyond these overall channel preferences, different segments focused on different channels, as detailed below. Traditionalists Focused overall on word of mouth and healthcare provider endorsement, including Prompting by pharmacist & pharmacy team Literature within pharmacies GPs/surgeries/hospitals Carers Family/friends Avoiders Focused overall on outreach/ communication via partners key partners varied by segment: Older men Pubs Tabloids Football clubs Wives/families Younger men Workplace Sports clubs/gyms Facebook/MySpace Wives/girlfriends Mens magazines Teenagers Schools (nurse/PSHE/ teachers) Soap storylines (esp. Hollyoaks) Facebook/MySpace/MSN messenger Their mothers More specific channels emerged as relevant for people with LTCs, as below. Traditionalists Literature within pharmacies Links with organisations/selfhelp groups for people with Enthusiasts GPs/surgeries Practice nurse Links with organisations/selfPage 12 of 13

Enthusiasts Focused on friendly, efficient, proactive advice/support and services for children/families communicated via Supermarkets Nurseries/schools GPs/surgeries Womens magazines

Indulgers Potential to trigger exploration of the pharmacy via the beauty counter Additionally Womens/health & beauty magazines Workplace Facebook/MySpace/Hotmail Soap storylines Gyms/sports clubs Family/friends

specific conditions Carers Community Matrons GPs/surgeries/hospitals Family/friends Avoiders Recommendation via GP/ hospital consultant A&E/GP Practice nurse/diabetes nurse/ asthma clinic/other specialist teams they are in touch with Family/friends

help groups for people with specific conditions Literature within pharmacies

Indulgers Practice nurse/diabetes nurse/ asthma clinic/other specialist teams they are in touch with Family/friends Literature within pharmacies

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