Table 2.

Facilitators and barriers to the provision of point-of-care C-reactive protein testing

Facilitators	Verbatim quotes
Accessibility	“It [the pharmacy] services its local community very, very well. It has been there a long time, so it has got a reputation in the area. And it tends to be a point of contact for information as well as products and services…the fact that we are so accessible and we don't need appointments … without having to sit in a room of other people that were really unwell like you do at a surgery.” (PO7-D) “They get good advice…being able to be so freely accessible, I think we've really got a huge role in the health industry, because we are front line. And people always come in for advice…And we have the capacity to be able to do that.” (PO8-D)
Enhance relationships with general practitioners	“Our next-door GP was really impressed that it was happening, and she thought it was a great service. I sent one person into her because…[they] had an elevated…level. But it wasn't highly elevated– a bit high– wanted to also show her how the system worked and how it can lead to referrals. And she said to the patient, "Yes…the pharmacist is right. It's not high, but there might be something on its way, so come back in a few days," and things like that. So it was good.” (PO7-D)
Improved professional image and strengthened existing or established new pharmacist-patient relationships	“They'll come in and ask us medical-related questions about things which I didn't expect them to be asking.” (PO2-A) “I think it helped build… trust in our services.” (PO4-B) “And so it's definitely been interesting to see the people that participated come back and people that had never presented to our pharmacy before, now becoming regulars because they appreciated the fact that you sat with them and had that conversation and gave them the support and tools that they needed to be able to get better.” (PO10-E) “I thought it was great to interact with our patients at that level and offer them a service that they really appreciated and that they valued…very positive. They [patients] appreciated it, and were really happy to get that sort of information … without having to make an appointment, without having to wait as well, and without having to sit in a room of other people that were really unwell like you do at a surgery. It also gave you that added interaction with your patient as well, which is really important to follow up.” (PO7-D)
Marketing and promotion to encourage service uptake	“…market it out, let all the doctors know in the surgery, not just across the road, but with all our local ones, as well. I feel that would have been a better uptake. But also if we had been able to market it out to the public openly, on all the social media platforms.” (PO9-E) “I think that there's a public need for ‘the service’, one, because it's not being offered anywhere else and two because … a lot of people were asking, "Why doesn't this get offered to me when I see my GP? Or …"I didn't realise there could be a test that was this fast and this accessible that I could do. The flyers and the things in the pharmacy helped a lot and a lot of people were like, "Oh, what is this test? Tell me about CRP." And just getting people, I guess, engaged in that conversation was pretty important.” (PO10-E)
Practice and experience promotes confidence	“…getting to learn how to use it…it's a bit tricky…it's just getting the right amount of blood and making sure the machine is working and stuff. But once you get the hang of it, it's very simple to do. So our times of actually doing the test started reducing, which is great because then the patients knew our time.” (PO2-A) “… after you do the first one or two people… I know how to do this service in a way that works for me. I understand how…it's integrated into the conversations I'm already having with people…felt more confident.” (PO10-E)
Supportive team	“Staff members were all engaged to see if anyone fits into the criteria that this study was looking for and alert us, or they actively offered ‘the service’ and let us know if the patient wanted it done. Once they started seeing how people can benefit from it and once they heard feedback from patients about how great they were to have this testing done, I think they become a bit more involved.” (PO3-B) “everything just flowed a lot better, especially as the other staff…got used to explaining ‘the service’ and recommending it as well to our customers. So they obviously had to be familiar with what was involved in it, how much time it took..” (PO4-B) “…it's not physically possible to catch everybody. But if your assistants or your dispensing technicians are aware of what to look out for, they can collect more people.” (PO10-E)

Barriers or challenges	Verbatim quotes
Challenging interactions with general practitioners	“GP's don't make an email address available, and if they did, it would be so much easier because you could just email them and say what the problem is.” (PO1-A) “…doctors' unwillingness to engage.” (PO3-B) “…quite a few only work one, two days a week. So it’s hard to contact them … Sometimes they're not there to have that discussion.” (PO5-C) “He's told me he's the doctor; I'm the pharmacist before. He's just from the old school.” (PO6-C) “… barrier would be receptionists… think there's also that part whereby GPs don't see the importance of communicating with pharmacists.” (PO9-E) “…what's tricky is when you're communicating to the practice manager and sometimes no information gets across to the GPs. But if you speak to the GP directly, that information then gets across. And I think that's where the relationship starts.” (PO10-E)
Competing demands	“…we were just flat out with flu bookings…we were sort of run off our feet.” (PO5-C) “At the beginning, it was sort of the end of the flu season. So we were backlogged with work with just trying to catch up on everything.” (PO6-C) “…too much is happening within the pharmacy …we had QCPP (Quality Care Parmacy Program) as [CRP testing] was starting.” (PO8-D)
Difficulty in follow ups	“A couple of people …were on the mines. So on the day we had to follow up, we couldn't get in touch with them, and then I had to follow up a couple of days later.” (PO2-A) “Some of them did not reply.” (PO3-8) “They wouldn't return calls so we weren't always getting that final section completed on the form…an email or a text service might work better.” (PO4-B) “The follow-up was fine. We had a bit of trouble reaching some of them, but that's just norm.” (PO5-C) “Getting in contact with them again in a couple days time was the trickiest…I just think that people don't answer phone numbers they don't recognise…a few people were going overseas. They requested to email them as opposed to calling them." (PO6-C) “Perhaps maybe a text message…more would be more inclined to answer a text message at their own convenience, rather than try to answer a phone call halfway through work…Email, probably not. Probably a text message would be better.” (PO9-E) “We just put in prompts in there to remind us to contact people back." (PO10-E)
Early stage of disease may not be reflected in CRP reading	“We were testing too early in the course of the disease. So if we had been able to say to the person, "Come back again in two days, and we'll test you again," I think that might've been a bit easier.” (PO1-A)
Heavy documentation	“When people hear, that they have to do some form of paperwork and when they're sick…straightaway turned off..” (PO5-C) “I did find that there was still a lot of paperwork and that it took quite a bit of time as far as the waiting time for the machinery. And I had a few people say to me, "Oh, look, I've gotta go. I've gotta go," and even though it's a short period of time and I've got them to do the paperwork at the time… although it was an opportunity to talk about their conditions and things…logging in and the recording of the name was a bit laborious.” (PO7-D)
Inadequate remuneration to justify multiple pharmacists at one time	“I'm the owner, and I don't necessarily draw a wage all of the time, but I couldn't afford to have two pharmacists on for the rest of the time. If they [assistants] could actually do the actual blood test, and then us interpret the results that would've been a bit easier, especially for an intern.” (PO1-A) “…it takes up quite a bit of staff time. Staffing can be an issue,…we can't predict when it's going to get busy.” (PO3-B) “…it's always so unpredictable the flow of traffic that you get in the pharmacy…taking around 15 min. It could take longer as well.” (PO4-B) “On top of the cost of covering the equipment and consumables, I think only a small fee…to cover the time and sort of services. Who should pay? Sometimes they will pay. I guess personally, the government should pay in terms of to try and decrease that burden in the healthcare system. That would be foremost.” (PO5-C)
Perspectives of patients – bulk billing from general practitioners	“There's these little bulk billing GPs popping up everywhere. Why would you go to a pharmacy and pay something if you could just go to the doctor for nothing.” (PO6-C) “Rather than you assess me and I have to pay 15 dollars, I can just go across the road, book an appointment, and the doctors will assess me, and it's the same outcome. And that will be covered by Medicare, although it's not exactly the same outcome, because you don't have a lab test sort of result to accompany you, but to them, a doctor's assessment is judged as gold.” (PO9-E)