This study evaluated the perceptions of the general public towards the services offered by community pharmacies, their interactions with and comprehension of community pharmacists, opinions on dispensing separation, private community pharmacies, and understanding of P medicines.

Pharmacy usage and preference for services

The respondents indicated a preference for receiving medical treatment from public institutions, government organizations, or private clinics, reflecting a potentially stronger trust in physicians [19, 20]. A study examining consumer perceptions of community pharmacists revealed a predilection for physicians in the context of health problem consultations [19].

Most respondents favoring public institutions or private clinics attributed this preference to familiarity or convenience. The shorter wait times at private clinics were highlighted as a distinct advantage. Furthermore, respondents who preferred public institutions often cited financial considerations, as services in Brunei’s public institutions are typically free or charged at a lower rate compared to private clinics and pharmacies, with just a nominal $1 registration fee.

The majority of respondents reported visiting community pharmacies every few months primarily to collect prescribed medications or buy over-the-counter drugs, mirroring findings from studies conducted in other countries [18, 19, 21]. This underlines a globally common perception of the principal roles of community pharmacies.

Specialized services, such as asthma and hypertension management, along with osteoporosis screening, were demonstrated to improve patients’ conditions and clinical outcomes (e.g., reduced blood pressure and increased peak expiratory flow) [22]. Screening programs also proved effective in enhancing disease detection and improving referral rates [23].

In our study, respondents displayed a readiness to utilize extended services if offered by community pharmacies. Screening services and treatment of minor illnesses received significant interest, whereas smoking cessation was least favored. A study conducted in Palestine found similar willingness among respondents to use extended services provided by community pharmacies [19]. It revealed a high consumer demand for such services, especially for screening procedures (blood cholesterol, blood glucose, blood pressure monitoring) and measurements of weight, height, and temperature [19]. A study from England indicated that participants were highly receptive to services, particularly health checks and advice related to cardiac conditions. Minor illnesses, being of low risk, are often deemed suitable for pharmacist-led treatment, while GP visits are reserved for chronic conditions [20].

A study from England also noted that smoking cessation services and alcohol advice were less popular [24]. One plausible explanation for the low popularity of smoking cessation in our study is the possibility of the respondents being non-smokers, therefore, having no interest in the service. Intriguingly, several respondents expressed interest in receiving medication reminders and appreciated the provision of traditional medicines.

Understanding of and satisfaction with pharmacists

The majority of respondents were cognizant of a pharmacist’s traditional role, primarily dispensing medicines (87.4%). In addition, counseling patients about their medications (76.1%) and collaborating with doctors to monitor patient medication (56.8%) were also identified as common roles of pharmacists. These findings align with a study by Mukattash et al., wherein dispensing medicines (46.2%) and counseling patients (34.6%) were recognized as the most crucial tasks of a pharmacist [14].

The study results indicated that respondents were well-versed with medication use, potency, and all relevant information concerning the medication before it was dispensed. Similarly, El-Kholy et al. reported that 72.8% of respondents concurred that pharmacists provided clear instructions on medication use [18].

Counseling services aim to enhance patients' understanding of their medicines and promote adherence [25]. Despite a significant proportion of respondents recognizing medication counseling as a typical role of a pharmacist, most respondents had not received these services. Potential barriers to providing counseling services could include time constraints or excessive workload of the pharmacists [6]. Among respondents who had received counseling, most expressed satisfaction with the session, appreciating the pharmacist’s knowledge and communication skills.

Respondents preferred to consult doctors in public institutions or private clinics for minor illnesses, consistent with their preferred destination for general medical treatment. However, the number of respondents choosing private pharmacies increased, suggesting that some trust private pharmacies to treat minor illnesses [19]. Gidman et al. reported that participants were more likely to visit community pharmacists for conditions deemed ‘low risk’ [20]. Some respondents might also be managing their minor conditions independently, viewing a doctor's visit as unnecessary [26].

Respondents demonstrated high expectations of pharmacists. Nearly all expected pharmacists to provide relevant information (use, strength, dosage, instructions for use, potential side effects, and warnings) about the medication before dispensing. This suggests a high degree of trust in the pharmacists' knowledge of medication. Another study reported that pharmacists were expected to counsel about potential interactions with other medications, use of the medications, and disease-related counseling [27]. Pharmacists are expected to provide drug information when dispensing medications, enabling patients to better understand their medication, be aware of potential side effects, and improve adherence [24]. Respondents also expected pharmacists to inquire about medical and medication history before dispensing and provide education on the use of their medical devices.

In general, respondents expressed satisfaction with the pharmacist's knowledge, attitude, professionalism, and communication skills, mirroring findings from a study that analyzed online patient feedback about pharmacies, where staff attitudes were perceived positively [28]. The impression of and relationship with the pharmacist were also viewed favorably.

While the general sentiment remained positive, a slightly higher proportion of respondents expressed dissatisfaction with the pharmacy’s waiting time. Similar findings have been reported in other studies [24, 28], with waiting times to receive medications from community pharmacies perceived as excessively long, ranging from hours to days [28]. An acceptable waiting time, not exceeding 15 min, was reported by respondents in an English study [24]. In addition, extended waiting times have been associated with decreased satisfaction [18].

Views on the dispensing separation system

The dispensing separation (DS) practice, where doctors solely prescribe and pharmacists dispense, is utilized in other countries and the public sector in Brunei. This system aims to enhance patient safety and reduce medication errors by enabling pharmacists to double-check prescriptions and prevent overprescribing [29].

The majority of respondents were unfamiliar with the term dispensing separation or its implementation overseas. Results from Malaysian studies revealed that 65% of respondents from Malaysia were unaware of DS [29], while 67.5% knew about the DS system implemented in other countries [15].

Private community pharmacies

Nearly half of the respondents had never visited private community pharmacies, possibly because there are fewer such establishments in Brunei, and they are not as heavily utilized as government community pharmacies located in health centres.

Among respondents who had visited private community pharmacies, most reported positive experiences, indicating the presence of a pharmacist, the gathering of relevant medical history, and the provision of medication information during the dispensing process. These results align with a study by El-Kholy et al., in which a majority of respondents confirmed the presence of a pharmacist to assist them (74.6%) and acknowledged that the pharmacist asked about their medication (45.5%) and medical conditions (49.1%) when preparing the prescription [18].

Despite visiting community pharmacies, respondents were largely unaware of the services provided there. This suggests that pharmacy owners or pharmacists may not be effectively promoting their services to their customers.

Respondents also expressed satisfaction with the pharmacist’s knowledge and communication skills, and felt that their queries were well-addressed. Pharmacists are often viewed as medication experts, and the public generally prefers consulting them for medication inquiries over doctors [14, 29]. Mukattash et al. found that the majority of respondents prefer to acquire information about medication from pharmacists [14]. However, a study in Qatar revealed that only 37% of respondents felt community pharmacists were knowledgeable enough and answered their questions satisfactorily, which is a lower percentage than found in this study (48.6%) [30].

In addition, respondents expressed satisfaction with the attention and time dedicated to them, suggesting that pharmacists devote substantial time to each customer to ensure adequate care [14].

In summary, the results indicate a satisfactory level of contentment with the availability and practices of pharmacists. However, gaps persist in public knowledge and usage of pharmacy services. These gaps could potentially be addressed through educational initiatives and awareness campaigns aimed at improving public comprehension of these issues.

The association between demographic variables and respondents’ views implies that specific strategies might need to be tailored to different age and gender groups for effective communication and implementation of changes in Brunei’s pharmacy sector.

Understanding of P medicines

Pharmacy (P) medicines can be purchased without a prescription in the presence of a pharmacist [16]. They are usually kept behind the counter and not displayed to the public.

The study’s results revealed that respondents are largely unfamiliar with the classification of medicines, as many did not know what a P medicine is and were unsure if they had ever bought one before. Among those who had bought P medicines before, a higher proportion had purchased them from private community pharmacies.

When asked whether Brunei should classify more medicines as P medicines to increase their availability at community pharmacies, respondents neither agreed nor disagreed strongly. This could be due to respondents’ lack of knowledge about P medicines and the potential benefits and risks associated with reclassification. Consequently, if Brunei intends to expand the P medicine category, it is important to assess both public understanding and pharmacists’ competency before making changes. The public should have adequate understanding of their conditions, while pharmacists should possess enough knowledge of the conditions and medications to provide appropriate recommendations.

The study’s results indicate a significant lack of awareness about key aspects of pharmaceutical services among respondents in Brunei. This includes unfamiliarity with the concept and implementation of a dispensing separation system, services provided by community pharmacies, and the classification of P medicines.

Limitations

The primary limitation of this study was the time constraints. Due to these constraints and the low number of respondents, the target sample size was not met. In addition, the majority of respondents were female, potentially skewing results towards the perspectives of the female population over the male population. Moreover, the study employed online questionnaires, which may have limited the participation of older generations. The respondents were also largely from an undergraduate educational background, but the study did not probe further into their specific fields of study. This limited the study's ability to correlate educational field with respondents’ understanding and in-depth knowledge, posing another potential limitation.

Recommendations for future research

To address the limitations of this study, several recommendations can be made for future research. First, efforts should be made to recruit an equal proportion of male and female respondents to avoid a skewed gender ratio. Second, in-person surveys could be conducted to reach a wider and more diverse demographic, including older populations. Furthermore, future research could explore the perceptions of healthcare professionals and stakeholders regarding the feasibility of dispensing separation (DS) in Brunei through qualitative studies.