PONE-D-24-58779Understanding the perspectives of people with dementia and family carers about clinical pharmacists in primary care: a qualitative studyPLOS ONE

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“Alice Burnand is supported by the National Institute for Health and Care Research (NIHR) School for Primary Care Research (project reference 575).

Abigail Woodward is supported by the National Institute for Health and Care Research (NIHR) School for Primary Care Research Capacity Award (grant reference C093).

Kumud Kantilal is supported by the National Institute for Health and Care Research ARC North Thames. The views expressed are those of the author(s) and not necessarily those of the National Institute for Health and Care Research or the Department of Health and Social Care.

Cini Bhanu is supported by the National Institute for Health and Care Research (NIHR) School for Primary Care Research.

Yogini Jani is supported by the UCLH NHS Foundation Trust and secondment to UCL.

Jill Manthorpe is supported by Kings College London and the National Institute for Health and Care Research (NIHR).

Mine Orlu is supported by the National Institute for Health and Care Research (NIHR) School for Primary Care Research.

Greta Rait is supported by grant and infrastructure from the National Institute for Health and Care Research (NIHR).

Madiha Sajid is supported by the National Institute for Health and Care Research (NIHR) School for Primary Care Research (project reference 575).

Kritika Samsi is supported by the National Institute for Health and Care Research (NIHR).

Victoria Vickerstaff is supported by the National Institute for Health and Care Research (NIHR) School for Primary Care Research (project reference 575).

Jane Ward is supported by the National Institute for Health and Care Research (NIHR) School for Primary Care Research (project reference 575).

Jane Wilcock is supported by the National Institute for Health and Care Research (NIHR) School for Primary Care Research (project reference 575).

Nathan Davies is supported by the National Institute for Health and Care Research (NIHR) School for Primary Care Research (project reference 575).”

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 “Alice Burnand is supported by the National Institute for Health and Care Research (NIHR) School for Primary Care Research (project reference 575).

Abigail Woodward is supported by the National Institute for Health and Care Research (NIHR) School for Primary Care Research Capacity Award (grant reference C093).

Kumud Kantilal is supported by the National Institute for Health and Care Research ARC North Thames. The views expressed are those of the author(s) and not necessarily those of the National Institute for Health and Care Research or the Department of Health and Social Care.

Cini Bhanu is supported by the National Institute for Health and Care Research (NIHR) School for Primary Care Research.

Yogini Jani is supported by the UCLH NHS Foundation Trust and secondment to UCL.

Jill Manthorpe is supported by Kings College London and the National Institute for Health and Care Research (NIHR).

Mine Orlu is supported by the National Institute for Health and Care Research (NIHR) School for Primary Care Research.

Greta Rait is supported by grant and infrastructure from the National Institute for Health and Care Research (NIHR).

Madiha Sajid is supported by the National Institute for Health and Care Research (NIHR) School for Primary Care Research (project reference 575).

Kritika Samsi is supported by the National Institute for Health and Care Research (NIHR).

Victoria Vickerstaff is supported by the National Institute for Health and Care Research (NIHR) School for Primary Care Research (project reference 575).

Jane Ward is supported by the National Institute for Health and Care Research (NIHR) School for Primary Care Research (project reference 575).

Jane Wilcock is supported by the National Institute for Health and Care Research (NIHR) School for Primary Care Research (project reference 575).

Nathan Davies is supported by the National Institute for Health and Care Research (NIHR) School for Primary Care Research (project reference 575)”

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Reviewers' comments:

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Comments to the Author

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Reviewer #1: Yes

Reviewer #2: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

Reviewer #2: N/A

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Thank you very much for the opportunity to read this interesting paper about pharmacists‘ services for patients with dementia.

In most (if not all) countries health services are some sort of restricted by financial constraints. This becomes particularly obvious for patients who are vulnerable and do have special needs. Moreover, patients living with dementia require caregiver, who are frequently overcharged.

However, to understand the role of clinical pharmacists and what they can contribute it is also mandatory, to understand the healthcare system. In this case it would be helpful fort he reader to know, how the NHS is financed and as I understand, the GP (who does not have enough time, why?) is included in the NHS services. And the pharmacists seem to have more time – but how is their time paid for? CG 14 on page 17 seems to understand, that the pharmacist is not part of the NHS?

In addition, what is the difference between a pharmacist and a clinical pharmacist in the UK? For example, in Germany the one who has a private pharmacy (where patients get their medications and advice) can specialise to become a clinical pharmacist, who is allowed after this special training to make medication reviews which are financed by the statutory health fund. This service is paid for with approx. 90,- € per medication review.

All together, the themes evolved and discussed show the lack of general service, e.g. patient-centered care, support between sectors (hospital care – day clinics – living at home) and less a problem of medications.

It would be helpful to go more into the details of a) what could pharmacists offer and b) what else is expected from the NHS.

There are some unclear aspects: are clinical pharmacists allowed to prescribe/deprescribe like some nurse practitioners?

The presenstation of the interviews is nicely embedded in the results section, however, the authors may think about a more systematic presentation by themes and sub-themes, requirements and potential solutions. As it is done in the paper by Sawan et al on a very similar topic, namely qualitative interviews with CGs about pharmacy services for patients with dementia after hospital discharge. This paper is very similar and should be considered for discussion.

Sawan MJ, Jeon YH, Bond C, Hilmer SN, Chen TF, Wennekers D, Gnjidic D. Caregivers' experiences of medication management advice for people living with dementia at discharge. J Eval Clin Pract. 2021 Dec;27(6):1252-1261. doi: 10.1111/jep.13551.

Reviewer #2: Peer Review

Summary:

This qualitative study explores the perspectives of individuals with dementia and their carers regarding the role and involvement of clinical pharmacists in primary care teams. Data were collected via semi-structured interviews and analyzed using reflexive thematic analysis. The paper presents three themes related to pharmacists' roles, their influence on care, and the absence of their involvement.

General Assessment:

The paper addresses a timely and relevant topic and is generally well written. However, several aspects require clarification and refinement to enhance its scientific rigor and transparency. It is unclear whether COREQ or SRQR guidelines were followed. The reference formatting, punctuation, and citation order require correction. The contribution of the large author group should be briefly explained.

Introduction

• The role of clinical pharmacists within the care team should be more clearly described. Do they work alongside general practitioners (GPs) or independently? How are they integrated into the team? How do patients access them?

• Additional contextualization is needed: What is already known about patients’ and carers’ perspectives on clinical pharmacists across various conditions? Why is it particularly important to explore the perspectives of people with dementia and their carers? Do the responsibilities of clinical pharmacists differ when working with this population? Given the limited pharmacological options for dementia treatment, what role do pharmacists play

Research Design

• Recruitment: The recruitment strategy and inclusion criteria need further elaboration, particularly regarding geographical diversity and participant selection. Also, clarify which social media platforms were used for advertising. Since a purposive sampling strategy was applied, how were participants actively selected?

• Inclusion Criteria: Was previous contact with a clinical pharmacist an inclusion criterion for both patients and carers? The range from mild to severe dementia entails significant differences in medical, nursing, and pharmaceutical care, which warrants further justification for the broad inclusion.

• More detail is needed on the development of the interview schedule and the involvement of PPIE. Including the interview guides as a table or supplement is recommended.

• The duration of the interviews and the composition of participant groups should be reported in the results section.

Results

• The themes in the results section lack clear structure and explanation. A table or figure summarizing themes and subthemes would aid comprehension. Themes should be introduced before detailing subthemes.

• There is some inconsistency in the focus—at times it is on the clinical pharmacist, and at other times on the broader care team. This should be addressed in the introduction to the themes or clarified throughout.

• The title of the first theme—“understanding”—is ambiguous. Does it refer to the researchers’ understanding of participants’ perspectives or participants’ perceived usefulness of clinical pharmacists? Would “perceived usefulness” alone suffice? Clarifying the focus and expanding the theme to include the broader context of clinical pharmacists’ roles within care teams would strengthen the discussion. If this broader perspective is not addressed, it should be noted, with examples to illustrate the focus.

• In the second subtheme, the third quote (“I think interactions between…”) appears to align more closely with the first subtheme. Please clarify its placement or consider moving it.

• The second theme begins with references to the clinical pharmacist but quickly shifts to more general language issues. This transition should be clarified or refocused.

• The third theme raises broader concerns. Some quotes appear to come from participants without pharmacist contact, which contradicts the stated inclusion criteria. Clarification is needed regarding timing and context of these experiences.

Discussion

• Some information presented in the discussion for the first time (PIPs) should be moved to the results section and later be discussed here.

• The potential role of pharmacists as intermediaries in dementia care teams is compelling but needs more emphasis in the results.

• From my view, interviews suggest that care teams without clinical pharmacists do not fully meet participants' needs, and that interprofessional collaboration remains a challenge even with their involvement. Why is an effective care team particularly important for individuals with dementia? The potential for pharmacists to serve as intermediaries warrants further exploration.

• While the issue of access is mentioned in the discussion, it is not addressed in the introduction and appears only briefly in the results. Greater emphasis on access throughout the paper would be beneficial.

• The limited diversity of the sample should be discussed as a potential limitation.

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Reviewer #1: No

Reviewer #2: No

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PONE-D-24-58779R1Understanding the perspectives of people with dementia and family carers about clinical pharmacists in primary care: a qualitative studyPLOS ONE

Dear Dr. Burnand,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Aug 28 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

We look forward to receiving your revised manuscript.

Kind regards,

Sascha Köpke

Academic Editor

PLOS ONE

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If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. 

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: (No Response)

Reviewer #2: Partly

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: (No Response)

Reviewer #2: N/A

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: (No Response)

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: (No Response)

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: (No Response)

Reviewer #2: Dear Authors,

Thank you very much for your revision.

The manuscript has improved substantially, especially the well-written introduction now provides a solid overview of the topic.

I have just a few remaining comments:

Methods

1. Page 9, line 232: Is "clinician" the correct term here? The revision is unclear—please consider clarifying or rephrasing.

2. How was the interview guide developed? Was it based on literature, and did you use an inductive or deductive approach? Was a pilot interview conducted? I could not locate the interview schedule in the version I received—possibly a formatting issue?

3. Please indicate how many participants were interviewed via phone, video, or in person. Remote interviews with people living with dementia can be challenging. If in-person interviews were not feasible, please explain and discuss this as a possible limitation, ideally supported by relevant literature.

Results

1. Some participants (how many?) had no prior contact with clinical pharmacists. This could be also mentioned later as a limitation, although it may have helped address recruitment challenges.

2. I think about reordering the themes: starting with the current Themes 1 and 3 would better reflect your research questions. Theme 2, based on a broader perspective, might fit better at the end.

3. Is it standard in your analysis approach to include brief descriptions of sub-themes in the main theme titles? From my experience, this is not always necessary if sub-themes are described in the text.

Discussion

1. I suggest focusing strongly on Themes 1 and 3 in the discussion. Theme 2 appears more speculative and might be best addressed at the end.

Thank you very much for your work.

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Reviewer #1: Yes:  Petra A. Thürmann

Reviewer #2: No

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Understanding the perspectives of people with dementia and family carers about clinical pharmacists in primary care: a qualitative study

PONE-D-24-58779R2

Dear Dr. Burnand,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Sascha Köpke

Academic Editor

PLOS ONE