[2026-06-23] Feasibility Assessment of Postal Refill Prescription Services Through Community Pharmacy Networks Under Thailand's National Health Security Office Project

Abstract

Background: Managing chronic noncommunicable disease patients often leads to hospital overcrowding. Transitioning from direct postal refills to a community pharmacy network allows the National Health Security Office (NHSO) to provide more than just delivery; it decentralizes pharmaceutical care. The system through community pharmacists improves medication monitoring and patient counseling while significantly reducing the hospital’s administrative burden and workload.

Objective: To assess the operational feasibility of transitioning the hospital’s postal refill prescription service to a community pharmacy network under the NHSO project, through workflow analysis, Failure Mode and Effects Analysis (FMEA) risk assessment, and a 6-dimension evaluation (demand, technical, financial, economic, environmental, and legal).

Methods: This mixed-methods study utilized semistructured interviews, onsite observations, and time-motion sampling of 49 prescriptions across 5 dispensing steps to map operational waste. Risk was evaluated using FMEA to identify potential failure modes and calculate Risk Priority Numbers. Feasibility was assessed through focus group discussions with 5 key hospital staff members, across 6 dimensions.

Results: Workflow analysis identified medication preparation as the most time-consuming task (mean 5 minutes 41 seconds). Redundant verification steps, driven by hospital standards, were identified as non-value-adding. FMEA ranked copayment and postal fee processing as the top 3 failure points due to low digital literacy among elderly patients. The feasibility assessment confirmed readiness across 5 dimensions: demand is sufficient, technical resources are adequate, and financial/environmental benefits include increased reimbursement and reduced congestion. Legal alignment with Ministry of Public Health policy is clear; however, economic impact remains inconclusive due to data limitations.

Conclusions: Integrating quantitative FMEA metrics with qualitative stakeholder feedback, the study finds that moving from the legacy postal system to an NHSO community pharmacy network is highly viable in 5 of 6 domains assessed (demand, technical, financial, environmental, and legal). The economic dimension remains indeterminate because of insufficient historical data.