Resilience in Urban Pharmacies: A Mixed-Methods Model for Performance and Patient Satisfaction During Crises

Abstract

Background: Urban pharmacies are essential for sustaining access to medicines and healthcare services during crises, particularly during the COVID-19 pandemic. The role of pharmacies and the services provided by pharmacists during crises have been relatively underexplored. Objectives: This study aims to propose a model for reforming pharmaceutical policy to ensure the continuity of pharmacist-led services during crises. Methods: In this cross-sectional study, a mixed-methods approach was employed. In the qualitative phase, semi-structured interviews were conducted with 15 experienced pharmacy experts, and thematic analysis was carried out. In the quantitative phase, structured questionnaires measuring resilience, performance, and satisfaction were distributed to 330 randomly selected pharmacies in Tehran, analyzed using SPSS version 25. Results: In the qualitative phase, the research identified three main themes, including resilience, performance, and patient satisfaction, along with nine subthemes. In the quantitative phase, significant positive correlations were found between pharmacy resilience and performance (R = 0.642), resilience and patient satisfaction (R = 0.496), and a moderate correlation between patient satisfaction and performance (R = 0.334). Partial correlation analysis confirmed the robustness of this model while accounting for potential confounders. Based on the results, a significant difference was observed between manager’s gender and pharmacy resilience, performance, and satisfaction of patient. Patient satisfaction was significantly higher in pharmacies managed by male directors compared to those managed by female directors (P < 0.05). A statistically significant association was found between drug availability and pharmacy performance (P < 0.05). Conclusions: Pharmacy resilience emerged as a crucial determinant of operational stability and patient-centered outcomes during health emergencies. The proposed model provides a practical framework for strengthening pharmacy readiness, response, recovery, and adaptive growth, with potential applicability to broaden health system resilience efforts. Policymakers and pharmacy managers are encouraged to integrate resilience-building strategies to ensure sustainable performance and patient satisfaction during future crises.