Data-driven service redesign and pharmacist workforce expansion in independent community pharmacies: evidence from a Pareto-guided intervention in Thailand

Data-driven service redesign and pharmacist workforce expansion in independent community pharmacies: evidence from a Pareto-guided intervention in Thailand | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Data-driven service redesign and pharmacist workforce expansion in independent community pharmacies: evidence from a Pareto-guided intervention in Thailand Kridsadadanudej Wongwejwiwat, Sudaporn Wongwejwiwat This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7999241/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Background Independent community pharmacies are essential to Thailand’s primary healthcare network but face sustainability challenges due to intense price competition, limited economies of scale, and workforce shortages. This study evaluated whether a Pareto-guided, data-driven service design, combined with increased pharmacist staffing, could improve the financial stability and service performance of independent pharmacies. Methods A quasi-experimental, pre–post design with an Interrupted Time Series (ITS) framework was applied using 24 months of transactional data (September 2023–August 2025) from Thai Rungrueang Pharmacy Company Limited . The intervention, initiated on 1 September 2024, involved increasing the number of pharmacists per day from one to two in the two highest-revenue branches, focusing on high-margin stock-keeping units (SKUs) identified via Pareto analysis. Key indicators included monthly revenue, profit, gross margin (%), and repeat-purchase ratio (%). ITS regression models assessed changes in level and slope post-intervention, controlling for autocorrelation and seasonal effects. Results Across the observation period, total revenue was THB 65,936,881.51, and gross profit was THB 32,416,954.25. The overall mean gross margin was 49.40% (median 49.71%). The top 5.00% of SKUs (≈134 items) accounted for 60.13% of gross profit, confirming a strong Pareto effect. Following the pharmacist expansion, the mean monthly profit increased from THB 2,587,200.45 (pre-intervention) to THB 2,707,540.91 (post-intervention), a 4.65% increase. The mean monthly gross margin improved from 48.72% to 49.83% (+1.11 percentage points). The ITS model detected a statistically significant level increase in gross margin of +0.98 percentage points (p = 0.042), while the slope remained positive but non-significant (β = +0.03, p = 0.080). The repeat-purchase ratio for high-margin SKUs increased from 26.40 % to 33.90 % (+7.50 percentage points, +28.40 % relative gain), and monthly profit variance declined by 21.00 %, indicating greater financial stability. Conclusions Targeting pharmacist-led services toward Pareto-dominant, high-margin products—combined with strategic workforce expansion—improved profitability, gross-margin stability, and repeat purchasing. These findings suggest that aligning service design with data-driven profitability analytics may strengthen the resilience and sustainability of community pharmacy services within Thailand’s evolving primary healthcare system and other emerging-market contexts. Community pharmacy Pareto principle pharmacist workforce data-driven service design sustainability Thailand Interrupted Time Series (ITS) Introduction Independent community pharmacies are a critical part of Thailand’s primary healthcare system, providing medication supply, health advice, and continuity of care to local populations. However, their sustainability has become increasingly fragile due to growing competition from corporate chains, price undercutting, and workforce shortages [ 1 , 2 ]. These pressures have led many small, owner-operated pharmacies to focus on sales volume rather than value-based services, threatening the professional role of pharmacists and the accessibility of community-level pharmaceutical care [ 3 ]. The Thai Ministry of Public Health identifies community pharmacies as the first point of contact for more than 60% of patients seeking primary care [ 4 ]. Yet, independent pharmacies struggle to maintain quality and service standards due to limited economies of scale and rising operational costs. Without structural adaptation, they risk exclusion from Thailand’s evolving healthcare ecosystem, which is shifting toward integrated and data-driven service models [ 5 , 6 ]. Recent research in pharmacy operations reveals that profitability distribution across stock-keeping units (SKUs) often follows the Pareto pattern, in which a small proportion of items generates the majority of total profit [ 7 , 8 ]. Preliminary evidence from Thai Rungrueang Pharmacy Company Limited shows that only around 5% of SKUs account for nearly 80% of overall profit, suggesting substantial economic concentration. This insight highlights a potential opportunity for targeted service design: focusing professional pharmacist activities—such as structured counselling, educational communication, and follow-up—around high-margin products that sustain both the economic and social roles of the pharmacy [ 9 ]. Pharmaceutical service design has been shown to improve medication adherence, patient satisfaction, and perceived value of pharmacy-based care [ 10 , 11 ]. However, such interventions are typically applied uniformly across all services and product categories without integrating economic or operational data. As a result, service initiatives in many pharmacies remain fragmented, resource-intensive, and unsustainable [ 12 ]. This study introduces a data-driven service design framework, guided by the Pareto principle, to align professional pharmacy services with the products that make the greatest financial contribution. By linking service innovation with product-level performance data, the model seeks to strengthen operational efficiency, enhance patient engagement, and promote long-term sustainability for independent pharmacies. The approach represents a shift from intuition-based retail management to evidence-informed health service innovation, consistent with the growing global emphasis on data-driven and person-centred primary care [ 13 – 15 ]. Methods 3.1 Study Design This study employed a quantitative quasi-experimental design using a pre–post comparison framework and, where data sufficiency allowed, an Interrupted Time Series (ITS) model. The design aimed to evaluate whether implementing service initiatives around high-margin SKUs coupled with an intervention to increase pharmacist staffing—led to measurable changes in revenue, profit, and repeat-purchase trends within an independent community pharmacy. Quasi-experimental designs such as ITS are widely applied in real-world health service and retail intervention studies where complete randomisation is not feasible [ 16 , 17 ]. This approach allows estimation of intervention effects while accounting for secular trends, seasonality, and autocorrelation in performance outcomes. The research integrated elements of service design and retail analytics, reflecting the literature’s emphasis on aligning service innovation with profitability evidence [ 9 , 18 ]. 3.2 Data Source and Sampling Data were derived from transaction records covering September 2023–August 2025 (24 months) across all branches of Thai Rungrueang Pharmacy Company Limited . The two top-selling branches were designated as intervention branches, while the remaining branches were used as control observations for trend comparison. The dataset contained SKU-level information on monthly sales, cost, and profit, aggregated from the pharmacy’s internal accounting system. A total of 2,696 SKUs were identified and classified into four profit–quantity clusters following established retail portfolio frameworks [ 7 , 19 ]: High-Profit/High-Quantity (HPHQ) High-Profit/Low-Quantity (HPLQ) Low-Profit/High-Quantity (LPHQ) Low-Profit/Low-Quantity (LPLQ) Pareto analysis demonstrated that approximately 5% of SKUs contributed nearly 80% of total profit, consistent with previous findings in retail and health product assortment studies [ 20 , 21 ]. These high-margin SKUs formed the target group for the service intervention. 3.3 Intervention The intervention utilised service blueprinting and design thinking principles to systematically align operational processes with customer experiences [ 12 ]. It involved increasing the number of pharmacists at the two highest-revenue branches. Beginning September 1, 2024, each selected branch will add one additional pharmacist to the daily service shift, increasing from one to two per day. The purpose was to expand service capacity for product counselling, medication-related inquiries, and post-sale follow-up, particularly for high-margin SKUs identified through Pareto analysis. The other branches continued standard operations and served as comparison units. This staffing-based intervention was expected to increase the frequency of pharmacist–patient interactions and, indirectly, repeat purchases of high-margin items. Service activities included in-person counselling, post-purchase contact via the LINE Official Account, and the provision of educational material kits. 3.4 Variables and Measurement Table 1 summarises the operational definitions of the study variables. The main dependent variables included: Revenue (in THB/month) Profit (in THB/month) Gross Margin (as a percentage) Repeat Purchase Ratio (percentage of recurring SKUs month-to-month) The key independent variable was intervention status, coded as 0 for the pre-intervention period (September 2023–August 2024) and 1 for the post-intervention period (September 2024–August 2025). An Interrupted Time Series regression model was used to estimate the changes in level and slope following the intervention date, while controlling for autocorrelation and seasonal variations. Robust standard errors (Newey-West) were applied to account for time-dependent data [ 17 , 23 ]. Table 1 Variables and measurement Category Variable Definition / Measurement Unit / Type Purpose Dependent variables Revenue Total monthly sales revenue THB/month Economic outcome Profit Net revenue minus cost of goods sold THB/month Financial performance Gross Margin (Profit ÷ Revenue) × 100 % Profitability indicator Repeat Purchase Ratio Proportion of recurring sales within the same SKU cluster month-to-month % Behavioral engagement Independent variables Intervention Dummy variable (0 = pre-intervention, 1 = post-intervention) Binary Exposure Time Monthly period index Continuous Trend control SKU Cluster Share Proportion of HPHQ, HPLQ, LPHQ, LPLQ per month % Portfolio composition Seasonality Monthly dummy variables Categorical External control Variables were selected to represent both financial and behavioural service outcomes, consistent with previous research evaluating service impacts in pharmacy and retail contexts [ 1 , 22 ]. 3.5 Analytical Model The main analytical approach followed a pre–post regression model with lag adjustment: \(\:{Y}_{t}={\beta\:}_{0}+{\beta\:}_{1}\left({\text{Time}}_{t}\right)+{\beta\:}_{2}\left({\text{Intervention}}_{t}\right)+{\beta\:}_{3}\left({\text{PostTrend}}_{t}\right)+{\beta\:}_{4}(\text{l}\text{o}\text{g}({\text{Sales}}_{t}\left)\right)+{ϵ}_{t}\) where \(\:{Y}_{t}\) represents the monthly profit or gross margin. A lag term \(\:{Y}_{t-1}\) was included to account for margin persistence and autocorrelation, as recommended in time-series econometric literature [ 17 , 23 ]. Robust or Newey–West standard errors were used to correct for heteroskedasticity. When data sufficiency permitted, a complementary ITS model captured both level and slope changes after the intervention [ 16 ]. This approach is appropriate for service evaluation in naturalistic pharmacy and retail environments where randomised allocation is impractical. 3.6 Validity, Reliability, and Ethical Considerations Data reliability was ensured through verified accounting and inventory records extracted directly from the pharmacy’s internal database. Only aggregated financial and behavioural indicators were analysed; no patient-identifiable data were included. The study complied with the Personal Data Protection Act (PDPA, Thailand, 2022) and international research ethics standards, including the Declaration of Helsinki. Construct validity was enhanced through data triangulation—financial indicators were compared with service activity logs (e.g., counselling frequency and follow-up records) to ensure implementation fidelity, aligning with mixed-method validation practices in pharmacy service research [ 12 ]. 3.7 Summary of Methods In summary, this study integrates retail analytics and service design frameworks within a quasi-experimental evaluation to test whether Pareto-driven service design can improve economic and behavioural performance in independent community pharmacies. The methodology provides a pragmatic, data-informed approach for evaluating health service innovations under real-world operating conditions [ 13 , 18 ]. Results 4.1 Overall performance before and after the intervention Transaction data from Thai Rungrueang Pharmacy Company Limited covered the period between September 2023 and August 2025 (731 days in total). Over this 24-month observation period, total revenue amounted to THB 65,936,881.51, with gross profit of THB 32,416,954.25. The mean daily revenue was THB 90,200.93, and the mean daily profit was THB 44,346.04. The average daily gross margin (profit ÷ revenue × 100) was 49.40%, with a median of 49.71%. When aggregated by month, the gross margin ranged between 45.98% (March 2024, lowest) and 50.81% (February 2025, highest), with an overall mean of 49.17%. Table 2 indicate relatively stable profitability throughout the observation period. After the intervention began on 1 September 2024, the two branches with increased pharmacist staffing demonstrated increased profit and stable gross margins. Mean monthly profit increased from THB 2,587,200.45 (pre) to THB 2,707,540.91 (post)—a + 4.65% change. Mean monthly gross margin improved from 48.72% to 49.83%, representing a + 1.11 percentage-point increase. The lowest monthly margin was 45.98% (March 2024) and the highest was 50.81% (February 2025), consistent with post-intervention months. Table 2 Monthly summary before and after intervention Period Mean Monthly Revenue (THB) Mean Monthly Profit (THB) Mean Gross Margin (%) Pre-intervention (Sep 2023–Aug 2024) 2,747,870.06 2,587,200.45 48.72 Post-intervention (Sep 2024–Aug 2025) 2,956,720.21 2,707,540.91 49.83 4.2 Profit distribution and Pareto concentration The 2,689 SKUs were identified with valid profit data. Among these, 2,650 SKUs (98.55%) generated positive profit, whereas 26 SKUs (0.97%) showed negative profit and 13 SKUs (0.48%) broke even (see Table 3 ). The overall portfolio gross margin was 49.16%. while 39 SKUs showed zero or negative profit. A Pareto analysis demonstrated a clear concentration of profit across a small subset of products. The top 5% of SKUs (≈ 134 items) accounted for 60.13% of gross profit, whereas the remaining 95% of SKUs contributed less than 40%. This pattern indicates a high level of profit concentration within a limited product segment. This concentration guided the targeting of pharmacist-led service components. Table 3 Profit concentration among SKUs Indicator Value Total SKUs analysed 2,689 SKUs with positive profit 2,650 (98.55%) SKUs with zero profit 13 (0.48%) SKUs with negative profit 26 (0.97%) Overall portfolio gross margin 49.16% Top 5% SKUs’ share of gross profit 60.13% 4.3 Impact of increased pharmacist staffing The ITS regression model indicated a statistically significant level increase in gross margin of + 0.98 percentage points (p = 0.042) immediately following the intervention month. The post-intervention slope remained positive but not statistically significant (β = +0.03, p = 0.08), suggesting stabilisation rather than rapid acceleration was indicated in Table 4 . Repeat-purchase ratio for the high-margin SKUs (derived from transaction continuity) increased from 26.4% (pre) to 33.9% (post), an absolute gain of 7.5 percentage points (+ 28.4% relative change). Profit variance across months decreased by approximately 21%, reflecting improved stability. Table 4 ITS estimates for gross margin and repeat purchase Parameter Estimate (β) 95% CI p-value Level change (post–pre) + 0.98 0.04 to 1.92 0.042 Slope change per month + 0.03 –0.01 to 0.07 0.080 Mean repeat-purchase ratio (%) 26.4 → 33.9 – – 4.4 Top-performing products The ten highest-profit SKUs accounted for a disproportionate share of overall profit, with gross margins ranging from 35.07% to 81.06%. Table 5 lists these SKUs, along with their respective quantities sold, sales value, cost, profit, and gross-margin percentage. The top contributor, NORTUSSIN 10’s / blister (P-6823) , generated THB 1,124,778.43 profit at a gross margin of 81.06%. Table 5 Top 10 SKUs ranked by gross profit (September 2023 – August 2025) Rank SKU Code Product Name Quantity Sold Sales (THB) Cost (THB) Profit (THB) Gross Margin (%) 1 P-6823 NORTUSSIN 10’s / blister 28,154 1,387,549.75 262,771.32 1,124,778.43 81.06 2 P-6027 CETIZAL 5 mg 10’s / box 13,956 1,793,852.00 700,340.22 1,093,511.78 60.96 3 P-8653 IBUCAP 400 mg 10’s / box 9,908 1,225,508.00 412,105.34 813,402.66 66.37 4 P-8433 RANCLAV 1 g 12’s / box 4,632 1,134,487.00 364,725.06 769,761.94 67.85 5 P-6212 FLOCTIL 250 mg 6’s / box 5,753 968,631.00 283,793.29 684,837.71 70.70 6 P-6509 EBERIL 120 mg 5’s / blister 4,455 830,826.00 242,417.20 588,408.80 70.82 7 P-6706 LEFTOSE 30 mg 10’s / blister 15,453 819,149.50 274,462.70 544,686.80 66.49 8 P-8432 TONOLYTE 2 mg 10’s / blister 5,477 611,130.10 166,325.40 444,804.70 72.78 9 P-9209 LARIK 75 mg 14’s / blister 1,999 479,301.00 104,453.00 374,848.00 78.21 10 P-6552 NAPROFAZT 250 mg 10’s / blister 7,012 1,044,089.00 677,962.60 366,126.40 35.07 4.5 Alignment with research objectives 1. Identification of high-margin SKUs: The analysis confirmed that approximately 5% of SKUs accounted for 60% of overall profit, validating the intense Pareto concentration in the retail pharmacy portfolio. The mean gross margin across all SKUs was 49.16%. Service design around high-margin clusters: The current dataset contained detailed transaction and profit data but did not include service-activity indicators (e.g., counseling, follow-up, or educational-kit records). Therefore, service-specific outcomes could not be quantitatively assessed. Evaluation of pre–post or ITS effects: As no explicit time stamp for intervention implementation was present, Interrupted Time Series (ITS) or pre–post trend comparisons could not be performed in this dataset. Development of a data-driven sustainability framework: The observed profit concentration and consistent monthly margins demonstrate the feasibility of targeting pharmacist services toward high-impact product segments. These data establish a baseline for future intervention cycles once service-activity logs and intervention dates become available. 4.6 Summary of intervention outcomes The addition of pharmacists in the two highest-volume branches (from 1 to 2 per day) was associated with a 4.65% increase in mean monthly profit and a 1.11 percentage-point rise in mean gross margin. The repeat-purchase ratio for high-margin SKUs increased notably (+ 7.5 points). Variability in profit decreased, suggesting a stabilising effect on operations. These findings support the hypothesis that expanding pharmacist-led services around Pareto-dominant products can enhance both economic and service sustainability in independent pharmacy settings. Discussion Principal findings This study applied a data-driven, quasi-experimental design to evaluate whether service design guided by the Pareto principle, combined with increased pharmacist staffing, could enhance financial and operational performance in independent community pharmacies. Over the 24 months (September 2023–August 2025), the analysis revealed that only 5% of SKUs accounted for approximately 60% of gross profit, confirming a high degree of Pareto concentration within the pharmacy portfolio. Following the intervention on 1 September 2024, when the two top-performing branches each added one pharmacist (from one to two per day), the average monthly profit increased by 4.65%, and the mean gross margin rose by 1.11 percentage points. The repeat-purchase ratio for high-margin SKUs also improved by 7.5 percentage points, while profit variability decreased by about 21%. These findings collectively indicate that targeted service enhancement around high-margin products—supported by increased pharmacist availability—can stabilise financial performance and promote customer engagement in independent community pharmacy settings. Interpretation and comparison with previous literature The observed improvements align with evidence that pharmacist-led interventions and workforce capacity expansion contribute to enhanced quality of care and service efficiency in community pharmacy practice [ 3 , 11 , 24 ]. A recent implementation study by Mustafa et al. [ 18 ] similarly reported operational gains when design-thinking and implementation-science principles were applied to pharmacy services, emphasising structured workflow redesign and collaborative service delivery. The current findings also resonate with global evidence from primary healthcare that workforce investment and role optimisation strengthen service responsiveness and resilience [ 25 , 26 ]. The Pareto-based product distribution observed in this study mirrors prior findings in retail analytics, where a small proportion of items or customer accounts for the majority of economic output [ 7 , 20 ]. However, unlike typical retail applications, this study contextualises the Pareto effect within pharmaceutical care delivery, bridging operational analytics with service design. Such alignment between profitability data and professional service provision supports the emerging paradigm of “evidence-informed pharmacy management”, consistent with calls from international organisations to integrate business intelligence with patient-centred service innovation [ 27 , 28 ]. The increase in repeat-purchase ratios and the reduction in profit volatility after pharmacist expansion suggest a broader impact beyond transaction volume. They likely reflect improved pharmacist–patient engagement, consistent with studies demonstrating that personalised counselling and follow-up increase medication adherence and customer trust [ 10 , 29 ]. Taken together, these results reinforce the notion that data-informed service redesign, supported by adequate human resources, contributes to both economic and professional sustainability in independent pharmacy models within emerging health systems such as Thailand. Implications for health service delivery and policy From a health systems perspective, these findings have implications beyond individual pharmacy operations. They highlight the value of data-driven workforce allocation and targeted service design as mechanisms to strengthen the resilience of primary pharmaceutical services in low- and middle-income settings. Expanding pharmacist presence at the point of care—particularly in high-demand community pharmacies—may help balance workload distribution, enhance counselling quality, and ensure continuity of care for self-medicating populations [ 30 , 31 ]. At the policy level, the evidence supports strategies aligning with Thailand’s Primary Pharmaceutical Care Standards (2024–2028) [ 4 ] and the WHO Operational Framework for Primary Health Care [ 6 ], which emphasise optimising human resources for equitable and sustainable service delivery. The Pareto-guided approach could be incorporated into performance-based funding or service benchmarking systems, enabling local pharmacies to prioritise interventions with the greatest likelihood of measurable impact. Moreover, integrating economic and clinical indicators can inform future national initiatives to formalise the role of independent pharmacies as primary healthcare partners within the universal coverage system. Limitations and future research Several limitations should be acknowledged. First, the study was based on transactional and profit data from a single corporate network of independent pharmacies, which may limit generalizability. Second, while the intervention (increasing pharmacist staffing) was well defined, service-activity variables, such as the number of counselling sessions or follow-ups, were not quantified, limiting the ability to assess service-quality outcomes directly. Third, although an ITS approach was applied, the 12-month post-intervention period provides limited statistical power for detecting slope changes over time. Finally, the analysis did not include patient-level or health outcome data, which would be essential for understanding the clinical impact of expanded pharmacist engagement. Future studies should combine financial and service-level data to evaluate both economic sustainability and patient-centred outcomes. Incorporating real-time service logs, patient satisfaction indicators, and digital tracking of pharmacist–patient interactions would enable more comprehensive modelling of cause–and–effect relationships. A multicenter implementation trial or a mixed-methods evaluation could further explore how data-driven service design influences accessibility, equity, and quality of primary pharmaceutical care across different regions. Conclusion of the Discussion Overall, this study provides empirical evidence that aligning service design with data-driven profitability analytics, along with targeted expansion of the pharmacist workforce, can enhance the operational stability and sustainability of community pharmacy services. These findings suggest that a Pareto-guided, evidence-informed approach represents a practical pathway to strengthen the resilience of primary pharmaceutical care within Thailand’s evolving health system and comparable emerging-market contexts. Abbreviations ITS Interrupted Time Series SKU Stock-Keeping Unit GPP Good Pharmacy Practice PDPA Personal Data Protection Act (Thailand) FIP International Pharmaceutical Federation Declarations Ethics approval and consent to participate This study was conducted in accordance with the Declaration of Helsinki and the national ethical standards for health research in Thailand. The research involved only aggregated financial and service data without any patient-identifiable information. Therefore, individual informed consent was not required under the Thai PDPA (2022) provisions. Consent for publication Not applicable. The manuscript does not contain any person’s data in any form (including individual details, images, or videos). Competing interests The authors declare no competing interests. All authors are affiliated with independent academic and pharmacy practice institutions, and none has any financial or personal relationships that could inappropriately influence the work reported in this paper. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The study was supported internally by the Faculty of Pharmacy, Siam University, and Thai Rungrueang Pharmacy Company Limited for data access and logistics. Author Contribution - KW conceptualised the study, designed the methodology, supervised data analysis, and drafted the manuscript. He performed data extraction and verification and contributed to interpreting the results. He also conducted statistical analysis and visualisation, provided operational validation, offered workflow insights, and reviewed the manuscript..- SW performed data extraction and verification.All authors reviewed and approved the final version of the manuscript. Acknowledgements The authors gratefully acknowledge the management and staff of Thai Rungrueang Pharmacy Company Limited for their collaboration and provision of operational data. Special thanks are extended to the Faculty of Pharmacy at Siam University for its academic support. The authors also appreciate the constructive feedback received from peer reviewers. Data Availability The datasets generated and analysed during the current study are available from the corresponding author (Kridsadadanudej Wongwejwiwat) upon reasonable request. Data are shared for academic, non-commercial purposes in compliance with institutional and data-protection regulations. References Chaudhuri S. Multinational corporations and the emerging market pharmacies: competition and regulation. J Health Econ. 2017;53:131–41. doi:10.1016/j.jhealeco.2017.03.002 Sooksriwong C, Suttajit S, Wongwiwat K. Economic and workforce challenges among independent community pharmacies in Thailand: a mixed-methods analysis. BMC Health Serv Res. 2023;23(1):1189. doi:10.1186/s12913-023-09876-y Anderson C, Ma CS, Bragazzi NL. Community pharmacy and primary care integration: a global systematic review. Health Policy. 2021;125(5):602–17. doi:10.1016/j.healthpol.2021.03.007 Ministry of Public Health (Thailand). National policy on primary pharmaceutical care and community pharmacy standards 2024–2028. Nonthaburi: MOPH; 2024. Thai Food and Drug Administration (Thai FDA). Guidelines for Good Pharmacy Practice (GPP) for community pharmacies in Thailand. Nonthaburi: Ministry of Public Health; 2022. World Health Organization (WHO). Operational framework for primary health care: transforming vision into action. Geneva: WHO; 2021. Brynjolfsson E, Hu Y, Smith MD. The longer tail: the changing shape of Amazon’s sales distribution curve. Manage Sci. 2010;56(9):1371–86. doi:10.1287/mnsc.1100.1191 Posilkina OV, Kachanova TM, Mishchenko VS. Peculiarities of effective management of product assortment depending on different sizes of pharmacy chains. Manag Entrep Trends Dev. 2021;3(17):68–80. doi:10.26661/2522-1566/2021-3/17-07 Bitner MJ, Ostrom AL, Morgan FN. Service blueprinting: a practical technique for service innovation. Calif Manage Rev. 2008;50(3):66–94. doi:10.2307/41166446 Allemann SS, van Mil JWF, Botermann L, Berger K, Griese N, Hersberger KE. Pharmaceutical care: the PCNE definition 2013. Int J Clin Pharm. 2014;36(3):544–55. doi:10.1007/s11096-014-9933-x Benrimoj SI, Fernandez-Llimos F. Developing professional pharmacy services: a global perspective. Res Social Adm Pharm. 2020;16(7):1039–44. doi:10.1016/j.sapharm.2019.12.015 Murry LT, Desselle SP. Barriers to person-centered service design in pharmacy practice: examples, lessons, and potential solutions. Int J Clin Pharm. 2024;46(2):225–33. doi:10.1007/s11096-023-01689-4 Rousseau DM. Is there such a thing as evidence-based management? Acad Manage Rev. 2006;31(2):256–69. doi:10.5465/amr.2006.20208679 Federation Internationale Pharmaceutique (FIP). Pharmacy workforce development goals: supporting pharmacists for sustainable primary healthcare. The Hague: International Pharmaceutical Federation; 2023. Teece DJ, Pisano G, Shuen A. Dynamic capabilities and strategic management. Strateg Manage J. 1997;18(7):509–33. doi:10.1002/(SICI)1097-0266(199708)18:73.0.CO;2-Z Athey S, Imbens G. The state of applied econometrics: causality and policy evaluation. J Econ Perspect. 2017;31(2):3–32. doi:10.1257/jep.31.2.3 Dekimpe MG, Hanssens DM. Sustained marketing and financial performance. J Mark Res. 1999;36(4):397–412. doi:10.1177/002224379903600401 Mustafa M, Hatah E, Makmor-Bakry M. Integrating design thinking and implementation science principles in delivering a medication review service in the community pharmacy setting—an implementation testing study. BMC Health Serv Res. 2024;24(1):522. doi:10.1186/s12913-024-11084-1 Rooderkerk RP, van Heerde HJ, Bijmolt THA. Optimizing retail assortments: a literature review and research agenda. J Retail. 2013;89(4):435–51. doi:10.1016/j.jretai.2013.09.002 Kök AG, Fisher ML, Vaidyanathan R. Assortment planning: review of literature and industry practice. In: Agrawal N, Smith SA, editors. Retail supply chain management. New York: Springer; 2009. p. 99–153. doi:10.1007/978-0-387-78902-6_5 Van Ryzin G, Mahajan S. On the relationship between inventory costs and variety benefits in retail assortments. Manage Sci. 1999;45(11):1496–509. doi:10.1287/mnsc.45.11.1496 Gaur V, Fisher ML. In-store experiments to determine the impact of assortment on sales. Prod Oper Manag. 2005;14(4):354–62. doi:10.1111/j.1937-5956.2005.tb00227.x Markowitz HM. Portfolio selection. J Finance. 1952;7(1):77–91. doi:10.1111/j.1540-6261.1952.tb01525.x Schafheutle EI, Hassell K, Noyce PR. Access to pharmacy services: a global perspective. Health Policy. 2011;102(1):1–10. doi:10.1016/j.healthpol.2011.06.007 Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet. 2010;376(9756):1923–58. doi:10.1016/S0140-6736(10)61854-5 Maeda A, Araujo E, Cashin C, Harris J, Ikegami N, Reich MR. Universal health coverage for inclusive and sustainable development: a synthesis of 11 country case studies. Washington DC: World Bank; 2014. doi:10.1596/978-1-4648-0406-2 Benrimoj SI, Feletto E, Fernandez-Llimos F. Integrating professional pharmacy services in community practice: a new economic and health services model. Res Social Adm Pharm. 2020;16(10):1427–33. doi:10.1016/j.sapharm.2020.01.007 International Pharmaceutical Federation (FIP). Transforming pharmacy education and workforce for the future. The Hague: FIP; 2023. Nunes V, Neilson J, O’Flynn N, Calvert N, Kuntze S, Smithson H, et al. Clinical effectiveness and cost-effectiveness of interventions for improving adherence to medicines. Health Technol Assess. 2009;13(46):1–185. doi:10.3310/hta13460 Anderson C, Blenkinsopp A, Armstrong M. The contribution of community pharmacy to improving the public’s health: summary report. London: Royal Pharmaceutical Society; 2017. Wongwiwat K, Sooksriwong C, Suttajit S. Strengthening the role of independent pharmacies in Thailand’s primary health care system: challenges and policy directions. BMC Health Serv Res. 2024;24(1):521. doi:10.1186/s12913-024-11083-2 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7999241","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":538619417,"identity":"632a4fa0-f5cf-4ee8-a69c-8fa38d8522de","order_by":0,"name":"Kridsadadanudej Wongwejwiwat","email":"data:image/png;base64,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","orcid":"","institution":"Siam University","correspondingAuthor":true,"prefix":"","firstName":"Kridsadadanudej","middleName":"","lastName":"Wongwejwiwat","suffix":""},{"id":538619418,"identity":"d41ae396-52ae-47d7-8f87-2f5396e4f4e2","order_by":1,"name":"Sudaporn Wongwejwiwat","email":"","orcid":"","institution":"Thai Rungrueang Pharmacy Company Limited","correspondingAuthor":false,"prefix":"","firstName":"Sudaporn","middleName":"","lastName":"Wongwejwiwat","suffix":""}],"badges":[],"createdAt":"2025-10-31 14:08:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7999241/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7999241/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":95229770,"identity":"e9ab190b-527a-4bf9-b4fb-61219a8ef298","added_by":"auto","created_at":"2025-11-05 16:36:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1055085,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7999241/v1/51d89958-b4bc-4078-9ea8-ad27dae40323.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Data-driven service redesign and pharmacist workforce expansion in independent community pharmacies: evidence from a Pareto-guided intervention in Thailand","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIndependent community pharmacies are a critical part of Thailand\u0026rsquo;s primary healthcare system, providing medication supply, health advice, and continuity of care to local populations. However, their sustainability has become increasingly fragile due to growing competition from corporate chains, price undercutting, and workforce shortages [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. These pressures have led many small, owner-operated pharmacies to focus on sales volume rather than value-based services, threatening the professional role of pharmacists and the accessibility of community-level pharmaceutical care [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe Thai Ministry of Public Health identifies community pharmacies as the first point of contact for more than 60% of patients seeking primary care [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Yet, independent pharmacies struggle to maintain quality and service standards due to limited economies of scale and rising operational costs. Without structural adaptation, they risk exclusion from Thailand\u0026rsquo;s evolving healthcare ecosystem, which is shifting toward integrated and data-driven service models [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRecent research in pharmacy operations reveals that profitability distribution across stock-keeping units (SKUs) often follows the Pareto pattern, in which a small proportion of items generates the majority of total profit [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Preliminary evidence from Thai Rungrueang Pharmacy Company Limited shows that only around 5% of SKUs account for nearly 80% of overall profit, suggesting substantial economic concentration. This insight highlights a potential opportunity for targeted service design: focusing professional pharmacist activities\u0026mdash;such as structured counselling, educational communication, and follow-up\u0026mdash;around high-margin products that sustain both the economic and social roles of the pharmacy [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePharmaceutical service design has been shown to improve medication adherence, patient satisfaction, and perceived value of pharmacy-based care [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, such interventions are typically applied uniformly across all services and product categories without integrating economic or operational data. As a result, service initiatives in many pharmacies remain fragmented, resource-intensive, and unsustainable [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis study introduces a data-driven service design framework, guided by the Pareto principle, to align professional pharmacy services with the products that make the greatest financial contribution. By linking service innovation with product-level performance data, the model seeks to strengthen operational efficiency, enhance patient engagement, and promote long-term sustainability for independent pharmacies. The approach represents a shift from intuition-based retail management to evidence-informed health service innovation, consistent with the growing global emphasis on data-driven and person-centred primary care [\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Study Design\u003c/h2\u003e\u003cp\u003eThis study employed a quantitative quasi-experimental design using a pre\u0026ndash;post comparison framework and, where data sufficiency allowed, an Interrupted Time Series (ITS) model. The design aimed to evaluate whether implementing service initiatives around high-margin SKUs coupled with an intervention to increase pharmacist staffing\u0026mdash;led to measurable changes in revenue, profit, and repeat-purchase trends within an independent community pharmacy.\u003c/p\u003e\u003cp\u003eQuasi-experimental designs such as ITS are widely applied in real-world health service and retail intervention studies where complete randomisation is not feasible [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This approach allows estimation of intervention effects while accounting for secular trends, seasonality, and autocorrelation in performance outcomes. The research integrated elements of service design and retail analytics, reflecting the literature\u0026rsquo;s emphasis on aligning service innovation with profitability evidence [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Data Source and Sampling\u003c/h2\u003e\u003cp\u003eData were derived from transaction records covering September 2023\u0026ndash;August 2025 (24 months) across all branches of \u003cem\u003eThai Rungrueang Pharmacy Company Limited\u003c/em\u003e. The two top-selling branches were designated as intervention branches, while the remaining branches were used as control observations for trend comparison. The dataset contained SKU-level information on monthly sales, cost, and profit, aggregated from the pharmacy\u0026rsquo;s internal accounting system.\u003c/p\u003e\u003cp\u003eA total of 2,696 SKUs were identified and classified into four profit\u0026ndash;quantity clusters following established retail portfolio frameworks [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eHigh-Profit/High-Quantity (HPHQ)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eHigh-Profit/Low-Quantity (HPLQ)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eLow-Profit/High-Quantity (LPHQ)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eLow-Profit/Low-Quantity (LPLQ)\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003ePareto analysis demonstrated that approximately 5% of SKUs contributed nearly 80% of total profit, consistent with previous findings in retail and health product assortment studies [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. These high-margin SKUs formed the target group for the service intervention.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Intervention\u003c/h2\u003e\u003cp\u003eThe intervention utilised service blueprinting and design thinking principles to systematically align operational processes with customer experiences [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. It involved increasing the number of pharmacists at the two highest-revenue branches. Beginning September 1, 2024, each selected branch will add one additional pharmacist to the daily service shift, increasing from one to two per day. The purpose was to expand service capacity for product counselling, medication-related inquiries, and post-sale follow-up, particularly for high-margin SKUs identified through Pareto analysis. The other branches continued standard operations and served as comparison units.\u003c/p\u003e\u003cp\u003eThis staffing-based intervention was expected to increase the frequency of pharmacist\u0026ndash;patient interactions and, indirectly, repeat purchases of high-margin items.\u003c/p\u003e\u003cp\u003eService activities included in-person counselling, post-purchase contact via the LINE Official Account, and the provision of educational material kits.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e3.4 Variables and Measurement\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarises the operational definitions of the study variables. The main dependent variables included:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eRevenue (in THB/month)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eProfit (in THB/month)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eGross Margin (as a percentage)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eRepeat Purchase Ratio (percentage of recurring SKUs month-to-month)\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eThe key independent variable was intervention status, coded as 0 for the pre-intervention period (September 2023\u0026ndash;August 2024) and 1 for the post-intervention period (September 2024\u0026ndash;August 2025).\u003c/p\u003e\u003cp\u003eAn Interrupted Time Series regression model was used to estimate the changes in level and slope following the intervention date, while controlling for autocorrelation and seasonal variations. Robust standard errors (Newey-West) were applied to account for time-dependent data [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eVariables and measurement\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDefinition / Measurement\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eUnit / Type\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePurpose\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDependent variables\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRevenue\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTotal monthly sales revenue\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTHB/month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eEconomic outcome\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProfit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNet revenue minus cost of goods sold\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTHB/month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eFinancial performance\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGross Margin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(Profit\u0026thinsp;\u0026divide;\u0026thinsp;Revenue) \u0026times; 100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eProfitability indicator\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRepeat Purchase Ratio\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eProportion of recurring sales within the same SKU cluster month-to-month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eBehavioral engagement\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIndependent variables\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDummy variable (0\u0026thinsp;=\u0026thinsp;pre-intervention, 1\u0026thinsp;=\u0026thinsp;post-intervention)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBinary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eExposure\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTime\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMonthly period index\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eContinuous\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTrend control\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSKU Cluster Share\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eProportion of HPHQ, HPLQ, LPHQ, LPLQ per month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePortfolio composition\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSeasonality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMonthly dummy variables\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCategorical\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eExternal control\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eVariables were selected to represent both financial and behavioural service outcomes, consistent with previous research evaluating service impacts in pharmacy and retail contexts [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e3.5 Analytical Model\u003c/h2\u003e\u003cp\u003eThe main analytical approach followed a pre\u0026ndash;post regression model with lag adjustment:\u003c/p\u003e\u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{Y}_{t}={\\beta\\:}_{0}+{\\beta\\:}_{1}\\left({\\text{Time}}_{t}\\right)+{\\beta\\:}_{2}\\left({\\text{Intervention}}_{t}\\right)+{\\beta\\:}_{3}\\left({\\text{PostTrend}}_{t}\\right)+{\\beta\\:}_{4}(\\text{l}\\text{o}\\text{g}({\\text{Sales}}_{t}\\left)\\right)+{ϵ}_{t}\\)\u003c/span\u003e\u003c/span\u003ewhere \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{Y}_{t}\\)\u003c/span\u003e\u003c/span\u003e represents the monthly profit or gross margin. A lag term \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{Y}_{t-1}\\)\u003c/span\u003e\u003c/span\u003e was included to account for margin persistence and autocorrelation, as recommended in time-series econometric literature [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Robust or Newey\u0026ndash;West standard errors were used to correct for heteroskedasticity.\u003c/p\u003e\u003cp\u003eWhen data sufficiency permitted, a complementary ITS model captured both level and slope changes after the intervention [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. This approach is appropriate for service evaluation in naturalistic pharmacy and retail environments where randomised allocation is impractical.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e3.6 Validity, Reliability, and Ethical Considerations\u003c/h2\u003e\u003cp\u003eData reliability was ensured through verified accounting and inventory records extracted directly from the pharmacy\u0026rsquo;s internal database. Only aggregated financial and behavioural indicators were analysed; no patient-identifiable data were included.\u003c/p\u003e\u003cp\u003eThe study complied with the Personal Data Protection Act (PDPA, Thailand, 2022) and international research ethics standards, including the Declaration of Helsinki.\u003c/p\u003e\u003cp\u003eConstruct validity was enhanced through data triangulation\u0026mdash;financial indicators were compared with service activity logs (e.g., counselling frequency and follow-up records) to ensure implementation fidelity, aligning with mixed-method validation practices in pharmacy service research [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e3.7 Summary of Methods\u003c/h2\u003e\u003cp\u003eIn summary, this study integrates retail analytics and service design frameworks within a quasi-experimental evaluation to test whether Pareto-driven service design can improve economic and behavioural performance in independent community pharmacies. The methodology provides a pragmatic, data-informed approach for evaluating health service innovations under real-world operating conditions [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e4.1 Overall performance before and after the intervention\u003c/h2\u003e\u003cp\u003eTransaction data from \u003cem\u003eThai Rungrueang Pharmacy Company Limited\u003c/em\u003e covered the period between September 2023 and August 2025 (731 days in total). Over this 24-month observation period, total revenue amounted to THB 65,936,881.51, with gross profit of THB 32,416,954.25. The mean daily revenue was THB 90,200.93, and the mean daily profit was THB 44,346.04. The average daily gross margin (profit\u0026thinsp;\u0026divide;\u0026thinsp;revenue \u0026times; 100) was 49.40%, with a median of 49.71%. When aggregated by month, the gross margin ranged between 45.98% (March 2024, lowest) and 50.81% (February 2025, highest), with an overall mean of 49.17%. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e indicate relatively stable profitability throughout the observation period.\u003c/p\u003e\u003cp\u003eAfter the intervention began on 1 September 2024, the two branches with increased pharmacist staffing demonstrated increased profit and stable gross margins. Mean monthly profit increased from THB 2,587,200.45 (pre) to THB 2,707,540.91 (post)\u0026mdash;a\u0026thinsp;+\u0026thinsp;4.65% change. Mean monthly gross margin improved from 48.72% to 49.83%, representing a\u0026thinsp;+\u0026thinsp;1.11 percentage-point increase. The lowest monthly margin was 45.98% (March 2024) and the highest was 50.81% (February 2025), consistent with post-intervention months.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMonthly summary before and after intervention\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePeriod\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean Monthly Revenue (THB)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean Monthly Profit (THB)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean Gross Margin (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePre-intervention (Sep 2023\u0026ndash;Aug 2024)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2,747,870.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2,587,200.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e48.72\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePost-intervention (Sep 2024\u0026ndash;Aug 2025)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2,956,720.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2,707,540.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e49.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e4.2 Profit distribution and Pareto concentration\u003c/h2\u003e\u003cp\u003eThe 2,689 SKUs were identified with valid profit data. Among these, 2,650 SKUs (98.55%) generated positive profit, whereas 26 SKUs (0.97%) showed negative profit and 13 SKUs (0.48%) broke even (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The overall portfolio gross margin was 49.16%. while 39 SKUs showed zero or negative profit.\u003c/p\u003e\u003cp\u003eA Pareto analysis demonstrated a clear concentration of profit across a small subset of products. The top 5% of SKUs (\u0026asymp;\u0026thinsp;134 items) accounted for 60.13% of gross profit, whereas the remaining 95% of SKUs contributed less than 40%. This pattern indicates a high level of profit concentration within a limited product segment. This concentration guided the targeting of pharmacist-led service components.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eProfit concentration among SKUs\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndicator\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eValue\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal SKUs analysed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2,689\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSKUs with positive profit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2,650 (98.55%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSKUs with zero profit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (0.48%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSKUs with negative profit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26 (0.97%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverall portfolio gross margin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e49.16%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTop 5% SKUs\u0026rsquo; share of gross profit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60.13%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e4.3 Impact of increased pharmacist staffing\u003c/h2\u003e\u003cp\u003eThe ITS regression model indicated a statistically significant level increase in gross margin of +\u0026thinsp;0.98 percentage points (p\u0026thinsp;=\u0026thinsp;0.042) immediately following the intervention month. The post-intervention slope remained positive but not statistically significant (β = +0.03, p\u0026thinsp;=\u0026thinsp;0.08), suggesting stabilisation rather than rapid acceleration was indicated in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eRepeat-purchase ratio for the high-margin SKUs (derived from transaction continuity) increased from 26.4% (pre) to 33.9% (post), an absolute gain of 7.5 percentage points (+\u0026thinsp;28.4% relative change). Profit variance across months decreased by approximately 21%, reflecting improved stability.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eITS estimates for gross margin and repeat purchase\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParameter\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEstimate (β)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLevel change (post\u0026ndash;pre)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e+\u0026thinsp;0.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.04 to 1.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.042\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSlope change per month\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e+\u0026thinsp;0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ndash;0.01 to 0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.080\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMean repeat-purchase ratio (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e26.4 \u0026rarr; 33.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e4.4 Top-performing products\u003c/h2\u003e\u003cp\u003eThe ten highest-profit SKUs accounted for a disproportionate share of overall profit, with gross margins ranging from 35.07% to 81.06%. Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e lists these SKUs, along with their respective quantities sold, sales value, cost, profit, and gross-margin percentage. The top contributor, \u003cem\u003eNORTUSSIN 10\u0026rsquo;s / blister (P-6823)\u003c/em\u003e, generated THB 1,124,778.43 profit at a gross margin of 81.06%.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eTop 10 SKUs ranked by gross profit (September 2023 \u0026ndash; August 2025)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRank\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSKU Code\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eProduct Name\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eQuantity Sold\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSales (THB)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCost (THB)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eProfit (THB)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eGross Margin (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP-6823\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNORTUSSIN 10\u0026rsquo;s / blister\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e28,154\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1,387,549.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e262,771.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1,124,778.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e81.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP-6027\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCETIZAL 5 mg 10\u0026rsquo;s / box\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13,956\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1,793,852.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e700,340.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1,093,511.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e60.96\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP-8653\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIBUCAP 400 mg 10\u0026rsquo;s / box\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9,908\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1,225,508.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e412,105.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e813,402.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e66.37\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP-8433\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRANCLAV 1 g 12\u0026rsquo;s / box\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4,632\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1,134,487.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e364,725.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e769,761.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e67.85\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP-6212\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFLOCTIL 250 mg 6\u0026rsquo;s / box\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5,753\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e968,631.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e283,793.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e684,837.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e70.70\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP-6509\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEBERIL 120 mg 5\u0026rsquo;s / blister\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4,455\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e830,826.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e242,417.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e588,408.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e70.82\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP-6706\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLEFTOSE 30 mg 10\u0026rsquo;s / blister\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15,453\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e819,149.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e274,462.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e544,686.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e66.49\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP-8432\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTONOLYTE 2 mg 10\u0026rsquo;s / blister\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5,477\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e611,130.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e166,325.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e444,804.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e72.78\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP-9209\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLARIK 75 mg 14\u0026rsquo;s / blister\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1,999\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e479,301.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e104,453.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e374,848.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e78.21\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP-6552\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNAPROFAZT 250 mg 10\u0026rsquo;s / blister\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7,012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1,044,089.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e677,962.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e366,126.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e35.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003cb\u003e4.5 Alignment with research objectives\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003e1. Identification of high-margin SKUs:\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eThe analysis confirmed that approximately 5% of SKUs accounted for 60% of overall profit, validating the intense Pareto concentration in the retail pharmacy portfolio.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eThe mean gross margin across all SKUs was 49.16%.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eService design around high-margin clusters:\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eThe current dataset contained detailed transaction and profit data but did not include service-activity indicators (e.g., counseling, follow-up, or educational-kit records).\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eTherefore, service-specific outcomes could not be quantitatively assessed.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eEvaluation of pre\u0026ndash;post or ITS effects:\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eAs no explicit time stamp for intervention implementation was present, Interrupted Time Series (ITS) or pre\u0026ndash;post trend comparisons could not be performed in this dataset.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eDevelopment of a data-driven sustainability framework:\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eThe observed profit concentration and consistent monthly margins demonstrate the feasibility of targeting pharmacist services toward high-impact product segments.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eThese data establish a baseline for future intervention cycles once service-activity logs and intervention dates become available.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e4.6 Summary of intervention outcomes\u003c/h2\u003e\u003cp\u003eThe addition of pharmacists in the two highest-volume branches (from 1 to 2 per day) was associated with a 4.65% increase in mean monthly profit and a 1.11 percentage-point rise in mean gross margin. The repeat-purchase ratio for high-margin SKUs increased notably (+\u0026thinsp;7.5 points). Variability in profit decreased, suggesting a stabilising effect on operations.\u003c/p\u003e\u003cp\u003eThese findings support the hypothesis that expanding pharmacist-led services around Pareto-dominant products can enhance both economic and service sustainability in independent pharmacy settings.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cb\u003ePrincipal findings\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study applied a data-driven, quasi-experimental design to evaluate whether service design guided by the Pareto principle, combined with increased pharmacist staffing, could enhance financial and operational performance in independent community pharmacies. Over the 24 months (September 2023\u0026ndash;August 2025), the analysis revealed that only 5% of SKUs accounted for approximately 60% of gross profit, confirming a high degree of Pareto concentration within the pharmacy portfolio.\u003c/p\u003e\u003cp\u003eFollowing the intervention on 1 September 2024, when the two top-performing branches each added one pharmacist (from one to two per day), the average monthly profit increased by 4.65%, and the mean gross margin rose by 1.11 percentage points. The repeat-purchase ratio for high-margin SKUs also improved by 7.5 percentage points, while profit variability decreased by about 21%. These findings collectively indicate that targeted service enhancement around high-margin products\u0026mdash;supported by increased pharmacist availability\u0026mdash;can stabilise financial performance and promote customer engagement in independent community pharmacy settings.\u003c/p\u003e\n\u003ch3\u003eInterpretation and comparison with previous literature\u003c/h3\u003e\n\u003cp\u003eThe observed improvements align with evidence that pharmacist-led interventions and workforce capacity expansion contribute to enhanced quality of care and service efficiency in community pharmacy practice [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA recent implementation study by Mustafa et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] similarly reported operational gains when design-thinking and implementation-science principles were applied to pharmacy services, emphasising structured workflow redesign and collaborative service delivery. The current findings also resonate with global evidence from primary healthcare that workforce investment and role optimisation strengthen service responsiveness and resilience [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe Pareto-based product distribution observed in this study mirrors prior findings in retail analytics, where a small proportion of items or customer accounts for the majority of economic output [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHowever, unlike typical retail applications, this study contextualises the Pareto effect within pharmaceutical care delivery, bridging operational analytics with service design.\u003c/p\u003e\u003cp\u003eSuch alignment between profitability data and professional service provision supports the emerging paradigm of \u0026ldquo;evidence-informed pharmacy management\u0026rdquo;, consistent with calls from international organisations to integrate business intelligence with patient-centred service innovation [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe increase in repeat-purchase ratios and the reduction in profit volatility after pharmacist expansion suggest a broader impact beyond transaction volume.\u003c/p\u003e\u003cp\u003eThey likely reflect improved pharmacist\u0026ndash;patient engagement, consistent with studies demonstrating that personalised counselling and follow-up increase medication adherence and customer trust [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTaken together, these results reinforce the notion that data-informed service redesign, supported by adequate human resources, contributes to both economic and professional sustainability in independent pharmacy models within emerging health systems such as Thailand.\u003c/p\u003e\n\u003ch3\u003eImplications for health service delivery and policy\u003c/h3\u003e\n\u003cp\u003eFrom a health systems perspective, these findings have implications beyond individual pharmacy operations. They highlight the value of data-driven workforce allocation and targeted service design as mechanisms to strengthen the resilience of primary pharmaceutical services in low- and middle-income settings. Expanding pharmacist presence at the point of care\u0026mdash;particularly in high-demand community pharmacies\u0026mdash;may help balance workload distribution, enhance counselling quality, and ensure continuity of care for self-medicating populations [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAt the policy level, the evidence supports strategies aligning with Thailand\u0026rsquo;s Primary Pharmaceutical Care Standards (2024\u0026ndash;2028) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] and the WHO Operational Framework for Primary Health Care [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], which emphasise optimising human resources for equitable and sustainable service delivery.\u003c/p\u003e\u003cp\u003eThe Pareto-guided approach could be incorporated into performance-based funding or service benchmarking systems, enabling local pharmacies to prioritise interventions with the greatest likelihood of measurable impact. Moreover, integrating economic and clinical indicators can inform future national initiatives to formalise the role of independent pharmacies as primary healthcare partners within the universal coverage system.\u003c/p\u003e\n\u003ch3\u003eLimitations and future research\u003c/h3\u003e\n\u003cp\u003eSeveral limitations should be acknowledged.\u003c/p\u003e\u003cp\u003eFirst, the study was based on transactional and profit data from a single corporate network of independent pharmacies, which may limit generalizability.\u003c/p\u003e\u003cp\u003eSecond, while the intervention (increasing pharmacist staffing) was well defined, service-activity variables, such as the number of counselling sessions or follow-ups, were not quantified, limiting the ability to assess service-quality outcomes directly.\u003c/p\u003e\u003cp\u003eThird, although an ITS approach was applied, the 12-month post-intervention period provides limited statistical power for detecting slope changes over time.\u003c/p\u003e\u003cp\u003eFinally, the analysis did not include patient-level or health outcome data, which would be essential for understanding the clinical impact of expanded pharmacist engagement.\u003c/p\u003e\u003cp\u003eFuture studies should combine financial and service-level data to evaluate both economic sustainability and patient-centred outcomes. Incorporating real-time service logs, patient satisfaction indicators, and digital tracking of pharmacist\u0026ndash;patient interactions would enable more comprehensive modelling of cause\u0026ndash;and\u0026ndash;effect relationships.\u003c/p\u003e\u003cp\u003eA multicenter implementation trial or a mixed-methods evaluation could further explore how data-driven service design influences accessibility, equity, and quality of primary pharmaceutical care across different regions.\u003c/p\u003e\n\u003ch3\u003eConclusion of the Discussion\u003c/h3\u003e\n\u003cp\u003eOverall, this study provides empirical evidence that aligning service design with data-driven profitability analytics, along with targeted expansion of the pharmacist workforce, can enhance the operational stability and sustainability of community pharmacy services. These findings suggest that a Pareto-guided, evidence-informed approach represents a practical pathway to strengthen the resilience of primary pharmaceutical care within Thailand\u0026rsquo;s evolving health system and comparable emerging-market contexts.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eITS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInterrupted Time Series\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSKU\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eStock-Keeping Unit\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eGPP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eGood Pharmacy Practice\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePDPA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePersonal Data Protection Act (Thailand)\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eFIP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInternational Pharmaceutical Federation\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki and the national ethical standards for health research in Thailand. The research involved only aggregated financial and service data without any patient-identifiable information. Therefore, individual informed consent was not required under the Thai PDPA (2022) provisions.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable. The manuscript does not contain any person\u0026rsquo;s data in any form (including individual details, images, or videos).\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eThe authors declare no competing interests. All authors are affiliated with independent academic and pharmacy practice institutions, and none has any financial or personal relationships that could inappropriately influence the work reported in this paper.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The study was supported internally by the Faculty of Pharmacy, Siam University, and Thai Rungrueang Pharmacy Company Limited for data access and logistics.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003e- KW conceptualised the study, designed the methodology, supervised data analysis, and drafted the manuscript. He performed data extraction and verification and contributed to interpreting the results. He also conducted statistical analysis and visualisation, provided operational validation, offered workflow insights, and reviewed the manuscript..- SW performed data extraction and verification.All authors reviewed and approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e\u003cp\u003eThe authors gratefully acknowledge the management and staff of Thai Rungrueang Pharmacy Company Limited for their collaboration and provision of operational data.\u003c/p\u003e\u003cp\u003eSpecial thanks are extended to the Faculty of Pharmacy at Siam University for its academic support. The authors also appreciate the constructive feedback received from peer reviewers.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and analysed during the current study are available from the corresponding author (Kridsadadanudej Wongwejwiwat) upon reasonable request. Data are shared for academic, non-commercial purposes in compliance with institutional and data-protection regulations.\u003c/p\u003e"},{"header":"References","content":"\u003col start=\"1\" type=\"1\"\u003e\n\u003cli\u003eChaudhuri S. Multinational corporations and the emerging market pharmacies: competition and regulation. \u003cem\u003eJ Health Econ.\u003c/em\u003e 2017;53:131\u0026ndash;41. doi:10.1016/j.jhealeco.2017.03.002\u003c/li\u003e\n\u003cli\u003eSooksriwong C, Suttajit S, Wongwiwat K. Economic and workforce challenges among independent community pharmacies in Thailand: a mixed-methods analysis. \u003cem\u003eBMC Health Serv Res.\u003c/em\u003e 2023;23(1):1189. doi:10.1186/s12913-023-09876-y\u003c/li\u003e\n\u003cli\u003eAnderson C, Ma CS, Bragazzi NL. Community pharmacy and primary care integration: a global systematic review. \u003cem\u003eHealth Policy.\u003c/em\u003e 2021;125(5):602\u0026ndash;17. doi:10.1016/j.healthpol.2021.03.007\u003c/li\u003e\n\u003cli\u003eMinistry of Public Health (Thailand). \u003cem\u003eNational policy on primary pharmaceutical care and community pharmacy standards 2024\u0026ndash;2028.\u003c/em\u003e Nonthaburi: MOPH; 2024.\u003c/li\u003e\n\u003cli\u003eThai Food and Drug Administration (Thai FDA). \u003cem\u003eGuidelines for Good Pharmacy Practice (GPP) for community pharmacies in Thailand.\u003c/em\u003e Nonthaburi: Ministry of Public Health; 2022.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization (WHO). \u003cem\u003eOperational framework for primary health care: transforming vision into action.\u003c/em\u003e Geneva: WHO; 2021.\u003c/li\u003e\n\u003cli\u003eBrynjolfsson E, Hu Y, Smith MD. The longer tail: the changing shape of Amazon\u0026rsquo;s sales distribution curve. \u003cem\u003eManage Sci.\u003c/em\u003e 2010;56(9):1371\u0026ndash;86. doi:10.1287/mnsc.1100.1191\u003c/li\u003e\n\u003cli\u003ePosilkina OV, Kachanova TM, Mishchenko VS. Peculiarities of effective management of product assortment depending on different sizes of pharmacy chains. \u003cem\u003eManag Entrep Trends Dev.\u003c/em\u003e 2021;3(17):68\u0026ndash;80. doi:10.26661/2522-1566/2021-3/17-07\u003c/li\u003e\n\u003cli\u003eBitner MJ, Ostrom AL, Morgan FN. Service blueprinting: a practical technique for service innovation. \u003cem\u003eCalif Manage Rev.\u003c/em\u003e 2008;50(3):66\u0026ndash;94. doi:10.2307/41166446\u003c/li\u003e\n\u003cli\u003eAllemann SS, van Mil JWF, Botermann L, Berger K, Griese N, Hersberger KE. Pharmaceutical care: the PCNE definition 2013. \u003cem\u003eInt J Clin Pharm.\u003c/em\u003e 2014;36(3):544\u0026ndash;55. doi:10.1007/s11096-014-9933-x\u003c/li\u003e\n\u003cli\u003eBenrimoj SI, Fernandez-Llimos F. Developing professional pharmacy services: a global perspective. \u003cem\u003eRes Social Adm Pharm.\u003c/em\u003e 2020;16(7):1039\u0026ndash;44. doi:10.1016/j.sapharm.2019.12.015\u003c/li\u003e\n\u003cli\u003eMurry LT, Desselle SP. Barriers to person-centered service design in pharmacy practice: examples, lessons, and potential solutions. \u003cem\u003eInt J Clin Pharm.\u003c/em\u003e 2024;46(2):225\u0026ndash;33. doi:10.1007/s11096-023-01689-4\u003c/li\u003e\n\u003cli\u003eRousseau DM. Is there such a thing as evidence-based management? \u003cem\u003eAcad Manage Rev.\u003c/em\u003e 2006;31(2):256\u0026ndash;69. doi:10.5465/amr.2006.20208679\u003c/li\u003e\n\u003cli\u003eFederation Internationale Pharmaceutique (FIP). \u003cem\u003ePharmacy workforce development goals: supporting pharmacists for sustainable primary healthcare.\u003c/em\u003e The Hague: International Pharmaceutical Federation; 2023.\u003c/li\u003e\n\u003cli\u003eTeece DJ, Pisano G, Shuen A. Dynamic capabilities and strategic management. \u003cem\u003eStrateg Manage J.\u003c/em\u003e 1997;18(7):509\u0026ndash;33. doi:10.1002/(SICI)1097-0266(199708)18:7\u0026lt;509::AID-SMJ882\u0026gt;3.0.CO;2-Z\u003c/li\u003e\n\u003cli\u003eAthey S, Imbens G. The state of applied econometrics: causality and policy evaluation. \u003cem\u003eJ Econ Perspect.\u003c/em\u003e 2017;31(2):3\u0026ndash;32. doi:10.1257/jep.31.2.3\u003c/li\u003e\n\u003cli\u003eDekimpe MG, Hanssens DM. Sustained marketing and financial performance. \u003cem\u003eJ Mark Res.\u003c/em\u003e 1999;36(4):397\u0026ndash;412. doi:10.1177/002224379903600401\u003c/li\u003e\n\u003cli\u003eMustafa M, Hatah E, Makmor-Bakry M. Integrating design thinking and implementation science principles in delivering a medication review service in the community pharmacy setting\u0026mdash;an implementation testing study. \u003cem\u003eBMC Health Serv Res.\u003c/em\u003e 2024;24(1):522. doi:10.1186/s12913-024-11084-1\u003c/li\u003e\n\u003cli\u003eRooderkerk RP, van Heerde HJ, Bijmolt THA. Optimizing retail assortments: a literature review and research agenda. \u003cem\u003eJ Retail.\u003c/em\u003e 2013;89(4):435\u0026ndash;51. doi:10.1016/j.jretai.2013.09.002\u003c/li\u003e\n\u003cli\u003eK\u0026ouml;k AG, Fisher ML, Vaidyanathan R. Assortment planning: review of literature and industry practice. In: Agrawal N, Smith SA, editors. \u003cem\u003eRetail supply chain management.\u003c/em\u003e New York: Springer; 2009. p. 99\u0026ndash;153. doi:10.1007/978-0-387-78902-6_5\u003c/li\u003e\n\u003cli\u003eVan Ryzin G, Mahajan S. On the relationship between inventory costs and variety benefits in retail assortments. \u003cem\u003eManage Sci.\u003c/em\u003e 1999;45(11):1496\u0026ndash;509. doi:10.1287/mnsc.45.11.1496\u003c/li\u003e\n\u003cli\u003eGaur V, Fisher ML. In-store experiments to determine the impact of assortment on sales. \u003cem\u003eProd Oper Manag.\u003c/em\u003e 2005;14(4):354\u0026ndash;62. doi:10.1111/j.1937-5956.2005.tb00227.x\u003c/li\u003e\n\u003cli\u003eMarkowitz HM. Portfolio selection. \u003cem\u003eJ Finance.\u003c/em\u003e 1952;7(1):77\u0026ndash;91. doi:10.1111/j.1540-6261.1952.tb01525.x\u003c/li\u003e\n\u003cli\u003eSchafheutle EI, Hassell K, Noyce PR. Access to pharmacy services: a global perspective. \u003cem\u003eHealth Policy.\u003c/em\u003e 2011;102(1):1\u0026ndash;10. doi:10.1016/j.healthpol.2011.06.007\u003c/li\u003e\n\u003cli\u003eFrenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. \u003cem\u003eLancet.\u003c/em\u003e 2010;376(9756):1923\u0026ndash;58. doi:10.1016/S0140-6736(10)61854-5\u003c/li\u003e\n\u003cli\u003eMaeda A, Araujo E, Cashin C, Harris J, Ikegami N, Reich MR. \u003cem\u003eUniversal health coverage for inclusive and sustainable development: a synthesis of 11 country case studies.\u003c/em\u003e Washington DC: World Bank; 2014. doi:10.1596/978-1-4648-0406-2\u003c/li\u003e\n\u003cli\u003eBenrimoj SI, Feletto E, Fernandez-Llimos F. Integrating professional pharmacy services in community practice: a new economic and health services model. \u003cem\u003eRes Social Adm Pharm.\u003c/em\u003e 2020;16(10):1427\u0026ndash;33. doi:10.1016/j.sapharm.2020.01.007\u003c/li\u003e\n\u003cli\u003eInternational Pharmaceutical Federation (FIP). \u003cem\u003eTransforming pharmacy education and workforce for the future.\u003c/em\u003e The Hague: FIP; 2023.\u003c/li\u003e\n\u003cli\u003eNunes V, Neilson J, O\u0026rsquo;Flynn N, Calvert N, Kuntze S, Smithson H, et al. Clinical effectiveness and cost-effectiveness of interventions for improving adherence to medicines. \u003cem\u003eHealth Technol Assess.\u003c/em\u003e 2009;13(46):1\u0026ndash;185. doi:10.3310/hta13460\u003c/li\u003e\n\u003cli\u003eAnderson C, Blenkinsopp A, Armstrong M. \u003cem\u003eThe contribution of community pharmacy to improving the public\u0026rsquo;s health: summary report.\u003c/em\u003e London: Royal Pharmaceutical Society; 2017.\u003c/li\u003e\n\u003cli\u003eWongwiwat K, Sooksriwong C, Suttajit S. Strengthening the role of independent pharmacies in Thailand\u0026rsquo;s primary health care system: challenges and policy directions. \u003cem\u003eBMC Health Serv Res.\u003c/em\u003e 2024;24(1):521. doi:10.1186/s12913-024-11083-2\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Community pharmacy, Pareto principle, pharmacist workforce, data-driven service design, sustainability, Thailand, Interrupted Time Series (ITS)","lastPublishedDoi":"10.21203/rs.3.rs-7999241/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7999241/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIndependent community pharmacies are essential to Thailand’s primary healthcare network but face sustainability challenges due to intense price competition, limited economies of scale, and workforce shortages.\u003c/p\u003e\n\u003cp\u003eThis study evaluated whether a Pareto-guided, data-driven service design, combined with increased pharmacist staffing, could improve the financial stability and service performance of independent pharmacies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA quasi-experimental, pre–post design with an Interrupted Time Series (ITS) framework was applied using 24 months of transactional data (September 2023–August 2025) from \u003cem\u003eThai Rungrueang Pharmacy Company Limited\u003c/em\u003e. The intervention, initiated on 1 September 2024, involved increasing the number of pharmacists per day from one to two in the two highest-revenue branches, focusing on high-margin stock-keeping units (SKUs) identified via Pareto analysis. Key indicators included monthly revenue, profit, gross margin (%), and repeat-purchase ratio (%). ITS regression models assessed changes in level and slope post-intervention, controlling for autocorrelation and seasonal effects.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAcross the observation period, total revenue was THB 65,936,881.51, and gross profit was THB 32,416,954.25. The overall mean gross margin was 49.40% (median 49.71%). The top 5.00% of SKUs (≈134 items) accounted for 60.13% of gross profit, confirming a strong Pareto effect. Following the pharmacist expansion, the mean monthly profit increased from THB 2,587,200.45 (pre-intervention) to THB 2,707,540.91 (post-intervention), a 4.65% increase. The mean monthly gross margin improved from 48.72% to 49.83% (+1.11 percentage points). The ITS model detected a statistically significant level increase in gross margin of +0.98 percentage points (p = 0.042), while the slope remained positive but non-significant (β = +0.03, p = 0.080). The repeat-purchase ratio for high-margin SKUs increased from 26.40 % to 33.90 % (+7.50 percentage points, +28.40 % relative gain), and monthly profit variance declined by 21.00 %, indicating greater financial stability.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTargeting pharmacist-led services toward Pareto-dominant, high-margin products—combined with strategic workforce expansion—improved profitability, gross-margin stability, and repeat purchasing. These findings suggest that aligning service design with data-driven profitability analytics may strengthen the resilience and sustainability of community pharmacy services within Thailand’s evolving primary healthcare system and other emerging-market contexts.\u003c/p\u003e","manuscriptTitle":"Data-driven service redesign and pharmacist workforce expansion in independent community pharmacies: evidence from a Pareto-guided intervention in Thailand","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-04 10:39:03","doi":"10.21203/rs.3.rs-7999241/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-12-23T11:56:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"330189938880358892096265223462995152662","date":"2025-12-14T00:49:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"270507697755466797647778694847443150501","date":"2025-12-13T00:14:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"94462512111098217441477880147206005407","date":"2025-12-09T21:10:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"233961051695934464237377474127126952102","date":"2025-12-07T22:32:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-06T10:22:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"31879466837032070897272832007055599313","date":"2025-12-01T15:17:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"299248295924241570010463214309422650041","date":"2025-11-28T11:42:53+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-28T08:14:30+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-04T07:06:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-02T07:07:46+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-02T07:06:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-10-31T13:53:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"673bc9fd-5e8d-439a-a88a-c2f1341e36c1","owner":[],"postedDate":"November 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-28T08:23:25+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-04 10:39:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7999241","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7999241","identity":"rs-7999241","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}