practice change in community pharmacy

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The international pharmacy practiceliterature has documented shifts inthe orientation of community pharmacypractice over the past century along acontinuum of manufacturing, com-pounding, and distribution to clinical ser-vices, pharmaceutical care, and more re-cently, cognitive pharmaceutical services(CPS).1 CPS are professional servicesprovided by pharmacists, using theirskills and knowledge to take an activerole in contributing to patient healththrough effective interaction with bothpatients and other health professionals.2

Community pharmacy in Australia hasbeen at the forefront of this internationaltrend toward the delivery of remuneratedCPS. Since 1990, the profession has ne-gotiated 5-year Community PharmacyAgreements with the Australian govern-ment. These agreements cover all as-pects of remuneration for community

pharmacies and have created an in-creased focus on CPS provision.3 Theagreements have been significant driversof practice change, which, in this context,refers to the shift in focus from productsupply to patient-centered service delivery.The factors causing this shift are complexand include issues such as changes in gov-

Practice Change in Community Pharmacy: Quantification of

Facilitators

Alison S Roberts, Shalom I Benrimoj, Timothy F Chen, Kylie A Williams, and Parisa Aslani

Author information provided at the end of thetext.

The Annals of Pharmacotherapy I 2008 June, Volume 42 I 861www.theannals.com

BACKGROUND: There has been an increasing international trend toward thedelivery of cognitive pharmaceutical services (CPS) in community pharmacy.

CPS have been developed and disseminated individually, without a framework

underpinning their implementation and with limited knowledge of factors that

might assist practice change. The implementation process is complex, involving

a range of internal and external factors.

OBJECTIVE: To quantify facilitators of practice change in Australian communitypharmacies.

METHODS: We employed a literature review and qualitative study to facilitate thedesign of a 43-item facilitators of practice change scale as part of a quantitative

survey instrument, using a framework of organizational theory. The questionnaire

was pilot-tested (n = 100), then mailed to a random sample of 2000 community

pharmacies, with a copy each for the pharmacy owner, employed pharmacist,

and pharmacy assistant. The construct validity and reliability of the scale were

established using exploratory factor analysis and Cronbachs , respectively.

RESULTS: A total of 735 (37%) pharmacies responded, with 1303 individualquestionnaires. Factor analysis of the scale yielded 7 factors, explaining 48.8% of

the total variance. The factors were: relationship with physicians (item loading

range 0.590.85; Cronbachs 0.90), remuneration (0.520.74; 0.82), pharmacy

layout (0.520.79; 0.81), patient expectation (0.520.85; 0.82), manpower/staff

(0.490.66; 0.80), communication and teamwork (0.370.65; 0.77), and external

support/assistance (0.470.69; 0.74).

CONCLUSIONS: All of the factors demonstrated good reliability and constructvalidity and explained approximately half of the variance. Implementing CPS

requires support not only with the clinical aspects of service delivery, but also forthe process of implementation itself, and remuneration models must reflect this.

The identified facilitators should be used in a multilevel strategy to integrate

professional services into the community pharmacy business, engaging

pharmacists and their staff, policy makers, educators, and researchers. Further

research is required to determine additional factors impacting the capacity of

community pharmacies to implement change.

KEY WORDS: cognitive pharmaceutical services, community pharmacy.

Ann Pharmacother 2008;42:861-8.

Published Online, 13 May 2008, www.theannals.com, DOI 10.1345/aph.1K617


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ernment policy, resulting in declining profit margins on pre-scription products, leading to the development of other in-come sources to ensure sustainability.4

CPS programs appear to have been developed and dis-seminated individually, without a framework underpinningtheir implementation or inclusion of factors that might fa-cilitate practice change. One of the major implications of

this is reduced uptake of CPS. Significant attention hasbeen given to barriers to CPS adoption, focusing largely atthe practitioner level. A review of facilitators of practicechange in community pharmacy concluded that there is aneed to clarify how identified facilitators (defined as ele-ments that make adopting a new behavior or practice easi-er) can be used in practice to accelerate the implementationof CPS.2 The factors affecting change are more than justthose confined to the individual pharmacist who is beingtrained through traditional, clinically focused, didactic edu-cation programs to provide CPS. Broader educational, so-cial, and financial factors are involved,4 and thus research

that adopts an organizational perspective is needed. Thisapproach, successfully used in other healthcare settings,5-7

allows the identification of factors affecting practicechange beyond the perspective of the individual pharma-cist, as aspects such as culture, structure, and the environ-ment are brought into consideration.8,9 The aim of our re-search, therefore, was to identify the key componentsneeded for the development of a practice change model forAustralian community pharmacies. The specific objectiveswere to develop and validate an instrument to allow theidentification and quantification of facilitators of practicechange, drawing on the experiences of those involved with

existing community pharmacy services and programs(Table 110). This approach was different from that of previ-ous studies in which services have been more loosely de-fined, and the proportion of respondents with experienceof the services has been low; hence, facilitators have some-times been based on perception rather than experience.2,11

Methods

THEORETICAL FRAMEWORK

A broad framework of organizational theory was used

to identify factors that affect practice change from a com-

munity pharmacy perspective and to assist in better under-standing the change process for the whole pharmacy.9 Thistheoretical framework was the underpinning for a qualita-tive study, the results of which were used to generate itemsfor the quantitative research instrument.12

INSTRUMENT DESIGN

Literature reviews2,13 and data from the qualitative study12

facilitated the design of a structured questionnaire, withsections that include adoption of Third Agreement Pro-grams4 (Table 1), facilitators of practice change scale (fa-cilitators scale) consisting of 74 items based on 13 con-structs that are measured using a 5-point Likert scale rang-ing from Strongly Disagree (1) to Strongly Agree (5),individual respondent and pharmacy demographics, andfree comments.

INSTRUMENT VALIDITY AND RELIABILITY TESTING

The content and construct validity of the questionnairewere established in a pilot mail survey of a random sampleof Australian community pharmacies (N = 100).14 To testconstruct validity, factor analysis was performed on thedata from the facilitators scale. Factor analysis is a tech-nique used to reduce a set of observed variables to a small-er number of underlying factors.15 The internal consistencyor reliability of the factors was measured using Cronbachs. The results of these analyses allowed changes to bemade to the research instrument and a sample size to becalculated for the main study.14

POPULATION AND SAMPLE

Ethics approval for the research was obtained from theHuman Research Ethics Committee at the University ofSydney. Contact details of all Australian community phar-macies (N = 4926) were obtained from the Pharmacyboards and the telephone directory. (Pharmacy boards areregulatory authorities in the 6 states and 2 territories withinAustralia and are responsible for the registration of phar-macists and approval of pharmacy premises.) Calculationswere based on the sample needed to detect statistically sig-

nificant differences (p < 0.05) between mean facilitator

862I The Annals of Pharmacotherapy I 2008 June, Volume 42 www.theannals.com

AS Roberts et al.

Table 1. Professional Practice Programs in the Third Community Pharmacy Agreement (20002005)10

Program Description

Residential Medication Management Review a medication review service for persons living in aged-care facilities

Home Medicines Review a collaborative medication review service for persons living at home

Medicines Information to Consumers provides brand-specific written information about medicinal products to consumers in communitypharmacies

Quality Care Pharmacy Program a quality assurance platform incorporating standards of professional services, retail skills, businessmanagement, and loss prevention practices


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factor scores for certain individual variables (eg, role) andpharmacy variables (eg, adopter category) deemed to be ofpractical importance, based on data from the pilot study.14

At 80% power (p = 0.05), 1130 individual responses wereneeded, more than that required to perform factoranalysis.16 Based on the pilot survey, there was an expecta-tion of receiving 1.7 individual responses per pharmacy;

therefore, to achieve the required sample size of 1130, 657pharmacies would need to respond. At an anticipated re-sponse rate of 33%, a total of 2000 pharmacies were ran-domly sampled (stratified by state).

The mail survey was conducted using the standardizedprocess described by Dillman.17 In keeping with the orga-nizational perspective, each pharmacy was sent 3 question-naires, one each for a pharmacy owner, an employed phar-macist, and a pharmacy assistant (including technicians).

RESPONSE

A total of 735 pharmacies responded (37% responserate), with 1303 individual responses received (Table 2).Of the respondents, 957 (73%) were pharmacists, whowere representative of the total population in terms of ageand sex.18 Of that group, 585 (61%) were proprietors. Thisproportion was significantly higher than the 45% in thepopulation of community pharmacists (2 = 10.34; p =0.001), which may be due to the fact that the questionnairewas sent to pharmacies, not to individual pharmacists, andnot all pharmacies returned multiple questionnaires.

DATA ANALYSIS

Factor analysis was performed on the facilitators scale.Examination of the correlation matrix indicated that allitems had a correlation greater than or equal to |0.30| withat least 3 other items in the matrix.15 Bartletts Test ofSphericity was significant (2 = 17655.21; p < 0.001), andthe KMO measure of sampling adequacy was 0.89. Princi-ple axis factoring was the method of extraction used, withequamax orthogonal rotation, as many correlations wereless than 0.32.19 The eigenvalue greater than 1 rule, visual

inspection of the scree plot, and the number of items load-ing well on the factor were all used to determine howmany factors to retain.15,20 Some items were removed dueto poor loading (


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relationships between pharmacists and physicians at the lo-cal level; this relationship is known to be a key facilitatorin the shift toward a greater service orientation and for arange of programs and services.2 At the political level,policies need to be developed and corresponding structuresput in place to connect pharmacists and physicians acrossall levels, from professional organizations to local net-

works. Pharmacists themselves need to work toward thisgoal. For example, the arms-length model of medicationreview delivery adopted by many pharmacies, which es-sentially sees a third party having the main communicationwith physicians,23 could hinder the development of collab-orative relationships.

REMUNERATION

Statements in the questionnaire referred to remunerationeither as incentive payments to assist with the implementa-tion process or payment for the delivery of a service itself,

with both concepts shown to be important. In the case ofHMR, remuneration was provided for delivery of the ser-vice only and did not address wider issues related to imple-mentation and sustainability. This is evident from the dataon HMR delivery, showing that, although nearly all Aus-tralian community pharmacies had registered to be part ofthe HMR program, the actual rate of participation and ser-vice delivery appeared to be low.23

PHARMACY LAYOUT

The items that made up this factor referred to the impor-

tance of the physical layout of the pharmacy relative to theimplementation of programs. Some items specifically re-ferred to the need for a private or designated area for deliv-ery of certain services. An appropriate pharmacy layout, interms of space and privacy, has been highlighted in the lit-erature as a potential facilitator concerning a range ofCPS.2 Many European countries have designated areas inpharmacies specifically for the delivery of services such asdisease state management. Policy makers in Australia havereacted to this research and have adopted the position thatan appropriate pharmacy layout is a prerequisite for partic-ipation in a number of remunerated programs.24

PATIENT EXPECTATION

The concept of consumer demand for services was ex-plored in the items that made up this factor, suggesting notonly that there is a perception that the public expects phar-macies to offer certain services, but also that this acts as afacilitator in the implementation of those services. Thisfinding is consistent with the traditional functions of phar-macies as part of their supply role and place in a retail en-vironment, that is, reacting to the needs of their customers

Practice Change in Community Pharmacy: Quantification of Facilitators


Table4.

CharacteristicsoftheSeven-FactorSolutionFacilitatorsofPracticeChange

Item

Responses,

Loading

Cronbachs

%

Variance

MedianFactor-

Factor-B

ased

Factor-Based

Factor

Facilitator

n

Items,n

Range

Explained

BasedScore

ScaleRa

nge

ScaleMidpoint

1

relationshipwithphysicians

1274

5

0.5

90.8

5

0.9

0

20.17

3.0

1

0.7

53.7

6

2.2

3

2

remuneration

1261

6

0.5

20.7

4

0.8

2

8.46

2.4

7

0.6

43.2

2

1.9

3

3

pharmacylayout

1260

5

0.5

20.7

9

0.8

1

6.16

2.4

5

0.6

43.1

9

1.9

2

4

patientexpectation

1280

4

0.5

20.8

5

0.8

2

4.38

2.2

5

0.7

13.5

3

2.1

2

5

manpower/staff

1273

5

0.4

90.6

6

0.8

0

3.93

2.4

3

0.9

73.0

4

2.0

1

6

communication/teamwork

1280

6

0.3

70.6

5

0.7

7

3.13

2.2

0

1.5

92.6

5

2.1

2

7

externalsupport/assistanc

e

1274

4

0.4

70.6

9

0.7

4

2.55

2.3

9

0.7

32.9

8

1.8

6


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or facing negative financial consequences. It follows that,if patients expect a certain service, the pharmacy will feelboth obliged and motivated to provide it.

MANPOWER/STAFF

Items loading on this factor suggested that having suffi-cient and appropriately trained staff was a key element of,and necessary for, successful implementation. Workforceshortages were a particular problem in Australia at the timeof the study,25 and discussions in the literature suggest thatit is also a problem internationally, with few solutions pro-posed.26-30 Closely linked to this issue is the workload gen-erated by the implementation of new programs and the re-sultant need for additional staff. However, this is not thecomplete solution. If new initiatives are introduced to com-munity pharmacy in an ad hoc manner, without any inte-gration, the workload will simply increase each time a newprogram is commenced. This is important for policy mak-

ers to consider during the planning phases; they should as-sess the workforce requirements not only in terms of num-bers, but also with regard to knowledge, skills, and compe-tencies. To avoid putting existing services at risk,pharmacies must be assisted in preparing for the adoptionof each new service prior to its dissemination.

COMMUNICATION AND TEAMWORK

Statements that made up this factor referred to the im-portance of communicating the reasons for change inter-nally, working as a team to make it happen, and having

someone to lead the change. Previous strategies for imple-menting CPS in community pharmacy seem to have large-ly focused on the pharmacy owner as the agent of change.It is now clear that, although the owners may take a leader-ship role at the pharmacy level, the change process is facil-itated by engaging the entire pharmacy team and allowingthe development of common goals toward which all mem-bers of the organization are working. These concepts, to-gether with leadership, are common elements among manyorganizational change models.13 Policy makers should beaware of this in developing strategies for the disseminationof new programs or services, and educators should include

these elements in training provided to pharmacists. Phar-macy owners should also be cognizant of the need to in-clude their entire staff in the implementation process, evenfor a service that is ostensibly delivered only by the phar-macist, and should include staff members in the processesof planning and goal setting.

EXTERNAL SUPPORT AND ASSISTANCE

For this factor, items highlighted the importance of be-ing able to call on experts and/or consultants, often from

outside pharmacy, when planning and implementingchange. This finding is of particular relevance to profes-sional pharmacy organizations in that they play a key rolein providing support to pharmacists. Implementing newCPS requires support not only with the clinical aspects ofservice delivery, but also with the process of implementa-tion. For example, pharmacies may need assistance in the

process of common goal setting or changing the pharmacylayout and workflow. Mentoring programs, which allowpharmacists to gain assistance from other pharmacists andhave been highlighted by others as facilitators of change,should be supported by policy makers and the professionas a whole.2

Although further research is required to determine addi-tional factors that are affecting the implementation of CPS,the facilitators identified in this study have been adoptedby policy makers in Australia as components of a multi-level practice change strategy for the implementation of re-munerated CPS in Australian community pharmacies.31

The findings also have international applicability; whileprevious research has identified some of these facilitatorsindividually in other countries,2 this study provides a prac-tical framework for their application by the different orga-nizational players.

Limitations

The model for facilitators identified through factor anal-ysis was developed using data from all respondents to givean organizational perspective, incorporating the views ofthe individuals within it. A potential limitation of this ap-

proach, however, is that pharmacy assistants (25% of re-spondents) were included, and they may play only a limit-ed role in the provision of Third Agreement Programs oth-er than the Quality Care Pharmacy Program (QCPP) and,therefore, compared with pharmacists, have a lesser levelof personal experience with the facilitators. Another poten-tial limitation is that a greater proportion of owner pharma-cists responded to the survey than would be expected inthe population18; thus, the results may not be generalizableto pharmacists in other positions.

The facilitators identified in this study reinforce the no-tion that successful practice change requires a multifactori-

al approach. It is clear that remuneration alone, for exam-ple, although a key factor, is not sufficient to achievewidespread change. Future programs for delivery in com-munity pharmacy must address the wider issues of sustain-ability in calculating the rates of remuneration or incentivepayments. Moreover, remuneration is only one factor with-in a broader solution incorporating elements relating to theoverall organizationits individuals and environment. Im-plementing new CPS requires support not only with theclinical aspects of service delivery, but also for the process ofimplementation. Engagement of other healthcare providers


AS Roberts et al.


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and consumers is critical. Enhancing pharmacistphysiciancollaboration and consumer awareness of CPS will facili-tate their uptake by community pharmacies.

Conclusions

Achieving integration of professional services into thebusiness of a community pharmacy requires the effectiveengagement of pharmacists and their staffs, policy makers,educators, and researchers. At the pharmacy level, whenpreparing to implement CPS, there needs to be a plan formanaging the change process that addresses the facilitatorsidentified in this study. Policy makers have a key role insupporting community pharmacies to implement CPS.New services must be part of a greater strategic plan orchange management strategy, and each service must havean implementation strategy that includes all of the individ-ual and organizational elements outlined above. Educationand training should also reflect these findings. Skills in ar-

eas such as leadership, task delegation, goal setting, andteamwork would seem to be of equal importance to phar-macists clinical skills when it comes to integrating a newservice into daily practice. It is critical that, at all levels ofpharmacy practice, there is not only awareness, but also acommitment to use these facilitators to allow the profes-sion to move forward in such a way that community phar-macys role in service provision is strengthened.

Alison S Roberts BPharm(Hons) PhD, Research Fellow, The Uni-versity of Sydney, New South Wales, Australia

Shalom I Benrimoj BPharm(Hons) PhD, Pro-Vice-Chancellor(Strategic Planning), The University of Sydney

Timothy F Chen BPharm DipHPharm PhD, Senior Lecturer, Fac-ulty of Pharmacy, The University of Sydney

Kylie A Williams BPharm DipHPharm PhD, Lecturer, Faculty ofPharmacy, The University of Sydney

Parisa Aslani BPharm(Hons) MSc PhD, Senior Lecturer, Faculty ofPharmacy, The University of Sydney

Reprints: Dr. Roberts, The University of Sydney, NSW 2006 Aus-tralia, fax 61 2 93514391, [email protected]

This work was presented orally and as an abstract entitled Prac-tice Change in Community Pharmacy: the Implementation of Cog-nitive Services at the Australasian Pharmaceutical Science Asso-ciation Scientific Meeting in Melbourne, Australia, 2006, and as aposter and abstract entitled Implementing Change in CommunityPharmacy: Facilitating Factors at the Pharmaceutical Care NetworkEurope Working Conference in Hillerd, Denmark, 2005.

This project was funded by the Australian Government Departmentof Health and Ageing as part of the Third Community PharmacyAgreement

References

1. Roberts AS, Benrimoj SI, Dunphy D, Palmer I. Community pharmacy:strategic change management. Sydney, Australia: McGraw-Hill, 2007.

2. Roberts AS, Benrimoj SI, Chen TF, Williams KA, Aslani P. Implement-ing cognitive services in community pharmacy: a review of facilitatorsof practice change. Int J Pharm Pract 2006;14:163-70.

3. Fact Sheet. Fourth Community Pharmacy Agreement. Australian Gov-ernment Department of Health and Ageing, 2005. www.health.gov.au/in-

ternet/wcms/publishing.nsf/Content/pharmacy-4cpafact2 (accessed2007 Oct 19).

4. Benrimoj SI, Roberts AS. Providing patient care in community pharma-cies in Australia. Ann Pharmacother 2005;39:1911-7. Epub 11 Oct 2005.DOI 10.1345/aph.1G165

5. Johansen IBT. Implementing a pharmaceutical care program in commu-nity pharmacies: effects of organizational characteristics on implementa-tion outcomes, in Pharmacy [PhD thesis]. Madison, WI: University ofWisconsin, 1999.

6. Tindall WN, Millonig MK. Leadership and success: lessons from non-pharmacists. In: Tindall WN, Millonig MK, eds. Pharmaceutical care:insights from community pharmacists. Boca Raton, FL: CRC Press,2003:49-62.

7. Garside P. Organisational context for quality: lessons from the fields oforganisational development and change management. Qual Health Care1998;7(suppl):S8-15.

8. Hopp TR, Srensen EW, Herborg H, Roberts A. Implementation of cog-nitive pharmaceutical services (CPS) in professionally active pharma-cies. Int J Pharm Pract 2005;13:21-32.

9. Roberts AS, Hopp T, Srensen EW, et al. Understanding practice changein community pharmacy: a qualitative research instrument based on or-ganisational theory. Pharm World Sci 2003;25:227-34.

10. The Commonwealth Department of Health and Ageing. Third Commu-nity Pharmacy Agreement Between The Commonwealth of Australia

and The Pharmacy Guild of Australia. 2000.11. Berbatis CG, Sunderland VB, Joyce A, Bulsara M, Mills C. Enhanced

pharmacy services, barriers and facilitators in Australias communitypharmacies: Australias National Pharmacy Database Project. Int JPharm Pract 2007;15:185-91.

12. Roberts AS, Benrimoj SI, Chen TF, Williams KA, Hopp TR, Aslani P.Understanding practice change in community pharmacy: a qualitativestudy in Australia. Res Soc Admin Pharm 2005;1:546-64.

13. Roberts AS, Benrimoj SI, Chen TF, Williams KA, Aslani P. Implement-ing cognitive services in community pharmacy: a review of models andframeworks for change. Int J Pharm Pract 2006;14:105-13.

14. Roberts A, Benrimoj SI, Chen TF, Williams K, Aslani P. Quantification offacilitators to accelerate uptake of cognitive pharmaceutical services (CPS)in community pharmacy. 2004, University of Sydney. www.guild.org.au/public/r&d.asp#reports (accessed 2007 Oct 19).

15. Pett MA, Lackey NR, Sullivan JJ. Making sense of factor analysis: theuse of factor analysis for instrument development in health care research.Thousand Oaks, CA: Sage Publications, 2003.

16. Comrey AL, Lee HB. A first course in factor analysis. 2nd ed. Hillsdale,NJ: Lawrence Erlbaum Associates, 1992.

17. Dillman DA. Mail and telephone surveys. New York: John Wiley &Sons, 1978.

18. Pharmacy labour force to 2001. In: Australian Institute of Health andWelfare, National Health Labour Force Series No. 25. Canberra, Aus-tralia, 2003.

19. Tabachnick BG, Fidell LS. Using multivariate statistics. 4th ed. Boston,MS: Allyn and Bacon, 2001.

20. Graetz B. Principal components and factor analysis. Australian Consor-tium for Social and Political Research Incorporated Winter Program.Melbourne, Australia: La Trobe University, 2003.

21. de Vaus DA. Surveys in social research. 5th ed. Crows Nest, Sydney,Australia: Allen & Unwin, 2002.

22. Peterson RA. A meta-analysis of variance accounted for and factor load-ings in exploratory factor analysis. Marketing Lett 2000;11:261-75.

23. Roberts AS, Benrimoj SI, Chen TF, Williams KA, Aslani P. Implementa-tion of home medicines review (HMR) in community pharmacy. AustPharm 2005;24:808-13.

24. Professional Programs and Services Advisory Committee. AustralianGovernment Department of Health and Ageing, 2007. Diabetes pilot pro-gram questions and answers. www.health.gov.au/internet/wcms/publishing.nsf/Content/ppsac-qa-dpp (accessed 2007 Aug 21).

25. Health Care Intelligence Pty Ltd. A study of the demand and supply ofpharmacists, 20002010 [final report]. Sydney: 2003. www.guild.org.au/

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uploadedfiles/Research_and_Development_Grants_Program/Projects/2001-501_fr.pdf (accessed 2007 Oct 19).

26. Dolovich L, Ho CS, Wichman K, Bowles-Jordan J. The provision of en-hanced pharmacy services in Ontario. Can Pharm J 2002;135:29-36.

27. Doucette WR, Koch YD. An exploratory study of community pharmacypractice change. J Am Pharm Assoc 2000;40:384-91.

28. MacKeigan L, Bennett M, Cable G, Buerki R. Cooperative model fordeveloping a pharmaceutical care system in a community pharmacy.Presented at: American Association of Colleges of Pharmacy Annual

Meeting, 1994.29. Odedina FT, Segal R, Hepler C. Providing pharmaceutical care in com-munity practice: differences between providers and non-providers ofpharmaceutical care. J Soc Admin Pharm 1995;12:170-80.

30. Tully MP, Seston EM, Cantrill JA. Motivators and barriers to the imple-mentation of pharmacist-run prescription monitoring and review servicesin two settings. Int J Pharm Pract 2000;8:188-97.

31. Australian Government Department of Health and Ageing, 2007. Pro-fessional programs and services. www.health.gov.au/internet/wcms/publishing.nsf/Content/ppsac-pps (accessed 2007 Oct 19).

Cambio de la Prctica Profesional de la Farmacia Comunitaria:Cuantificacin de Factores que lo Facilitan

AS Roberts, SI Benrimoj, TF Chen, KA Williams, y P Aslani

Ann Pharmacother2008;42:861-8.

EXTRACTO

INTRODUCCIN: Internacionalmente hay una creciente tendencia hacia laprestacin de servicios farmacuticos cognitivos (CPS) en la farmaciacomunitaria. Los CPS se han desarrollado y diseminadoindividualmente, sin una estructura que apuntale su implementacin ycon un conocimiento limitado de los factores que pueden ayudar alcambio en la prctica profesional. El proceso de implementacin escomplejo y engloba un conjunto de factores internos y externos.

OBJETIVO: Cuantificar los factores que facilitan el cambio de la prcticaprofesional en las farmacias comunitarias australianas.

MTODOS: Una revisin bibliogrfica y un estudio cualitativo inspiraronel diseo de una escala de 43 puntos que facilitan el cambio deprctica como parte de un instrumento de investigacin, utilizando unaestructura de teora organizativa. El cuestionario fue pilotado (n = 100) yluego enviado por correo electrnico a una muestra aleatoria de 2000farmacias comunitarias, con una copia para cada farmacutico titular,farmacutico adjunto y auxiliar de farmacia. La validez y fiabilidad de laescala fueron establecidas utilizando el anlisis de factores exploratoriosy la alpha de Cronbach, respectivamente.

RESULTADOS: Respondieron 735 farmacias (tasa de respuesta 37%), con1303 cuestionarios individuales. El anlisis de los factores de la escalamostr que siete factores explicaban el 48.8% de la varianza total. Losfactores fueron: relacin con los mdicos (rango de ponderacin 0.590.85; alfa de Cronbach 0.90), remuneracin (0.520.74; 0.82), estructurade la farmacia (0.520.79; 0.81), expectativas de los pacientes (0.520.85;

0.82), personal/plantilla (0.490.66; 0.80), comunicacin y trabajo enequipo (0.370.65; 0.77) y apoyo externo/asistencia (0.470.69; 0.74).

CONCLUSIONES: Todos los factores mostraron una buena fiabilidad yvalidez de constructo y explicaron aproximadamente la mitad de lavarianza. Implementar los CPS requiere apoyo, no slo con los aspectos

clnicos de la prestacin del servicio, sino tambin para el proceso deimplementacin en si mismo y ello debe reflejarse en los modelos deremuneracin. Los factores que facilitan el cambio identificados debenutilizarse en una estrategia multinivel para integrar los serviciosprofesionales en la actividad de la farmacia comunitaria; implicar a losfarmacuticos y su personal, a quienes disean las polticas y a loseducadores e investigadores. Es necesario realizar nuevasinvestigaciones para establecer que otros factores influyen en lacapacidad de la farmacia comunitaria para implementar el cambio.

Traducido por Juan del Arco

Agents de Changement dans la Pratique en PharmacieCommunautaire

AS Roberts, SI Benrimoj, TF Chen, KA Williams, et P Aslani

Ann Pharmacother2008;42:861-8.

RSUM

MISE EN CONTEXTE: Une forte tendance sest dveloppe au niveauinternational pour la prestation de soins pharmaceutiques et deconsultation (SPC) en pharmacie communautaire. Les SPC se sontdvelopps de faon individuelle et se sont dissmins sans la prsencedun cadre entourant leur implmentation et avec une connaissance

limite des facteurs pouvant influencer un tel changement. Ce processusdimplmentation est complexe et comprends une varit de facteursinternes et externes.

OBJECTIFS: Mesurer les agents de changement dans les pharmaciescommunautaires en Australie.

MTHODES: Une revue de littrature et une tude qualitative ont servi lacration dune chelle de 43 points Agents de changements de lapratique faisant partie dun instrument de sondage quantificatif utilisantun concept de thorie organisationnelle. Le questionnaire a t dabordvalid (n = 100) puis post au hasard 2000 pharmaciescommunautaires, une copie tant destine au propritaire, pharmaciensalari et assistant-pharmacien. La validit et la fiabilit de lchelle ontt tablies avec une analyse de facteur exploratoire et le test alpha deCronbach, respectivement.

RSULTATS: Sept cent trente cinq pharmacies ont rpondu au

questionnaire (taux de rponse 37%), soit 1303 questionnairesindividuels. Lanalyse des facteurs a permis lidentification de 7variables expliquant 48.8% de la variance totale. Ces facteurs taient:relations avec les mdecins (limite de charge 0.590.85; Cronbach 0.90),rmunration (0.520.74; 0.82), amnagement de la pharmacie(0.520.79; 0.81), attentes des patients (0.520.85; 0.82), ressourceshumaines (0.490.66; 0.80), communication et travail dquipe(0.370.65; 0.77), et ressources externes (0.470.69; 0.74).

CONCLUSIONS: Tous les facteurs ont dmontr une bonne fiabilit et unevalidit, expliquant approximativement la moiti de la variance.Limplmentation des SPC ncessitent du support non seulement pourles aspects cliniques, mais aussi sur les processus dimplmentation quedoivent reflter les modles de rmunration. Lidentification de cesfacteurs devrait tre employe dans une stratgie visant intgrer lesservices professionnels dans la pratique de la pharmacie communautaireet rejoindre les pharmaciens et leur personnel, les lgislateurs, le

milieu dducation et les chercheurs. Plus dtudes sont ncessaires afinde dterminer les facteurs affectant la capacit des pharmaciescommunautaires implanter ces changements.

Traduit par Nicolas Paquette-Lamontagne


AS Roberts et al.

practice change in community pharmacy

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