Practice Change in Community Pharmacy: Quantification of Facilitators

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

he international pharmacy practice literature has documented shifts in the orientation of community pharmacy practice over the past century along a continuum of manufacturing, compounding, and distribution to clinical services, pharmaceutical care, and more recently, cognitive pharmaceutical services (CPS).1 CPS are professional services provided by pharmacists, using their skills and knowledge to take an active role in contributing to patient health through effective interaction with both patients and other health professionals.2 Community pharmacy in Australia has been at the forefront of this international trend toward the delivery of remunerated CPS. Since 1990, the profession has negotiated 5-year Community Pharmacy Agreements with the Australian government. These agreements cover all aspects of remuneration for community pharmacies and have created an increased focus on CPS provision.3 The agreements have been significant drivers of practice change, which, in this context, refers to the shift in focus from product supply to patient-centered service delivery. The factors causing this shift are complex and include issues such as changes in govAuthor information provided at the end of the text.

There has been an increasing international trend toward the delivery 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:

BACKGROUND:

To quantify facilitators of practice change in Australian community

pharmacies.
METHODS: We employed a literature review and qualitative study to facilitate the design 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 individual questionnaires. 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 construct validity and explained approximately half of the variance. Implementing CPS requires support not only with the clinical aspects of service delivery, but also for the 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.

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ernment policy, resulting in declining profit margins on prescription products, leading to the development of other income sources to ensure sustainability.4 CPS programs appear to have been developed and disseminated individually, without a framework underpinning their implementation or inclusion of factors that might facilitate practice change. One of the major implications of this is reduced uptake of CPS. Significant attention has been given to barriers to CPS adoption, focusing largely at the practitioner level. A review of facilitators of practice change in community pharmacy concluded that there is a need to clarify how identified facilitators (defined as elements that make adopting a new behavior or practice easier) can be used in practice to accelerate the implementation of CPS.2 The factors affecting change are more than just those confined to the individual pharmacist who is being trained through traditional, clinically focused, didactic education programs to provide CPS. Broader educational, social, and financial factors are involved,4 and thus research that adopts an organizational perspective is needed. This approach, successfully used in other healthcare settings,5-7 allows the identification of factors affecting practice change beyond the perspective of the individual pharmacist, as aspects such as culture, structure, and the environment are brought into consideration.8,9 The aim of our research, therefore, was to identify the key components needed for the development of a practice change model for Australian community pharmacies. The specific objectives were to develop and validate an instrument to allow the identification and quantification of facilitators of practice change, drawing on the experiences of those involved with existing community pharmacy services and programs (Table 110). This approach was different from that of previous studies in which services have been more loosely defined, and the proportion of respondents with experience of the services has been low; hence, facilitators have sometimes been based on perception rather than experience.2,11 Methods
THEORETICAL FRAMEWORK

munity pharmacy perspective and to assist in better understanding the change process for the whole pharmacy.9 This theoretical framework was the underpinning for a qualitative study, the results of which were used to generate items for the quantitative research instrument.12
INSTRUMENT DESIGN

Literature reviews2,13 and data from the qualitative study12 facilitated the design of a structured questionnaire, with sections that include adoption of Third Agreement Programs4 (Table 1), facilitators of practice change scale (facilitators scale) consisting of 74 items based on 13 constructs that are measured using a 5-point Likert scale ranging from Strongly Disagree (1) to Strongly Agree (5), individual respondent and pharmacy demographics, and free comments.
INSTRUMENT VALIDITY AND RELIABILITY TESTING

The content and construct validity of the questionnaire were established in a pilot mail survey of a random sample of Australian community pharmacies (N = 100).14 To test construct validity, factor analysis was performed on the data from the facilitators scale. Factor analysis is a technique used to reduce a set of observed variables to a smaller number of underlying factors.15 The internal consistency or reliability of the factors was measured using Cronbachs . The results of these analyses allowed changes to be made to the research instrument and a sample size to be calculated for the main study.14
POPULATION AND SAMPLE

A broad framework of organizational theory was used to identify factors that affect practice change from a com-

Ethics approval for the research was obtained from the Human Research Ethics Committee at the University of Sydney. Contact details of all Australian community pharmacies (N = 4926) were obtained from the Pharmacy boards and the telephone directory. (Pharmacy boards are regulatory authorities in the 6 states and 2 territories within Australia and are responsible for the registration of pharmacists and approval of pharmacy premises.) Calculations were based on the sample needed to detect statistically significant differences (p < 0.05) between mean facilitator

Table 1. Professional Practice Programs in the Third Community Pharmacy Agreement (20002005)10
Program Residential Medication Management Review Home Medicines Review Medicines Information to Consumers Quality Care Pharmacy Program Description a medication review service for persons living in aged-care facilities a collaborative medication review service for persons living at home provides brand-specific written information about medicinal products to consumers in community pharmacies a quality assurance platform incorporating standards of professional services, retail skills, business management, and loss prevention practices

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factor scores for certain individual variables (eg, role) and pharmacy variables (eg, adopter category) deemed to be of practical importance, based on data from the pilot study.14 At 80% power (p = 0.05), 1130 individual responses were needed, more than that required to perform factor analysis.16 Based on the pilot survey, there was an expectation of receiving 1.7 individual responses per pharmacy; therefore, to achieve the required sample size of 1130, 657 pharmacies would need to respond. At an anticipated response rate of 33%, a total of 2000 pharmacies were randomly sampled (stratified by state). The mail survey was conducted using the standardized process described by Dillman.17 In keeping with the organizational perspective, each pharmacy was sent 3 questionnaires, one each for a pharmacy owner, an employed pharmacist, and a pharmacy assistant (including technicians).
RESPONSE

inspection of the scree plot, and the number of items loading well on the factor were all used to determine how many factors to retain.15,20 Some items were removed due to poor loading (<0.30) or cross-loading. The decision of item retention was assisted by the use of Cronbachs , to see whether the coefficient would be positively affected by the removal of an item.15 Factor scores were calculated using the weighted factor-based scales method, which takes the factor loadings into account so that items with the highest loadings contribute the most to the factor score.16,21 Results
FACTOR ANALYTICAL MODEL

A total of 735 pharmacies responded (37% response rate), with 1303 individual responses received (Table 2). Of the respondents, 957 (73%) were pharmacists, who were representative of the total population in terms of age and sex.18 Of that group, 585 (61%) were proprietors. This proportion was significantly higher than the 45% in the population of community pharmacists (2 = 10.34; p = 0.001), which may be due to the fact that the questionnaire was sent to pharmacies, not to individual pharmacists, and not all pharmacies returned multiple questionnaires.
DATA ANALYSIS

Seven facilitators were identified (Table 3). This factor solution explained 48.8% of the total variance (Table 4), and although there are no definitive guidelines as to what constitutes an appropriate amount of variance explained, this result can be considered good.15,22 Each of the factors was judged as reliable, having a Cronbachs of greater than 0.7 (Table 4). In all cases, the factor-based scales were non-normally distributed. The median factor score was higher than the midpoint of the new scale range, which indicated that the majority of respondents were in agreement with the items forming that factor. Discussion Our study identified 7 facilitators of practice change. Although some of them have previously been identified individually, they have not been presented as elements of a total solution, with little effort given toward exploring how they could be integrated for use in practice, particularly at the different organizational levels.2 Furthermore, the facilitators identified in this study were based on existing programs disseminated to community pharmacies, and participants responded based on their actual experience of implementing the programs. The facilitators are therefore discussed below with specific emphasis on their practical application and relevance for key stakeholder groups.
RELATIONSHIP WITH PHYSICIANS

Factor analysis was performed on the facilitators scale. Examination of the correlation matrix indicated that all items had a correlation greater than or equal to |0.30| with at least 3 other items in the matrix.15 Bartletts Test of Sphericity was significant (2 = 17655.21; p < 0.001), and the KMO measure of sampling adequacy was 0.89. Principle axis factoring was the method of extraction used, with equamax orthogonal rotation, as many correlations were less than 0.32.19 The eigenvalue greater than 1 rule, visual

Table 2. Respondents Roles/Positions in the Pharmacy

Relative Frequency (%) 44.9 26.9 25.0 2.1 1.2 100

Position Proprietor pharmacist Employee pharmacist Pharmacy assistant (including technicians) Other Missing data
TOTAL

Frequency (n) 585 350 326 27 15 1303

Items that constituted this factor referred to the role of pharmacistphysician relationships for the implementation of new programs, suggesting that building rapport with local physicians was important to the programs success. This factor contributed almost half of the total solution, which is not surprising given that the main CPS experience for most pharmacies related to home medicines review (HMR), a service involving collaboration between physicians and pharmacists (Table 1). There needs to be greater focus on the development and maintenance of cooperative
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Table 3. Factor Loadings of Items in the Seven-Factor Solution from the Facilitators Scalea
Items 0.846 0.820 0.765 0.737 0.588 0.032 0.049 0.082 0.053 0.060 0.742 0.730 0.697 0.602 0.576 0.519 0.037 0.033 0.027 0.017 0.001 0.043 0.014 0.026 0.009 0.014 0.005 0.037 0.175 0.155 0.073 0.149 0.075 0.110 0.125 0.123 0.145 0.136 0.088 0.127 0.165 0.143 0.157 0.134 0.088 0.072 0.115 0.124 0.192 0.097 0.085 0.005 0.039 0.034 0.024 0.114 0.107 0.096 0.009 0.077 0.036 0.008 0.169 0.075 0.024 0.062 1 2 3 4 5 6 7 0.061 0.071 0.101 0.107 0.172 0.016 0.023 0.053 0.022 0.072 0.042

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0.084 0.114 0.167 0.049 0.161 0.085 0.152 0.092 0.182 0.119 0.085 0.118 0.146 0.077 0.050 0.045 0.105 0.103 0.083 0.075 0.145 0.043 0.082 0.069 0.028 0.018 0.054 0.016 0.091 0.162 0.159 0.185 0.116 0.004 0.040 0.008 0.011 0.100 0.034 0.064 0.045 0.069 0.019 0.084 0.080 0.046 0.036 0.090 0.792 0.728 0.596 0.555 0.518 0.061 0.090 0.109 0.110 0.161 0.038 0.143 0.135 0.149 0.123 0.062 0.157 0.151 0.093 0.126 0.141 0.152 0.105 0.055 0.106 0.122 0.084 0.076 0.122 0.168 0.139 0.050 0.130 0.079 0.854 0.006 0.756 0.039 0.692 0.018 0.519 0.114 0.080 0.050 0.012 0.026 0.055 0.066 0.095 0.069 0.110 0.145 0.072 0.109 0.120 0.113 0.069 0.663 0.657 0.634 0.593 0.493 0.090 0.132 0.059 0.171 0.162 0.155 0.076 0.065 0.006 0.151 0.114 0.002 0.215 0.084 0.163 0.067 0.040 0.185 0.099 0.298 0.060 0.129 0.011 0.257

Factor

1 Relationship with physicians

communicating with physicians assists the implementation of Third Agreement Programs it is important to work with physicians when implementing Third Agreement Programs a good working relationship with physicians is essential for implementing Third Agreement Programs cooperation with physicians is a key element of Third Agreement Programs having a good relationship with local general practitioners aids implementation of Third Agreement Programs

2 Remuneration

payment is necessary for implementation of Third Agreement Programs without payment, Third Agreement Programs would not be sustainable there should be incentive payment for pharmacies to implement Third Agreement Programs it is important to ensure that Third Agreement Programs are profitable for pharmacies Third Agreement Programs cannot be implemented without pharmacies receiving payment having payment available for Third Agreement Programs is a key concern in deciding to implement them

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3 Pharmacy layout

having the right pharmacy layout is important for implementing Third Agreement Programs an appropriate pharmacy design is necessary for Third Agreement Programs we need a designated area in the pharmacy for delivering certain Third Agreement Programs pharmacy store design is important for the implementation of Third Agreement Programs it is important to have a room or private space in the pharmacy for delivery of some Third Agreement Programs

0.071 0.144 0.083 0.197 0.118 0.091 0.111 0.070 0.128 0.079 0.033 0.165 0.092 0.068 0.652 0.176 0.588 0.164 0.574 0.194 0.568 0.112 0.435 0.209 0.368 0.220 0.077 0.689 0.137 0.680 0.178 0.549 0.228 0.469

4 Patient expectation

we are motivated to implement Third Agreement Programs because our customers expect them we become involved in Third Agreement Programs because our patients expect us to be involved the publics expectations of us are that we provide Third Agreement Programs there is demand from the public for Third Agreement Programs

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5 Manpower/staff

having enough staff is important for Third Agreement Programs Third Agreement Programs cannot be implemented without having enough staff the amount of manpower in the pharmacy affects the implementation of Third Agreement Programs without sufficient numbers of pharmacists and other staff, Third Agreement Programs cannot be implemented sufficient manpower is a key factor in implementing Third Agreement Programs

6 Communication/ teamwork

it is important that all staff work as a team when implementing a Third Agreement Program Third Agreement Programs are implemented by the pharmacy staff working together it is important to communicate to all staff what changes will be occurring in the pharmacy when implementing Third Agreement Programs having good communication strategies in the pharmacy helps in the implementation of Third Agreement Programs it is important that someone take a leadership role when implementing Third Agreement Programs mechanisms for communication, such as staff meetings, are important when implementing Third Agreement Programs

7 External support/ assistance

it is good to have people external to the pharmacy who can provide support for practice change when we need it it is helpful to have access to someone from outside the pharmacy to assist us with implementing Third Agreement Programs external expert advisors can provide support to us when we are implementing Third Agreement Programs it is of help to us to have access to experts in implementing Third Agreement Programs extraction method: principal axis factoring rotation method: equamax with Kaiser normalization

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Factor loadings appear in bold face.

Practice Change in Community Pharmacy: Quantification of Facilitators

Median FactorBased Score

relationships between pharmacists and physicians at the local level; this relationship is known to be a key facilitator in the shift toward a greater service orientation and for a range of programs and services.2 At the political level, policies need to be developed and corresponding structures put in place to connect pharmacists and physicians across all levels, from professional organizations to local networks. Pharmacists themselves need to work toward this goal. For example, the arms-length model of medication review delivery adopted by many pharmacies, which essentially sees a third party having the main communication with physicians,23 could hinder the development of collaborative relationships.
REMUNERATION

Factor-Based Scale Midpoint

2.23

1.93

1.92

2.12

2.01 0.973.04 2.43

2.12 1.592.65 2.20

Factor-Based Scale Range

0.753.76

0.643.22

0.643.19

0.713.53

3.01

2.47

2.45

2.25

Table 4. Characteristics of the Seven-Factor SolutionFacilitators of Practice Change

2.39

0.732.98

1.86

Statements in the questionnaire referred to remuneration either as incentive payments to assist with the implementation process or payment for the delivery of a service itself, with both concepts shown to be important. In the case of HMR, remuneration was provided for delivery of the service only and did not address wider issues related to implementation and sustainability. This is evident from the data on HMR delivery, showing that, although nearly all Australian community pharmacies had registered to be part of the HMR program, the actual rate of participation and service delivery appeared to be low.23
PHARMACY LAYOUT

% Variance Explained

20.17

8.46

6.16

4.38

3.93 0.80 0.490.66

3.13 0.77 0.370.65

Cronbachs

0.90

0.82

0.81

0.82

0.590.85

0.520.74

0.520.79

0.520.85

Item Loading Range

0.470.69

0.74

2.55

external support/assistance

relationship with physicians

The items that made up this factor referred to the importance of the physical layout of the pharmacy relative to the implementation of programs. Some items specifically referred to the need for a private or designated area for delivery of certain services. An appropriate pharmacy layout, in terms of space and privacy, has been highlighted in the literature as a potential facilitator concerning a range of CPS.2 Many European countries have designated areas in pharmacies specifically for the delivery of services such as disease state management. Policy makers in Australia have reacted to this research and have adopted the position that an appropriate pharmacy layout is a prerequisite for participation in a number of remunerated programs.24
PATIENT EXPECTATION

Items, n

5 1273 manpower/staff

6 1280 communication/teamwork

Responses, n

1274

1261

1260

1280

pharmacy layout

patient expectation

Facilitator

1274

The concept of consumer demand for services was explored in the items that made up this factor, suggesting not only that there is a perception that the public expects pharmacies to offer certain services, but also that this acts as a facilitator in the implementation of those services. This finding is consistent with the traditional functions of pharmacies as part of their supply role and place in a retail environment, that is, reacting to the needs of their customers
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or facing negative financial consequences. It follows that, if patients expect a certain service, the pharmacy will feel both obliged and motivated to provide it.
MANPOWER/STAFF

Items loading on this factor suggested that having sufficient and appropriately trained staff was a key element of, and necessary for, successful implementation. Workforce shortages were a particular problem in Australia at the time of the study,25 and discussions in the literature suggest that it is also a problem internationally, with few solutions proposed.26-30 Closely linked to this issue is the workload generated by the implementation of new programs and the resultant need for additional staff. However, this is not the complete solution. If new initiatives are introduced to community pharmacy in an ad hoc manner, without any integration, the workload will simply increase each time a new program is commenced. This is important for policy makers to consider during the planning phases; they should assess the workforce requirements not only in terms of numbers, but also with regard to knowledge, skills, and competencies. To avoid putting existing services at risk, pharmacies must be assisted in preparing for the adoption of each new service prior to its dissemination.
COMMUNICATION AND TEAMWORK

outside pharmacy, when planning and implementing change. This finding is of particular relevance to professional pharmacy organizations in that they play a key role in providing support to pharmacists. Implementing new CPS requires support not only with the clinical aspects of service delivery, but also with the process of implementation. For example, pharmacies may need assistance in the process of common goal setting or changing the pharmacy layout and workflow. Mentoring programs, which allow pharmacists to gain assistance from other pharmacists and have been highlighted by others as facilitators of change, should be supported by policy makers and the profession as a whole.2 Although further research is required to determine additional factors that are affecting the implementation of CPS, the facilitators identified in this study have been adopted by policy makers in Australia as components of a multilevel practice change strategy for the implementation of remunerated CPS in Australian community pharmacies.31 The findings also have international applicability; while previous research has identified some of these facilitators individually in other countries,2 this study provides a practical framework for their application by the different organizational players. Limitations

Statements that made up this factor referred to the importance of communicating the reasons for change internally, working as a team to make it happen, and having someone to lead the change. Previous strategies for implementing CPS in community pharmacy seem to have largely focused on the pharmacy owner as the agent of change. It is now clear that, although the owners may take a leadership role at the pharmacy level, the change process is facilitated by engaging the entire pharmacy team and allowing the development of common goals toward which all members of the organization are working. These concepts, together with leadership, are common elements among many organizational change models.13 Policy makers should be aware of this in developing strategies for the dissemination of new programs or services, and educators should include these elements in training provided to pharmacists. Pharmacy owners should also be cognizant of the need to include their entire staff in the implementation process, even for a service that is ostensibly delivered only by the pharmacist, and should include staff members in the processes of planning and goal setting.
EXTERNAL SUPPORT AND ASSISTANCE

For this factor, items highlighted the importance of being able to call on experts and/or consultants, often from
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The model for facilitators identified through factor analysis was developed using data from all respondents to give an organizational perspective, incorporating the views of the individuals within it. A potential limitation of this approach, however, is that pharmacy assistants (25% of respondents) were included, and they may play only a limited role in the provision of Third Agreement Programs other than the Quality Care Pharmacy Program (QCPP) and, therefore, compared with pharmacists, have a lesser level of personal experience with the facilitators. Another potential limitation is that a greater proportion of owner pharmacists responded to the survey than would be expected in the population18; thus, the results may not be generalizable to pharmacists in other positions. The facilitators identified in this study reinforce the notion that successful practice change requires a multifactorial approach. It is clear that remuneration alone, for example, although a key factor, is not sufficient to achieve widespread change. Future programs for delivery in community pharmacy must address the wider issues of sustainability in calculating the rates of remuneration or incentive payments. Moreover, remuneration is only one factor within a broader solution incorporating elements relating to the overall organizationits individuals and environment. Implementing new CPS requires support not only with the clinical aspects of service delivery, but also for the process of implementation. Engagement of other healthcare providers
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and consumers is critical. Enhancing pharmacistphysician collaboration and consumer awareness of CPS will facilitate their uptake by community pharmacies. Conclusions Achieving integration of professional services into the business of a community pharmacy requires the effective engagement of pharmacists and their staffs, policy makers, educators, and researchers. At the pharmacy level, when preparing to implement CPS, there needs to be a plan for managing the change process that addresses the facilitators identified in this study. Policy makers have a key role in supporting community pharmacies to implement CPS. New services must be part of a greater strategic plan or change management strategy, and each service must have an implementation strategy that includes all of the individual and organizational elements outlined above. Education and training should also reflect these findings. Skills in areas such as leadership, task delegation, goal setting, and teamwork would seem to be of equal importance to pharmacists clinical skills when it comes to integrating a new service into daily practice. It is critical that, at all levels of pharmacy practice, there is not only awareness, but also a commitment to use these facilitators to allow the profession to move forward in such a way that community pharmacys role in service provision is strengthened.
Alison S Roberts BPharm(Hons) PhD, Research Fellow, The University 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, Faculty of Pharmacy, The University of Sydney Kylie A Williams BPharm DipHPharm PhD, Lecturer, Faculty of Pharmacy, The University of Sydney Parisa Aslani BPharm(Hons) MSc PhD, Senior Lecturer, Faculty of Pharmacy, The University of Sydney Reprints: Dr. Roberts, The University of Sydney, NSW 2006 Australia, fax 61 2 93514391, roberts_alison@bigpond.com
This work was presented orally and as an abstract entitled Practice Change in Community Pharmacy: the Implementation of Cognitive Services at the Australasian Pharmaceutical Science Association Scientific Meeting in Melbourne, Australia, 2006, and as a poster and abstract entitled Implementing Change in Community Pharmacy: Facilitating Factors at the Pharmaceutical Care Network Europe Working Conference in Hillerd, Denmark, 2005. This project was funded by the Australian Government Department of Health and Ageing as part of the Third Community Pharmacy Agreement

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AS Roberts et al. uploadedfiles/Research_and_Development_Grants_Program/Projects/ 2001-501_fr.pdf (accessed 2007 Oct 19). Dolovich L, Ho CS, Wichman K, Bowles-Jordan J. The provision of enhanced pharmacy services in Ontario. Can Pharm J 2002;135:29-36. Doucette WR, Koch YD. An exploratory study of community pharmacy practice change. J Am Pharm Assoc 2000;40:384-91. MacKeigan L, Bennett M, Cable G, Buerki R. Cooperative model for developing a pharmaceutical care system in a community pharmacy. Presented at: American Association of Colleges of Pharmacy Annual Meeting, 1994. Odedina FT, Segal R, Hepler C. Providing pharmaceutical care in community practice: differences between providers and non-providers of pharmaceutical care. J Soc Admin Pharm 1995;12:170-80. Tully MP, Seston EM, Cantrill JA. Motivators and barriers to the implementation of pharmacist-run prescription monitoring and review services in two settings. Int J Pharm Pract 2000;8:188-97. Australian Government Department of Health and Ageing, 2007. Professional programs and services. www.health.gov.au/internet/wcms/ publishing.nsf/Content/ppsac-pps (accessed 2007 Oct 19).

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clnicos de la prestacin del servicio, sino tambin para el proceso de implementacin en si mismo y ello debe reflejarse en los modelos de remuneracin. Los factores que facilitan el cambio identificados deben utilizarse en una estrategia multinivel para integrar los servicios profesionales en la actividad de la farmacia comunitaria; implicar a los farmacuticos y su personal, a quienes disean las polticas y a los educadores e investigadores. Es necesario realizar nuevas investigaciones para establecer que otros factores influyen en la capacidad de la farmacia comunitaria para implementar el cambio.
Traducido por Juan del Arco

29.

30.

Agents de Changement dans la Pratique en Pharmacie Communautaire

AS Roberts, SI Benrimoj, TF Chen, KA Williams, et P Aslani Ann Pharmacother 2008;42:861-8.
RSUM

31.

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 Pharmacother 2008;42:861-8.
EXTRACTO
INTRODUCCIN: Internacionalmente hay una creciente tendencia hacia la prestacin de servicios farmacuticos cognitivos (CPS) en la farmacia comunitaria. Los CPS se han desarrollado y diseminado individualmente, sin una estructura que apuntale su implementacin y con un conocimiento limitado de los factores que pueden ayudar al cambio en la prctica profesional. El proceso de implementacin es complejo y engloba un conjunto de factores internos y externos. OBJETIVO: Cuantificar los factores que facilitan el cambio de la prctica profesional en las farmacias comunitarias australianas. MTODOS: Una revisin bibliogrfica y un estudio cualitativo inspiraron el diseo de una escala de 43 puntos que facilitan el cambio de prctica como parte de un instrumento de investigacin, utilizando una estructura de teora organizativa. El cuestionario fue pilotado (n = 100) y luego enviado por correo electrnico a una muestra aleatoria de 2000 farmacias comunitarias, con una copia para cada farmacutico titular, farmacutico adjunto y auxiliar de farmacia. La validez y fiabilidad de la escala fueron establecidas utilizando el anlisis de factores exploratorios y la alpha de Cronbach, respectivamente. RESULTADOS: Respondieron 735 farmacias (tasa de respuesta 37%), con 1303 cuestionarios individuales. El anlisis de los factores de la escala mostr que siete factores explicaban el 48.8% de la varianza total. Los factores fueron: relacin con los mdicos (rango de ponderacin 0.59 0.85; alfa de Cronbach 0.90), remuneracin (0.520.74; 0.82), estructura de 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 en equipo (0.370.65; 0.77) y apoyo externo/asistencia (0.470.69; 0.74). CONCLUSIONES: Todos los factores mostraron una buena fiabilidad y validez de constructo y explicaron aproximadamente la mitad de la varianza. Implementar los CPS requiere apoyo, no slo con los aspectos

Une forte tendance sest dveloppe au niveau international pour la prestation de soins pharmaceutiques et de consultation (SPC) en pharmacie communautaire. Les SPC se sont dvelopps de faon individuelle et se sont dissmins sans la prsence dun cadre entourant leur implmentation et avec une connaissance limite des facteurs pouvant influencer un tel changement. Ce processus dimplmentation est complexe et comprends une varit de facteurs internes et externes. OBJECTIFS: Mesurer les agents de changement dans les pharmacies communautaires en Australie. MTHODES: Une revue de littrature et une tude qualitative ont servi la cration dune chelle de 43 points Agents de changements de la pratique faisant partie dun instrument de sondage quantificatif utilisant un concept de thorie organisationnelle. Le questionnaire a t dabord valid (n = 100) puis post au hasard 2000 pharmacies communautaires, une copie tant destine au propritaire, pharmacien salari et assistant-pharmacien. La validit et la fiabilit de lchelle ont t tablies avec une analyse de facteur exploratoire et le test alpha de Cronbach, respectivement. RSULTATS: Sept cent trente cinq pharmacies ont rpondu au questionnaire (taux de rponse 37%), soit 1303 questionnaires individuels. Lanalyse des facteurs a permis lidentification de 7 variables 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), ressources humaines (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 une validit, expliquant approximativement la moiti de la variance. Limplmentation des SPC ncessitent du support non seulement pour les aspects cliniques, mais aussi sur les processus dimplmentation que doivent reflter les modles de rmunration. Lidentification de ces facteurs devrait tre employe dans une stratgie visant intgrer les services professionnels dans la pratique de la pharmacie communautaire et rejoindre les pharmaciens et leur personnel, les lgislateurs, le milieu dducation et les chercheurs. Plus dtudes sont ncessaires afin de dterminer les facteurs affectant la capacit des pharmacies communautaires implanter ces changements.
MISE EN CONTEXTE:

Traduit par Nicolas Paquette-Lamontagne

868

The Annals of Pharmacotherapy

2008 June, Volume 42

www.theannals.com