What is holding pharmacists back?

Abstract

Much has been written about the scope of pharmacy practice in Canada over the past decade. The benefits of pharmacists to the primary care team, in terms of both cost and patient health, are well documented, as are the reasons why community pharmacists have yet to widely adopt this new role.1-3 Barriers commonly reported by pharmacists generally involve issues of time, money, training and lack of support from patients and other health care professionals.4-6 Despite these self-perceived barriers, expectations of pharmacists continue to increase, as do support and funding, particularly in Alberta. Alberta, a worldwide leader in pharmacy practice, has given pharmacists one of the largest scopes of practice and amount of financial support in the world. Despite this, uptake of pharmacy services remains largely superficial. Pharmacists in Alberta are able to prescribe and adapt medications, administer medications by injection and develop patient care plans, but they average fewer than 2 of these services per pharmacy per day.7-9 The continued support for pharmacy services in Alberta brings into question whether the aforementioned barriers are the only issues holding back pharmacists. Indeed, evidence suggests that removing self-reported barriers is not sufficient to promote practice change.5 Rosenthal et al.10 provided a unique explanation of this poor uptake of clinical services. These authors hypothesized that pharmacists themselves are holding back practice change by undervaluing their own training and being unable to apply their knowledge in the novel ways expected from a primary care clinician. I believe that the ideas suggested by Rosenthal et al. are likely a major contributor to the lack of uptake of practice change, but I also believe that the issue comes back to a more basic problem: Many pharmacists do not perceive the necessity of change.