Cognitive Pharmaceutical Services Research Articles

Preferences of patients regarding community pharmacy services: A discrete choice experiment

BackgroundThe community pharmacy profession is in transition, with emphasis on the provision of cognitive pharmaceutical services (CPS). In contrast, previous research showed that the general public prefers more convenience related services. However, this was based on currently available services and not on innovative services. ObjectiveTo identify patients’ preferences regarding innovative pharmacy services and whether they tend towards convenience related or CPS. DesignOnline survey using a discrete choice experiment (DCE). ParticipantsParticipants were from the AMP pharmacy patient panel. Main outcome measures: Preferences (utility scores) and the identification of specific classes (latent class analysis). ResultsIn total 2462 panel members (27.3%) filled out the completed the online DCE questionnaire. The majority of participants were male (54.1%) with an average age of 65.3 years and used on average 4.6 medicines. Four patient classes were distinguished based on preferences for services. Highly preferred were an online mediation record, prescription drugs for minor ailments without a doctors’ prescription and clinical testing with diagnosis by the pharmacist. Discussion and conclusionThe majority of participants tend towards a more CPS focused approach by the community pharmacist. Patients visiting community pharmacies can have a diverging set of preferences regarding services being provided. In daily practice, community pharmacists should provide both convenience and CPS related services to address this diverse set of preferences.

An in-depth examination of funded and unfunded cognitive pharmaceutical services

BackgroundA substantial expansion in the scope of practice of community pharmacists has become evident over the years, with increased government remuneration pledged to support cognitive pharmaceutical services (CPS) delivery as part of the Australian Community Pharmacy Agreements. Exploring experiences in providing funded and unfunded CPS within the existing work environment will enable better understanding of community pharmacists' roles and responsibilities in delivering CPS. ObjectiveTo explore pharmacists' roles, responsibilities, experiences, and perceived impact associated with delivering CPS. MethodsQualitative semi-structured interviews (n = 25) were conducted with practising community pharmacists in Australia who were engaged in delivering CPS during the time when the Sixth Community Pharmacy Agreement (6CPA) was in effect. Verbatim transcripts were thematically analysed (inductive analysis). ResultsAll participants reported an expansion of services being provided in community pharmacies. Pharmacists offered a broad range of CPS within the community pharmacy setting, via 6CPA-funded and non-6CPA or unfunded initiatives. Almost all participants reported that their pharmacy provided 6CPA-funded initiatives such as dose administration aids, clinical interventions, MedsChecks/Diabetes MedsChecks, and Home Medicines Reviews. User-pay services being offered included pharmacist-led flu vaccinations, opioid substitution therapy, sleep apnoea services, and absence from work certificates, among other services. However, profit margins on user-pay services were minimal. CPS provision was seen to have positive impacts at patient and health care system levels. Pharmacists felt they enabled timely and convenient access to health care for patients in the community pharmacy setting, and facilitated quality use of medicines, which in turn had positive impact on the community pharmacy business. ConclusionsA prominent shift in the provision of CPS was evident. Professional services provision has become the status quo for the practice of the profession, indicative of a likely shift in the work value of community pharmacists. Pharmacists should be further recognised professionally and financially for their contributions as health care professionals within the broader health care system.

The evolving profile of cognitive pharmaceutical services in Australia.

Globally, the availability and delivery of cognitive pharmaceutical services (CPS) by pharmacists has expanded over time. Australia has been no exception to this trend, with government funding to support the provision of certain CPS significantly increasing over the last two decades. Whilst medication management services have been consistently funded by the government for more than 15 years, fluctuations in the funding of other CPS have been observed; for example, certain disease state management CPS and introduction of funded MedsChecks. Furthermore, legislative changes have broadened pharmacists' scope of practice and the CPS provided, contributing to an increase in user-pay services. Although the literature to date has highlighted positive impacts associated with CPS on economic, clinical and/or humanistic outcomes, context-specific, real world evidence for the benefits of CPS is much needed to ensure the profession engages in evidence-based practice. The aim of this commentary is to outline the changes in CPS provision and funding within the Australian context, the existing evidence for CPS, and highlight the implications for future research.

An Online Module Series to Prepare Pharmacists to Facilitate Cognitive Pharmaceutical Services

An online module series offered to prepare pharmacists to facilitate cognitive pharmaceutical services. Four e-courses were uploaded in the e-based continuing pharmacy education (CPE) for community pharmacists. The four courses offered were the patient counselling aspects of hypertension, diabetes mellitus, peptic ulcer and asthma. Each course covered the necessary information about the disease, brief pathophysiology, treatment options, lifestyle modifications, expected side effects, ADR of treatment, Dos and Don’ts by the patients. The contents of these courses were presented online in the form of slides in reading format. The presentation included text, pictures and graphs. Out of 70 respondents, about 65.71% of (n=46) were male. Majority of the pharmacists (68.57%), (n=48) found to be D.Pharm. Holders Among 70 pharmacists about 55 pharmacists completed the patient counselling modules Majority of the respondents (n=38; 54%) believed that increasing the knowledge of the pharmacists would help to enhance the present status of pharmacy practice. More than three fourth (n=53; 76%) of the community pharmacists responded that continuing pharmacy education programs to be attended to develop their professional expertise. The feedback on the e-learn modules undergone by the participants was very encouraging and promising. All the participants agreed that the faculty of the module had got sound knowledge, and the modules were practical. This study's results suggest that a series of self-paced online modules with appropriate content can improve pharmacists confidence to provide cognitive pharmaceutical service.

Primary healthcare policy and vision for community pharmacy and pharmacists in Germany.

Germany is the highest populated country in Europe with a population of 82.3 million in 2019. As in many other developed countries, it has an aging population. Approximately 10% of the gross domestic product is spent on healthcare. The healthcare system is characterized by its accessibility. Patients are generally free to choose their primary care physicians, both family doctors and specialists, pharmacy, dentist, or emergency service. Up to a certain income, health insurance is mandatory with the statutory health insurance (SHI) system, covering 88% of the population. Major challenges are the lack of cooperation and integration between the different sectors and healthcare providers. This is expected to change with the introduction of a telematic infrastructure that is currently being implemented. It will not only connect all providers in primary and secondary care in a secure network but will also enable access to patients’ electronic record/medical data and at the same time switch from paper to electronic prescriptions. Approximately 52,000 of the 67,000 pharmacists are working in approximately 19,000 community pharmacies. These pharmacies are owner-operated by a pharmacist. Pharmacists may own up to three subsidiaries nearby to their main pharmacy. Community pharmacy practice mainly consists of dispensing drugs, counselling patients on drug therapy and safety, and giving advice on lifestyle and healthy living. Many cognitive pharmaceutical services have been developed and evaluated in the past 20 years. Discussions within the profession and with stakeholders on the national level on the roles and responsibilities of pharmacists have resulted in nationally agreed guidelines, curricula, and services. However, cognitive services remunerated by the SHI funds on the national level remain to be negotiated and sustainably implemented. A law passed in November 2020 by parliament will regulate the remuneration of pharmaceutical services by the SHI funds with an annual budget of EUR 150 million. The type of services and their remuneration remain to be negotiated in 2021. The profession has to continue on all levels to advocate for a change in pharmacy practice by introducing pharmacy services into routine care.

How does the general public balance convenience and cognitive pharmaceutical services in community pharmacy practice.

Community pharmacy is shifting its focus from traditional, product-focused roles to the provision of cognitive pharmaceutical services (CPS). Previous research has indicated that community pharmacists predominantly want to devote their capacity to CPS. Ideally, services provided also address users' needs. The general public's preferences regarding the services provided by community pharmacists are currently less understood. This study investigates the general public's preferences and perceived importance of CPS versus convenience in community pharmacy practice. An online survey of 1.500 members of the Dutch Health Care Consumer Panel containing questions regarding preferences for CPS and convenience was distributed. Descriptive statistics and linear regression analysis were performed to investigate the relationship between preferences and participant characteristics. 516 panel members completed all questions regarding preferences and importance of the availability of services. The majority preferred convenience (68.2%) and a smaller proportion preferred CPS (27.7%). However, participants considered it important from a societal viewpoint that CPS is provided (45.0%). Participants who preferred CPS over convenience were generally older (p<0.001) and used more medicines (p<0.001). Convenience of community pharmacy services is most preferred by the general public. However, CPS is perceived as important, especially for elderly who use more medicines. Elderly patients who use more medicines more often rate CPS as more important than convenience. These findings suggest that community pharmacists should ensure that pharmacy logistics are organized efficiently before focusing on the provision of CPS.

Knowledge, attitude and perception of general public on the cognitive pharmaceutical care services provided by community pharmacists – A Cross sectional study

Knowledge, attitude and perception of general public on the cognitive pharmaceutical care services provided by community pharmacists – A Cross sectional study

Balancing traditional activities and cognitive pharmaceutical services by community pharmacists: a work sampling study

Background Community pharmacy is undergoing a transition, shifting focus from traditional roles to the provision of cognitive pharmaceutical services. However, traditional activities performed by community pharmacists reduce the amount of available time for implementing and providing such services. Therefore, hampering the community pharmacist in the transition. Objective The aim of this study was to identify characteristics of community pharmacists that spend a higher proportion of their time on cognitive pharmacy services and to identify activities that compete with time spent on such activities by community pharmacists. Setting Daily community pharmacy practice. Method Self-reporting work sampling using smartphone technology was used to register the activities of community pharmacists. Participating pharmacists recorded their current activity five times per working day for 6 weeks and also completed an online survey about baseline characteristics. Main outcome measure Time utilization. Results Ninety-one Dutch community pharmacists provided work-sampling data. The results showed that Dutch community pharmacists are predominantly spending less time on managerial activities when spending more time on cognitive services (from 25.7% to 14.5%, p = 0.016). Pharmacists who are spending more time on such services, want to spend even more time on direct patient contact compared to pharmacists who spend less time on it (p = 0.030). Conclusion This study shows that community pharmacists that spend more time on cognitive pharmacy services are devoting less time on managerial activities, logistics and other activities. Pharmacists spending more time on cognitive pharmaceutical services are mostly locum pharmacists or work at a pharmacy located in a residential area with largely older inhabitants.

Competence, competition and collaboration: Perceived challenges among Swedish community pharmacists engaging in pharmaceutical services provision and research.

Creating evidence of effectiveness is an important part of service development. In an ongoing research project Swedish community pharmacists participate in services research by recruiting patients initiated on statins to an adherence-promoting cognitive pharmaceutical service, jointly run by nurses and pharmacists. To explore the pharmacists' experiences of providing part of the service and their views regarding future participation in practice research aiming at developing cognitive pharmaceutical services. Focus group interviews were conducted with community pharmacists from pharmacies participating in the project. A semi-structured interview guide was developed, based on the aim and earlier research. The domains identified were the service itself, operative conditions, the pharmacists' role/profession and stakeholders. The research project was thought to promote the local pharmacy to customers, increase job satisfaction and contribute to service development. However, a perceived lack of competence among pharmacists affected both patient communication and project involvement. Additional resources and strengthened collaboration with other local healthcare were requested. Competition among pharmacy chains was identified as a barrier to patient-centred service provision and research. The current operative conditions in Swedish community pharmacies were perceived by pharmacists as hampering cognitive pharmaceutical services provision and research. Additional resources, improved communication skills and research competence, and increased collaboration with other healthcare and across pharmacy chains are necessary changes. A stronger patient-centred perspective among all stakeholders is required.

How community pharmacists prioritize cognitive pharmaceutical services.

There is broad consensus that community pharmacists should focus on the provision of pharmaceutical care. Studies, however, have shown that community pharmacists still spend a considerable amount of time on traditional activities such as dispensing instead of cognitive pharmaceutical services (CPS). It is not clear whether community pharmacists prefer their current time-utilization or if they are willing to spend more time on CPS. The aim of this study was to identify how community pharmacists ideally would prioritize CPS compared to other daily activities. A cross-sectional study design with Q-methodology was used to identify different viewpoints regarding task prioritization. Community pharmacists were asked to rank a total of 48 daily activities. Data was collected online using FlashQ©. Q-sorts were analyzed by principal component factor analysis and varimax rotation using PQmethod 2.35. In total, 166 community pharmacists participated in this study. Three distinguishing groups were found based on task prioritization explaining 59% of the total variance among respondents. All groups ranked the provision of CPS as important, in differing degrees. Group 1 ranked CPS as most important and was also the group that contained most participants. Group 2 and 3 ranked quality assurance as most important with CPS as second. Logistics and pharmacy management were ranked low by all groups. Community pharmacists rank the provision of CPS as important. So factors, probably other than task prioritization, are keeping the pharmacist from focusing on CPS in daily practice. In other studies, time constraints are mostly mentioned as major barrier. Activities such as logistics and pharmacy management are given less priority and should be delegated to supporting staff members as much as possible, to enable pharmacists to focus their available time on activities they deem important.

Pharmacy in transition: A work sampling study of community pharmacists using smartphone technology.

The nature of community pharmacy is changing, shifting from the preparation and distribution of medicines to the provision of cognitive pharmaceutical services (CPS); however, often the provision of traditional services leaves little time for innovative services. This study investigated the time community pharmacists spend on the tasks and activities of daily practice and to what extent they are able to implement CPS-related services in daily practice. Self-reporting work sampling was used to register the activities of community pharmacists. A smartphone application, designed specifically for this purpose, alerted participants to register their current activity five times per working day for 6 weeks. Participants also completed an online survey about baseline characteristics. Ninety-one Dutch community pharmacists provided work-sampling data (7848 registered activities). Overall, 51.5% of their time was spent on professional activities, 35.4% on semi-professional activities, and 13.1% on non-professional activities. The proportion of time devoted to CPS decreased during the workweek, whereas the time spent on traditional task increased. This study shows it is feasible to collect work-sampling data using smartphone technology. Community pharmacists spent almost half of their time on semi-professional and non-professional activities, activities that could be delegated to other staff members. In practice, the transition to CPS is hampered by competing traditional tasks, which prevents community pharmacists from profiling themselves as pharmaceutical experts in daily practice.

The Effect of Community Pharmacy Technicians on Industry Standard Adherence Performance Measures After Cognitive Pharmaceutical Services Training

Background: Cognitive pharmaceutical services (CPS) provided by pharmacists can improve patient adherence and industry standard performance measures. Community pharmacy technicians can aid in CPS support tasks on training, but it is unknown to what extent. Objective: To determine the effect of community pharmacy technicians on industry standard adherence performance measures after CPS training. Methods: Sixteen community pharmacy technicians within a supermarket chain division were chosen to participate in CPS training based on internal pharmacy benchmarking data. The training program consisted of 3 components: (1) classroom and (2) web-based training for medication therapy management platforms and (3) Hands-on in-pharmacy training. Researchers used pharmacy-specific EQuIPP reports of the proportion of days covered (PDC) for adherence related to diabetes, cholesterol, and hypertension to measure the primary outcome. September through October 2015 represented baseline data. November 2015 through March 2016 represented intervention data. Descriptive and inferential statistics were utilized for this retrospective analysis. The University of Tennessee Institutional Review Board classified the study exempt from review. Results: Overall, 100% of Cholesterol PDC 4-Star sites improved to a 5-Star score and 56% of sites improved in the Diabetes PDC score. All sites maintained a 5-Star score for RASA PDC postintervention. An average increase of 2.36% was observed for Cholesterol PDC across all sites. Possible lag time between the intervention and score improvements may limit relatability of results. Conclusions: This is the first study to report a positive trend between technician involvement in CPS and improvement in industry standard adherence performance measures. Further research capturing a longer time frame may be beneficial.

Knowledge, Attitude and Practice of Community Pharmacists towards Cognitive Pharmaceutical Care Services in Tamil Nadu, India

The objective of this prospective cross sectional survey was to assess the knowledge, attitude and practice of community pharmacists towards cognitive pharmaceutical care services in the state of Tamil Nadu, India. The self-administered survey questionnaire contained a total of 20 questions out of which, couple of questions is to assess the knowledge and 9 questions each for assessing the attitude and perception of the community pharmacists. The questionnaire was validated for the reliability and validity through a pilot survey conducted with 20 respondents prior to the full-fledged survey. Two hundred fifty six pharmacists completed the self-administered questionnaire. Data analysis was done using descriptive statistics. The <25% of pharmacists in this study were familiar with the term pharmaceutical care. Nearly 70% of the respondents felt that their knowledge and skills have to be further developed to equip themselves to provide pharmaceutical care services. Also, the insufficient curriculum, training and lack of confidence were spelled as barriers for providing pharmaceutical care services. This revealed the mismatch between the basic pharmacy curriculum and training in India and the expected practice standards globally. The present practice of pharmacy in the community set-up needs shifting its focus from product oriented to patient oriented services. Most of the pharmacists were willing to participate in continuing professional education program to update their knowledge and skills pertaining to pharmaceutical care services. In these contexts, we urge the regulators, professional associations and other stakeholders to provide a well-structured continuing professional education programs with adequate credit points should be offered to Indian community pharmacists.

Delegation: a solution to the workload problem? Observations and interviews with community pharmacists in England.

This study aims to describe how pharmacists utilise and perceive delegation in the community setting. Non-participant observations and semi-structured interviews with a convenience sample of community pharmacists working in Kent between July and October 2011. Content analysis was undertaken to determine key themes and the point of theme saturation informed sample size. Findings from observations were also compared against those from interviews. Observations and interviews were undertaken with 11 pharmacists. Observations showed that delegation occurred in four different forms: assumed, active, partial and reverse. It was also employed to varying extents within the different pharmacies. Interviews revealed mixed views on delegation. Some pharmacists presented positive attitudes towards delegation while others were concerned about maintaining accountability for delegated tasks, particularly in terms of accuracy checking of dispensed medication. Other pharmacists noted the ability to delegate was not a skill they found inherently easy. Comparison of observation and interview data highlighted discrepancies between tasks pharmacists perceived they delegated and what they actually delegated. Effective delegation can potentially promote better management of workload to provide pharmacists with additional time to spend on cognitive pharmaceutical services. To do this, pharmacists' reluctance to delegate must be addressed. Lack of insight into own practice might be helped by self-reflection and feedback from staff. Also, a greater understanding of legal accountability in the context of delegation needs to be achieved. Finally, delegation is not just dependent on pharmacists, but also on support staff; ensuring staff are empowered and equipped to take on delegated roles is essential.

Intervention research to enhance community pharmacists' cognitive services: A systematic review

Positive impact of community pharmacists' cognitive pharmaceutical services (CPS) is well documented. However, community pharmacists have been slow to expand CPS roles. This systematic review explores how community pharmacy intervention research can help inform efforts to expand cognitive pharmaceutical service delivery. To: 1) identify community pharmacy CPS intervention studies that report data on pharmacist behaviors, either as a final study outcome itself or as a fidelity measure in patient outcome studies, and 2) describe the state of this research to help frame future research agendas. Empirical articles examining improvement or expansion of community pharmacist cognitive services published through December 2010 were searched using various search engines, bibliography searches and authors' libraries. Studies were included if they: 1) reported findings on pharmacist behaviors during cognitive service delivery, 2) employed a minimum of pre-post design or two study arms for pharmacists/pharmacies, and 3) were in community-based pharmacies. A total of 50 studies evaluated impact of community pharmacy based CPS delivery; however, only 21 included a pharmacist behavior outcome measure as a final outcome or as a fidelity measure. The majority (14 out of 21) of studies used a randomized controlled trial design. Nearly half (10 of 21) addressed asthma or tobacco cessation. Limited details were provided about interventions to prepare pharmacists for CPS delivery. The most frequent measures of pharmacist behavior were patient surveys and observation of pharmacists' behavior by secret shoppers; electronic data sets were rarely used. There is a need for well-designed intervention research that evaluates how interventions impact on pharmacist cognitive service behavior. Positive findings from this review reinforce that planned interventions have the potential to improve and expand pharmacist cognitive service delivery; however, more detail is needed in study publications for this potential to be fully realized.

Evidence of the clinical effectiveness of cognitive pharmaceutical services for aged patients

cognitive pharmaceutical services (CPSs) encompass a variety of pharmacists' interventions to optimise pharmacotherapy. The clinical effectiveness of CPSs for aged patients remains controversial. to analyse and describe the evidence of the clinical effectiveness of CPSs in aged patients by means of performing a systematic review of systematic reviews. using the recommended methodology by Cochrane, a search was undertaken for systematic reviews of the clinical effectiveness of CPSs in MEDLINE, EMBASE, DOAJ, SCIELO and COCHRANE LIBRARY. Reviews were assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) instrument. Quality of the evidence in the reviews was ranked using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. a total of 14 systematic reviews and one meta-analysis were analysed. The overall quality of the reviews was moderate. High and moderate strength of evidence was found for the positive effect of certain CPSs on reducing the number and improving the appropriateness of medicines. There was conflicting evidence of the effect on adherence. There was limited evidence of high and moderate strength on clinical outcomes. No positive evidence was found on mortality, hospitalisations, functional capacity and cognitive function. No systematic reviews reported the effect on the level of control of health problems. certain types of CPSs reduce the number of medicines and improve the appropriateness of prescriptions. Longer follow-up periods and/or the use of surrogate clinical variables measuring the short-term impact are required to demonstrate the effect on clinical outcomes.

A qualitative assessment of a community pharmacy cognitive pharmaceutical services program, using a work system approach

BackgroundAlthough lack of time, trained personnel, and reimbursement have been identified as barriers to pharmacists providing cognitive pharmaceutical services (CPS) in community pharmacies, the underlying contributing factors of these barriers have not been explored. One approach to better understand barriers and facilitators to providing CPS is to use a work system approach to examine different components of a work system and how the components may impact care processes. ObjectivesThe goals of this study were to identify and describe pharmacy work system characteristics that pharmacists identified and changed to provide CPS in a demonstration program. MethodsA qualitative approach was used for data collection. A purposive sample of 8 pharmacists at 6 community pharmacies participating in a demonstration program was selected to be interviewed. Each semistructured interview was audio recorded and transcribed, and the text was analyzed in a descriptive and interpretive manner by 3 analysts. Themes were identified in the text and aligned with 1 of 5 components of the Systems Engineering Initiative for Patient Safety (SEIPS) work system model (organization, tasks, tools/technology, people, and environment). ResultsA total of 21 themes were identified from the interviews, and 7 themes were identified across all 6 interviews. The organization component of the SEIPS model contained the most (n=10) themes. Numerous factors within a pharmacy work system appear important to enable pharmacists to provide CPS. Leadership and foresight by the organization to implement processes (communication, coordination, planning, etc.) to facilitate providing CPS was a key finding across the interviews. Expanding technician responsibilities was reported to be essential for successfully implementing CPS. ConclusionsTo be successful in providing CPS, pharmacists must be cognizant of the different components of the pharmacy work system and how these components influence providing CPS.

The relationship between leadership style and provision of the first Danish publicly reimbursed cognitive pharmaceutical service—A qualitative multicase study

Background Evidence suggests that leadership style is important to the sustainability of cognitive pharmaceutical services, yet only scarce literature on the relationship exists. Objectives Support of the sustainability of the first publicly reimbursed cognitive service in Denmark, the Inhaler Technique Assessment Service (ITAS), was ascertained through a qualitative study to explore how leadership style shapes the implementation process of the service. Sustainability in this project was defined as the state where those asthma patients whose symptom status is negatively clinically affected (as defined by Global Initiative for Asthma guidelines) by inappropriate inhalation technique are identified and offered the service by pharmacy staff. Methods The study was an exploratory qualitative multicase study that used triangulation of both data sources and methods. A theoretical framework of Bolman and Deal inspired the analysis of how leadership style influenced the local process of implementation of the ITAS. Four pharmacies were selected for the analysis because they differed in terms of leadership actions in their implementation process and achievement of ITAS sustainability. The analysis was inductive and linked factors that influence ITAS provision as perceived by employees with the interpreted leadership style of the owner. Results Three main themes emerged: (1) the alignment of the owner and staff values, (2) whether owners perceived ITAS development as being under their own control, and (3) whether owners explicated the responsibilities of employees in the implementation process. The themes were interrelated. Conclusions Pharmacy owner's leadership style was significant to sustainability of the ITAS. A strong wish by the owner to have ITAS implemented was important, followed by aligning the owner's values and visions with those of the employees. The widespread perception by owners that experienced users are not interested in the ITAS needs to be addressed to achieve sustainability.

Measuring organizational flexibility in community pharmacy: Building the capacity to implement cognitive pharmaceutical services

Background Community pharmacy is undergoing transformation with increasing pressure to build its capacity to deliver cognitive pharmaceutical services (“services”). The theoretical framework of organizational flexibility (OF) may be used to assess the capacity of community pharmacy to implement change programs and guide capacity-building initiatives. Objective To test the applicability of an existing scale measuring OF to the industry of community pharmacy in Australia. Methods A mail survey was used to test a preexisting scale measuring OF amended from 28 items to 20 items testing 3 underlying factors of operational, structural, and strategic flexibility in the Australian community pharmacy context. The sample was 2006 randomly-stratified community pharmacies. A confirmatory factor analysis was conducted to assess the validity and reliability of the 1-factor models for each underlying construct and the full measurement model. Results Responses were received from a total of 395 (19.7%) community pharmacies. The 1-factor models of operational, structural, and strategic flexibility fit the data with appropriate respecification. Overall, the favorable fit of the individual factor constructs suggested that the multiple-factor measurement model should be tested. However, this model did not yield an interpretable response. Operational flexibility covaried negatively to the other factors, whereas structural and strategic flexibility shared covariance. Despite this, the results highlighting the individual factor fit suggest the constructs have application to pharmacy. Conclusions The individual OF constructs were useful in the development and initial testing of a scale adapted for community pharmacy. When further developed and validated, the scale could be used to identify group of pharmacies that require individualized assistance to build capacity and integrate services and other new endeavors.

Implementation of cognitive pharmaceutical services in Danish community pharmacies — perceptions of strategists and practitioners

Abstract Objective To understand how projects for the implementation of cognitive pharmaceutical services (CPS) are perceived as facilitators of change from the perspectives of practitioners and strategists. Setting Sixteen community pharmacies in Denmark and three organisations working on implementing CPS in pharmacy practice. Method Twenty semi-structured interviews were conducted with practitioners (pharmacy staff and owners) in ‘professionally active’ pharmacies, and eight interviews were conducted with ‘professional strategists’ in the field of pharmacy practice. Informants were asked about their goals for participation in and development of projects regarding implementation of CPS, and about change strategies used for implementation. An interview guide based on organisational theory was used, and an organisational theory framework formed the basis of the analysis. Key findings Eleven goals for the development of projects relating to CPS implementation from the strategist's perspective were identified. From the practitioners' perspective, nine goals for participation in such projects were identified. The two groups share four categories of goals regarding: competence development; implementation of CPS; marketing of the pharmacy; and improvement of patients' drug use and outcomes. Other goals from the two perspectives predominantly differ from each other. Two metaphors were developed as images of the two different ways of perceiving CPS projects. The strategists develop projects as ‘standard menus’, and the practitioners select projects in which to participate as if they were one of many dishes on a ‘buffet’. Strategies for change were also identified. The humanistic change strategy predominated from both groups of informants' perspective. Conclusion While they have some goals in common, there is a clear difference in the perspectives of strategists and practitioners in the development of and participation in CPS-related projects. The metaphors ‘standard menu’ and ‘buffet’ are two ways of understanding implementation. If these metaphors are accepted as a premise in the field of pharmacy practice, future work with implementation of CPS should take these differences into account.