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Understanding practice change in community pharmacy: a qualitative research instrument based on organisational theory

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Abstract

Introduction: The past decade has seen a notable shift in the practice of pharmacy, with a strong focus on the provision of cognitive pharmaceutical services (CPS) by community pharmacists. The benefits of these services have been well documented, yet their uptake appears to be slow. Various strategies have been developed to overcome barriers to the implementation of CPS, with varying degrees of success, and little is known about the sustainability of the practice changes they produce. Furthermore, the strategies developed are often specific to individual programs or services, and their applicability to other CPS has not been explored. There seems to be a need for a flexible change management model for the implementation and dissemination of a range of CPS, but before it can be developed, a better understanding of the change process is required. Objectives: This paper describes the development of a qualitative research instrument that may be utilised to investigate practice change in community pharmacy. Specific objectives included gaining knowledge about the circumstances surrounding attempts to implement CPS, and understanding relationships that are important to the change process. Methods: Organisational theory provided the conceptual framework for development of the qualitative research instrument, within which two theories were used to give insight into the change process: Borum's theory of organisational change, which categorises change strategies as rational, natural, political or open; and Social Network Theory, which helps identify and explain the relationships between key people involved in the change process. Results: A semi‐structured interview guide was produced, combining the factors affecting practice change found in the literature that warranted further investigation with the theoretical perspectives of organisational change and social networks. To address the research objectives, the instrument covered four broad themes: roles, experiences, strategies and networks.Conclusion: The qualitative research instrument developed in this study provides a starting point for future research to lead to a description and understanding of practice change in community pharmacy, and subsequent development of models for the sustainable implementation of CPS.

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References

  1. Cipolle J, Strand LM, Morley PC. A reimbursement system for pharmaceutical care. In: Pharmaceutical care practice. New York: McGraw-Hill, 1998.

    Google Scholar 

  2. World Health Organization (WHO). Good pharmacy practice (GPP) in community and hospital settings. Geneva: WHO, 1996.

    Google Scholar 

  3. Emerson L, Whitehead P, Benrimoj SI. The value of professional pharmacist services. ACT: The Pharmacy Guild of Australia, 1998.

  4. Sørensen EW, Herborg H, Mount JK. The development of pharmacy practice research in Denmark 1980–1990. J Soc Admin Pharm 1997; 14(2): 76–92.

    Google Scholar 

  5. Benrimoj SI, Langford JH, Berry G, Collins D, Lauchlan R, Stewart K et al. Economic impact of increased clinical intervention rates in community pharmacy. Pharmacoeconomics 2000; 18(5): 459–68.

    Google Scholar 

  6. Shibley MCH, Pugh CB. Implementation of pharmaceutical care services for patients with hyperlipidemias by independent community pharmacy practitioners. Ann Pharmacother 1997; 31: 713–9.

    Google Scholar 

  7. Schommer JC. Using humanistic outcomes to justify clinical pharmacy services. In: Pharmacoeconomics and outcomes: applications for patient care. Kansas City: American College of Clinical Pharmacy, 1996.

    Google Scholar 

  8. Farris KB, Schopflocher DP. Between intention and behavior: An application of community pharmacists' assessment of pharmaceutical care. Soc Sci Med 1999; 49(1): 55–66.

    Google Scholar 

  9. Holland RW, Nimmo CM. Transitions in pharmacy practice, Part 3: Effecting change - the three-ring circus. Am J Health Syst Pharm 1999; 56(21): 2235–41.

    Google Scholar 

  10. Rovers JP, Currie JD, Hagel HP, McDonough RP, Sobotka JL. Developing a practice implementation plan. In: Meade V, editor. A practical guide to pharmaceutical care. Washington: American Pharmaceutical Association, 1998.

    Google Scholar 

  11. Odedina FT, Segal R, Hepler C, Lipowski E, Kimberlin C. Changing pharmacists' practice pattern: pharmacists' implementation of pharmaceutical care factors. J Soc Admin Pharm 1996; 13(2): 74–88.

    Google Scholar 

  12. Herborg H, Soendergaard B, Froekjaer B, Fonnesbaek L, Jorgensen T, Hepler C et al. Improving drug therapy for patients with asthma - Part 1: patient outcomes. J Am Pharm Assoc 2001; 41(4): 539–50.

    Google Scholar 

  13. Chen TF, Crampton M, Krass I, Benrimoj SI. Collaboration between community pharmacists and GPs - the medication review process. J Soc Admin Pharm 1999; 16(3/4): 145–56.

    Google Scholar 

  14. Grainger-Rousseau T, Miralles MA, Hepler C, Segal R, Doty RE, Ben-Joseph R. Therapeutic outcomes monitoring: Applications of pharmaceutical care guidelines to community pharmacy. J Am Pharm Assoc 1997; NS37(6): 647–61.

    Google Scholar 

  15. March G, Gilbert A, Roughead E, Quintrell N. Developing and evaluating a model for pharmaceutical care in Australian community pharmacies. Int J Pharm Pract 1999; 7: 220–9.

    Google Scholar 

  16. Doucette WR, Koch YD. An exploratory study of community pharmacy practice change. J Am Pharm Assoc 2000; 40(3): 384–91.

    Google Scholar 

  17. Mobach MP, van der Werf JJ, Tromp FJ. APOM-project: a first study of pharmacy organization and management. Pharm World Sci 1998; 20(5): 219–24.

    Google Scholar 

  18. Anonymous. Community Pharmacy Summit Report. 'Shaping the future for community pharmacy': The Pharmacy Guild of Australia, 2000.

  19. Paton RA, McCalman J. Change management: a guide to effective implementation, 2nd ed. London: Sage, 2000.

    Google Scholar 

  20. Silverman D. Doing qualitative research: a practical handbook. London: Sage, 2000.

    Google Scholar 

  21. Smith F. Qualitative interviews. Int J Pharm Pract 1998; 6: 97–108.

    Google Scholar 

  22. Strati A. theory and method in organization studies. Paradigms and choices. London: Sage, 2000.

    Google Scholar 

  23. Symon G, Cassell C, editors. Qualitative methods and analysis in organizational research: a practical guide. London: Sage, 1998.

    Google Scholar 

  24. Scott WR. Organizations: rational, natural and open systems, 4th ed. Upper Saddle River, New Jersey: Prentice-Hall, 1998.

    Google Scholar 

  25. Borum F. Strategier for organisationsændring. [Strategies for organisational change.] Copenhagen: Handelshøjskolens Forlag, 1995.

    Google Scholar 

  26. Gordon RD. Developing a research framework for the study of organizational change. In: Asia pacific researchers in organizational studies: organizing knowledge economies and societies. Sydney: University of Technology, 2000.

    Google Scholar 

  27. Øvretveit J. Organisational Behaviour Research in Health Care: An Overview. In: Ashburner L, editor. Organisational behaviour and organisational studies in health care: reflections on the future. Basingstoke: Palgrave, 2001.

    Google Scholar 

  28. Mobach MP. Organisational theories as a basis for pharmaceutical care research. In: Quality issues working conference, 2001. Pharmakon, Hillerød, Denmark: Pharmaceutical Care Network Europe (PCNE), 2001.

    Google Scholar 

  29. Doucette WR, Jambulingam T. Pharmacy entrepreneurial orientation: Antecedents and its effect on the provision of innovative pharmacy services. J Soc Admin Pharm 1999; 16(1): 26–37.

    Google Scholar 

  30. Harding G, Gantley M, Taylor K. Analysing qualitative data. In: Taylor K, Harding G, editors. Pharmacy practice. London: Taylor & Francis, 2001.

    Google Scholar 

  31. Nørgaard LS, Morgall JM, Bissell P. Arguments for theorybased pharmacy practice research. Int J Pharm Pract 2000; 8: 77–81.

    Google Scholar 

  32. Flick U. An introduction to qualitative research. London: Sage, 1998.

    Google Scholar 

  33. Harding G, Gantley M. Qualitative methods: beyond the cookbook. Family Pract 1998; 15(1): 76–9.

    Google Scholar 

  34. May T. Social research. Issues, methods and process, 2nd ed. Buckingham: Open University Press, 1997.

    Google Scholar 

  35. Choi T, Greenberg JN. Social science approaches to Health Services research. In: Wertheimer AI, Smith MC, editors. Pharmacy practice. Social and behavioural aspects. Baltimore: Williams and Wilkins, 1989.

    Google Scholar 

  36. Aslani P. Use of consumer medicine information by community pharmacists [PhD thesis]. Sydney: University of Sydney, 1999.

    Google Scholar 

  37. Odedina FT, Hepler CD, Segal R, Miller D. The pharmacists' implementation of pharmaceutical care (PIPC) model. Pharm Res 1997; 14(2): 135–44.

    Google Scholar 

  38. Nørgaard LS, Sørensen EW, Morgall JM. Social constructivist analysis of a patient medication record experiment - why a good idea and good intentions are not enough. Int J Pharm Pract 2000; 8: 237–46.

    Google Scholar 

  39. Pronk MCM, Blom ATG, Jonkers R, Van Burg A. The diffusion process of patient education in Dutch community pharmacy: an exploration. Patient Educ Couns 2001; 42(2): 115–21.

    Google Scholar 

  40. Chen TF, Crampton M, Krass I, Benrimoj SI. Collaboration between community pharmacists and GPs in innovative clinical services - a conceptual model. J Soc Admin Pharm 1999; 16(3/4): 134–44.

    Google Scholar 

  41. Bell HM, McElnay JC, Hughes CM. Societal perspectives on the role of the community pharmacist and community-based pharmaceutical services. J Soc Admin Pharm 2000; 17(2): 119–28.

    Google Scholar 

  42. Rutter PR, Hunt AJ, Jones IF. Exploring the gap: community pharmacists' perceptions of their current role compared with their aspirations. Int J Pharm Pract 2000; 8(3): 204–8.

    Google Scholar 

  43. Holland RW, Nimmo CM. Transitions, Part 1: beyond pharmaceutical care. Am J Health Syst Pharm 1999; 56(17): 1758–64.

    Google Scholar 

  44. Gruda B. Pharmaceutical care or business as usual. J Am Pharm Assoc 1996; NS36(9): 544.

    Google Scholar 

  45. Maddux MS, Dong BJ, Miller WA, Nelson KM, Raebel MA, Raehl CL et al. A vision of pharmacy's future roles, responsibilities, and manpower needs in the United States. Pharmacotherapy 2000; 20(8): 981–90.

    Google Scholar 

  46. Bell HM, McElnay JC, Hughes CM, Woods A. A qualitative investigation of the attitudes and opinions of community pharmacists to pharmaceutical care. J Soc Admin Pharm 1998; 15(4): 284–95.

    Google Scholar 

  47. Rovers JP, Currie JD, Hagel HP, McDonough RP, Sobotka JL. Barriers to pharmaceutical care. In: Meade V, editor. A practical guide to pharmaceutical care. Washington: American Pharmaceutical Association, 1998.

    Google Scholar 

  48. Venkataraman K, Madhavan S, Bone P. Barriers and facilitators to pharmaceutical care in rural community practice. J Soc Admin Pharm 1997; 14(4): 208–19.

    Google Scholar 

  49. Barnette DJ, Murphy CM, Carter BL. Clinical skill development for community pharmacists. J Am Pharm Assoc 1996; NS36(9): 573–80.

    Google Scholar 

  50. Pugh CB. Pre-OBRA '90 Medicaid Survey: How community pharmacy practice is changing. J Am Pharm Assoc 1995; NS35(2): 17–23.

    Google Scholar 

  51. Desselle SP, Tipton DJ. Factors contributing to the satisfaction and performance ability of community pharmacists: A path model analysis. J Soc Admin Pharm 2001; 18(1): 15–23.

    Google Scholar 

  52. Leavitt HJ. Applied organization change in industry: Structural, technical and human approaches. In: Cooper WW, Leavitt HJ, Shelly MW, editors. New perspectives in organzational research. New York: Wiley, 1964.

    Google Scholar 

  53. Swiss Association of Pharmacists. International quality guidelines QMS Pharmacy Label, 2001.

  54. Anonymous. Quality care pharmacy program. The Pharmacy Guild of Australia, 1998.

  55. Anonymous. Denmark says yes to Free-Sale Sector. OTC Bulletin 2000 (15 November): 1, 20.

    Google Scholar 

  56. Galbally R. Review of drugs, poisons and controlled substances legislation draft final report, 2000.

  57. Ford S, Jones K. Integrating pharmacy fully into the primary care team. BMJ 1995; 310(6995): 1620–1.

    Google Scholar 

  58. Australian Pharmaceutical Industries. Retail Pharmacies: Pharmacist Advice for Pharmacists 2002. http://www.api.net.au/retail_pharmacies_pharmacy_advice.asp

  59. Whitehead P, Atkin P, Krass I, Benrimoj SI. Patient drug information and consumer choice of pharmacy. Int J Pharm Pract 1999; 7: 71–9.

    Google Scholar 

  60. Sørensen EW, Haugbølle LS, Herborg H, Lorentzen L. Participatory action research as an implementation strategy for development of pharmacy practice: the pharmacy-university project. In: 12th International Social Pharmacy Workshop, 2002. Sydney: Faculty of Pharmacy, University of Sydney, 2002.

    Google Scholar 

  61. Greenwood DJ, Levin M. Introduction to action research: social research for social change. Thousand Oaks, California: Sage, 1998.

    Google Scholar 

  62. Morgan G. Images of organization, 2nd ed. Thousand Oaks, California: Sage, 1997.

    Google Scholar 

  63. Nohria N. Is a network perspective a useful way of studying organizations? In: Nohria N, Eccles RG, editors. Networks and organizations: structure, form and action. New York: Harvard Business School, 1992.

    Google Scholar 

  64. Scott J. Social network analysis: a handbook, 2nd ed. London: Sage, 2000.

    Google Scholar 

  65. Degenne A, Forse M. Introducing social networks. London: Sage, 1999.

    Google Scholar 

  66. Berkman LF. Assessing social networks and social support in epidemiological studies. In: Mortensen EL, Egsgaard J, editors. National Symposium on Networks and Health, 1994. Copenhagen: Institut for Sygdomsforebyggelse, 1994.

    Google Scholar 

  67. Hanson BS, Östergren P. social networks and health: theories and empirical evidence from Malmö, Sweden. In: Mortensen EL, Egsgaard J, editors. National Symposium on Networks and Health, 1994. Copenhagen: Institut for Sygdomsforebyggelse, 1994.

    Google Scholar 

  68. Trotter RT. Ethnography and network analysis: the study of social context in cultures and societies. In: Albrecht GL, Fitzpatrick R, Scrimshaw SC, editors. The handbook of social studies in health and medicine. London: Sage, 2000.

    Google Scholar 

  69. Kvale S. InterViews: An introduction to qualitative research interviewing. Thousand Oaks, California: Sage, 1996.

    Google Scholar 

  70. Morse JM. Designing Funded Qualitative Research. In: Denzin NK, Lincoln YS, editors. Handbook of qualitative research. Thousand Oaks, California: Sage, 1994.

    Google Scholar 

  71. Minichiello V, Aroni R, Timewell E, Alexander L. In-depth interviewing. Principles, techniques, analysis, 2nd ed. Sydney: Addison Wesley Longman, 1995.

    Google Scholar 

  72. de Almeida Neto AC, Kelly F, Benrimoj SI. Shaping practice behaviour: novel training methodology. Int J Pharm Pract 2001; 9(3): 203–10.

    Google Scholar 

  73. Kröger E, Moisan J, Gregoire J-P. Billing for cognitive services: understanding Quebec pharmacists' behavior. Ann Pharmacother 2000; 34: 309–16.

    Google Scholar 

  74. Goel P, Ross-Degnan D, Berman P, Soumerai S. Retail pharmacies in developing countries: A behavior and intervention framework. Soc Sci Med 1996; 42(8): 1155–61.

    Google Scholar 

  75. Wertheimer AI, Smith MC, editors. Pharmacy practice. Social and behavioural aspects. 3rd ed. Baltimore: Williams and Wilkins, 1989.

    Google Scholar 

  76. Christensen DB, Hansen RW. Characteristics of pharmacies and pharmacists associated with the provision of cognitive services in the community setting. J Am Pharm Assoc 1999; 39(5): 640–9.

    Google Scholar 

  77. Mount JK, Sørensen EW. Quality development theories and strategies and their use in pharmaceutical care research. In: 10th Social Pharmacy Workshop, 1998.

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Roberts, A., Hopp, T., Sørensen, E.W. et al. Understanding practice change in community pharmacy: a qualitative research instrument based on organisational theory. Pharm World Sci 25, 227–234 (2003). https://doi.org/10.1023/A:1025880012757

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