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.
Similar content being viewed by others
References
Cipolle J, Strand LM, Morley PC. A reimbursement system for pharmaceutical care. In: Pharmaceutical care practice. New York: McGraw-Hill, 1998.
World Health Organization (WHO). Good pharmacy practice (GPP) in community and hospital settings. Geneva: WHO, 1996.
Emerson L, Whitehead P, Benrimoj SI. The value of professional pharmacist services. ACT: The Pharmacy Guild of Australia, 1998.
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.
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.
Shibley MCH, Pugh CB. Implementation of pharmaceutical care services for patients with hyperlipidemias by independent community pharmacy practitioners. Ann Pharmacother 1997; 31: 713–9.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Doucette WR, Koch YD. An exploratory study of community pharmacy practice change. J Am Pharm Assoc 2000; 40(3): 384–91.
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.
Anonymous. Community Pharmacy Summit Report. 'Shaping the future for community pharmacy': The Pharmacy Guild of Australia, 2000.
Paton RA, McCalman J. Change management: a guide to effective implementation, 2nd ed. London: Sage, 2000.
Silverman D. Doing qualitative research: a practical handbook. London: Sage, 2000.
Smith F. Qualitative interviews. Int J Pharm Pract 1998; 6: 97–108.
Strati A. theory and method in organization studies. Paradigms and choices. London: Sage, 2000.
Symon G, Cassell C, editors. Qualitative methods and analysis in organizational research: a practical guide. London: Sage, 1998.
Scott WR. Organizations: rational, natural and open systems, 4th ed. Upper Saddle River, New Jersey: Prentice-Hall, 1998.
Borum F. Strategier for organisationsændring. [Strategies for organisational change.] Copenhagen: Handelshøjskolens Forlag, 1995.
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.
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.
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.
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.
Harding G, Gantley M, Taylor K. Analysing qualitative data. In: Taylor K, Harding G, editors. Pharmacy practice. London: Taylor & Francis, 2001.
Nørgaard LS, Morgall JM, Bissell P. Arguments for theorybased pharmacy practice research. Int J Pharm Pract 2000; 8: 77–81.
Flick U. An introduction to qualitative research. London: Sage, 1998.
Harding G, Gantley M. Qualitative methods: beyond the cookbook. Family Pract 1998; 15(1): 76–9.
May T. Social research. Issues, methods and process, 2nd ed. Buckingham: Open University Press, 1997.
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.
Aslani P. Use of consumer medicine information by community pharmacists [PhD thesis]. Sydney: University of Sydney, 1999.
Odedina FT, Hepler CD, Segal R, Miller D. The pharmacists' implementation of pharmaceutical care (PIPC) model. Pharm Res 1997; 14(2): 135–44.
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.
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.
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.
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.
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.
Holland RW, Nimmo CM. Transitions, Part 1: beyond pharmaceutical care. Am J Health Syst Pharm 1999; 56(17): 1758–64.
Gruda B. Pharmaceutical care or business as usual. J Am Pharm Assoc 1996; NS36(9): 544.
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.
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.
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.
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.
Barnette DJ, Murphy CM, Carter BL. Clinical skill development for community pharmacists. J Am Pharm Assoc 1996; NS36(9): 573–80.
Pugh CB. Pre-OBRA '90 Medicaid Survey: How community pharmacy practice is changing. J Am Pharm Assoc 1995; NS35(2): 17–23.
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.
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.
Swiss Association of Pharmacists. International quality guidelines QMS Pharmacy Label, 2001.
Anonymous. Quality care pharmacy program. The Pharmacy Guild of Australia, 1998.
Anonymous. Denmark says yes to Free-Sale Sector. OTC Bulletin 2000 (15 November): 1, 20.
Galbally R. Review of drugs, poisons and controlled substances legislation draft final report, 2000.
Ford S, Jones K. Integrating pharmacy fully into the primary care team. BMJ 1995; 310(6995): 1620–1.
Australian Pharmaceutical Industries. Retail Pharmacies: Pharmacist Advice for Pharmacists 2002. http://www.api.net.au/retail_pharmacies_pharmacy_advice.asp
Whitehead P, Atkin P, Krass I, Benrimoj SI. Patient drug information and consumer choice of pharmacy. Int J Pharm Pract 1999; 7: 71–9.
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.
Greenwood DJ, Levin M. Introduction to action research: social research for social change. Thousand Oaks, California: Sage, 1998.
Morgan G. Images of organization, 2nd ed. Thousand Oaks, California: Sage, 1997.
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.
Scott J. Social network analysis: a handbook, 2nd ed. London: Sage, 2000.
Degenne A, Forse M. Introducing social networks. London: Sage, 1999.
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.
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.
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.
Kvale S. InterViews: An introduction to qualitative research interviewing. Thousand Oaks, California: Sage, 1996.
Morse JM. Designing Funded Qualitative Research. In: Denzin NK, Lincoln YS, editors. Handbook of qualitative research. Thousand Oaks, California: Sage, 1994.
Minichiello V, Aroni R, Timewell E, Alexander L. In-depth interviewing. Principles, techniques, analysis, 2nd ed. Sydney: Addison Wesley Longman, 1995.
de Almeida Neto AC, Kelly F, Benrimoj SI. Shaping practice behaviour: novel training methodology. Int J Pharm Pract 2001; 9(3): 203–10.
Kröger E, Moisan J, Gregoire J-P. Billing for cognitive services: understanding Quebec pharmacists' behavior. Ann Pharmacother 2000; 34: 309–16.
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.
Wertheimer AI, Smith MC, editors. Pharmacy practice. Social and behavioural aspects. 3rd ed. Baltimore: Williams and Wilkins, 1989.
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.
Mount JK, Sørensen EW. Quality development theories and strategies and their use in pharmaceutical care research. In: 10th Social Pharmacy Workshop, 1998.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
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
Issue Date:
DOI: https://doi.org/10.1023/A:1025880012757