Pharmacy ownership in Canada: Implications for the authority and autonomy of community pharmacy managers

Exploring the Role of Practice Managers in Dutch Oral Healthcare Practices

INTRODUCTION AND AIMS

The practice manager (PM) is a familiar position in Dutch oral healthcare. However, little is known about in which type of practice they work and what their responsibilities are. The aims of this study were to analyse the characteristics of oral healthcare practices that employ a PM and practices that do not, to determine responsibility for tasks described in the PM function description, and to assess to what extent the role of a PM varies between those with an oral healthcare and another background, and across practices with different characteristics.

METHODS

At the end of 2022, a questionnaire with questions about the employment of a PM in the practice was presented to 991 randomly selected general dental practitioners. The questions about the tasks of the PM were based on the job description of the PM drawn up by the Royal Dutch Dental Association. Data were analysed using chi-square test, one-way ANOVA, linear regression, and logistic regression analyses.

RESULTS

A PM was employed in the practice of 56% of the general dental practitioners. In many cases, this PM was responsible for a large number of tasks within the sub-areas of care process, human resources, operational policy, and communication. Compared to independent practices, practices affiliated with a corporate dental company often employed a PM and the PMs had a relatively large amount of responsibility.

CONCLUSION

PMs are now commonly found in Dutch oral healthcare practices, especially in ones that are affiliated with a corporate dental company. The tasks of PMs vary, suggesting an evolving professional profile.

Pharmacists' Professional Satisfaction and Challenges: A Netnographic Analysis of Reddit and Facebook Discussions

Pharmacists, essential healthcare providers, face significant challenges in professional satisfaction and well-being. This study investigates the factors influencing pharmacists' professional satisfaction, mainly focusing on workload, organizational support, job autonomy, work-life balance, and resilience against burnout. Data were collected from relevant online forums on Facebook and Reddit using a netnographic methodology. The data were anonymized and thematically coded to identify key themes from 23 conversation threads, primarily involving or concerning Romanian pharmacists. The analysis revealed several critical issues: widespread dissatisfaction with salaries, challenges in professional recognition, and the demanding nature of university education. Additional themes included economic and financial insights, global trends and technological impacts, personal experiences and satisfaction, professional growth and education, regulatory and market environment, and workplace dynamics. Findings indicate these factors significantly impact pharmacists' job satisfaction and overall well-being. The study concludes that addressing these issues through targeted interventions, such as policy reforms, educational updates, and enhanced organizational support, can improve the professional lives of pharmacists, thereby enhancing their contributions to healthcare outcomes.

Dispensing mifepristone for medical abortion in Canada: Pharmacists' experiences of the first year

Background

Mifepristone for medical abortion was first dispensed by community pharmacists in Canada directly to patients in January 2017. We asked about pharmacists' experiences over their first year dispensing mifepristone in order to evaluate the frequency of the new practice and assess availability in urban/rural pharmacies.

Methods

From August to December 2019, we invited 433 community pharmacists who had completed a baseline survey at least 1 year prior to participate in a follow-up online survey. We summarized categorical data using counts and proportions and conducted a qualitative thematic analysis of open-ended responses.

Results

Among 122 participants, 67.2% had dispensed the product, and 48.4% routinely stocked mifepristone. Pharmacists reported a mean of 26 and median of 3 (interquartile range, 1, 8) mifepristone prescriptions filled in their pharmacies in the previous year. Participants perceived that the benefits of making mifepristone available in pharmacies included increased abortion access for patients (n = 115; 94.3%), reduced pressure on the health care system (n = 104; 85.3%), increased rural and remote abortion access (n = 103; 84.4%) and increased interprofessional collaborations (n = 48; 39.3%). Few participants reported challenges to maintaining adequate stock of mifepristone, but these challenges included low demand (n = 24; 19.7%), short expiry dating (n = 12; 9.8%) and drug shortages (n = 8; 6.6%). The overwhelming majority, 96.7%, reported that their communities did not resist the provision of mifepristone by their pharmacy.

Interpretation

Participating pharmacists reported many benefits and very few barriers to stocking and dispensing mifepristone. Both urban and rural communities responded positively to enhanced access to mifepristone in their community.

Conclusions

Mifepristone is well accepted by pharmacists within the primary care system in Canada.

"Reigns but does not govern": A reflection on professionalism and the autonomy of the pharmacist

INTRODUCTION

In recent decades, the professionalization of pharmacy has been debated worldwide. With the advent of industrialization, pharmacist autonomy has weakened, especially in the retail pharmacy market. Manegers and mentors of pharmacy chains serve as links between the profession and drug users. This study sought to understand the perceptions of retail pharmacy stakeholders regarding pharmacist autonomy and how to improve it, and to reflect on theories of professionalism.

METHOD

19 semi-structured interviews were conducted. The interviews were transcribed and analyzed through analyst triangulation and categorical content analysis, using the ATLAS.ti software.

RESULTS

Interviews were conducted with nine mentors and ten managers in retail medicine. They reported aspects related to managerial and technical autonomy regulated by law, and strategies for enhancing professional autonomy in retail pharmacy. Autonomy was considered limited by pharmacists' dependence on employability and self-devaluation; and market control exposed the weaknesses in pharmaceutical professionalism. Entrepreneurship and ownership attitude strategies were feasible only in a retail micro-political context.

CONCLUSION

The retail medicine continues to have business model centered on the product and controlling the pharmaceutical practice model. To ensure autonomy and professional strengthening, it is necessary that pharmacy recognizes itself as a clinical profession and develops a stable professional identity.

Community Pharmacists' Beliefs about Suboptimal Practice during the Times of COVID-19

Introduction: Community pharmacies are high-performance workplaces; if the environment is not conducive to safe practice, mistakes can occur. There has been increasing demand for pharmacists during the COVID-19 pandemic as they have become integral to the response. Suboptimal practices in the work environment and with pharmacists and their teams can impact the safe delivery of services. New Zealand pharmacists' perceptions of the current work environment and beliefs around whether suboptimal practice have increased within the last five years and the effect of the COVID-19 pandemic on their practices are unknown. Aim/Objectives: To assess what New Zealand pharmacists associate with suboptimal practice in their workplace and investigate the effect of the COVID-19 pandemic on pharmacists and their workplaces. Methods: We employed an anonymous online questionnaire derived from a human factors framework utilised in the aviation industry to explore the potential environment, team and organisational factors as the determinants of suboptimal work practices. The software, hardware, environment and liveware (S.H.E.L.L) model was adapted to create questions classifying the risk factors to potentially identify aspects of work systems that are vulnerable and may provide risks to optimal practice. Additional perceptions around the effect of COVID-19 on their workplace and roles as pharmacists were explored. Participants were community pharmacists working in New Zealand contacted via a mailing list of the responsible authority for the profession. Findings: We received responses from 260 participants. Most participants indicated that suboptimal practice had increased in the last 5 years (79.8%). The majority of participants indicated that COVID-19 had impacted their workplaces (96%) and their roles as pharmacists (92.1%). Participants perceived that suboptimal practice was associated with a lack of leadership and appropriate management; poor access to resourcing, such as adequate staff and narrow time constraints for work tasks; a lack of procedures; competition; and stress. A lack of experience, professionalism and poor communication between staff, patients and external agencies were also issues. COVID-19 has affected pharmacists personally and their work environments. Further study in this area is required. Conclusions: We have identified that pharmacists across all sectors of New Zealand agreed that suboptimal practices had increased in the last 5 years. A human factors S.H.E.L.L framework can be used to classify themes to understand the increases in suboptimal practice and the role of COVID-19 on pharmacist practice. Many of these themes build on the growing body of the international literature around the effect of the pandemic on pharmacist practice. Areas for which there are less historical data to compare longitudinally include pharmacist wellbeing and the impact of COVID-19.

Pharmacy service factors and pharmacy performance: the role of patient satisfaction in community pharmacies

Purpose

This study aims to examine the effects of pharmacy service factors (namely, medication teaching, service promptness, pharmacist attitudes, medication supply and pharmacy location) on patient satisfaction with community pharmacies in Jordan and to explore the effect of patient satisfaction on pharmacy performance.

Design/methodology/approach

Descriptive analytical methodology, with a quantitative approach using survey strategy was applied. The study population represented the whole population of Jordan (2.033 million households). Data were collected using an online questionnaire. A convenient quota sample of 1,000 respondents was targeted; 502 valid questionnaires were returned, representing an effective response rate of 50.2%. The study hypotheses were tested using path analysis.

Findings

The results showed that the service factors contributing most significantly to patient satisfaction in Jordan are medication supply, pharmacist attitudes, medication teaching and service promptness, in descending order of influence. Meanwhile, the effect of pharmacy location on patient satisfaction proved to be insignificant. In addition, patient satisfaction proved to have a highly positive impact on pharmacy performance.

Originality/value

This study addresses a debatable issue in the literature regarding the influence that pharmacy service factors can have on patient satisfaction. In addition, to the best of the researchers’ knowledge, this is the first study to explore the proposed effects in Jordan. It is also one of the first to investigate the effect of patient satisfaction on community pharmacy performance.

Instruments measuring community pharmacist role stress and strain measures: A systematic review

BACKGROUND

While macro and meso approaches to implementing public health initiatives in community pharmacies have been studied, the micro perspective of their pharmacist providers requires more inspection. Community pharmacists report increasing stress, overload, and limited control over facets of their work.1-7 Social exchange principles, e.g. role price, may help to typify pharmacist work decisions so problematic situations can be modified, thus protecting workforce health. To do so, the underlying pressures of the pharmacist role (i.e. role stresses) and indicators of systemically-caused strain (i.e. role strains) should be measurable.

OBJECTIVES

To summarise validated and reliable instruments used to measure role stress and strain among community pharmacists and evaluate compatibility in testing a theoretically-derived framework.

METHODS

In April 2020, journal articles describing reliable and validated instruments measuring role stress and strain responses among community pharmacists were identified from an online search via Scopus, Web of Science and PubMed. English-language articles after 1990 were selected; duplicates were deleted. Inclusion and exclusion criteria were used to screen title/abstracts and full texts. Reference lists were manually searched. Resultant instruments were analysed for theoretical compatibility.

RESULTS

After review, 26 separate instruments were found: seven psychological strain instruments, 14 social strain response instruments, and five role stress instruments. Role stresses were often present as facet-specific dimensions in psychological and social strain instruments. Strain instruments measuring individual evaluation of work were compatible with a social exchange approach.

CONCLUSIONS

Twenty-six reliable and validated instruments measuring role stress and role strain were found to measure negative role outcomes from the micro community pharmacist perspective. Structural measurement of role stress and resultant negative responses enable detailed examination into pharmacist roles and insights into pharmacist behaviour. Further research is required to develop additional role stress and strain instruments, and to discover pharmacist role benefits and their influence.

A participatory research approach in community pharmacy research: The case for video-reflexive ethnography

Video-reflexive ethnography (VRE) is a qualitative methodology that explores the complex nature of healthcare 'as it really is'. Its collaborative and reflexive process invites stakeholders (e.g. pharmacists and pharmacy support staff) to participate in analysing their everyday work practices as captured on video footage. Through close collaboration with practitioners and attention to their work contexts, VRE may be a useful methodology to engage a time-poor pharmacy workforce in research about themselves, encouraging more practitioner involvement in practice-based research. Aside from research, VRE has also been used effectively as an intervention to facilitate learning and change in healthcare settings, and could be effective in provoking change in otherwise resistant pharmacy environments. Much like traditional ethnographic approaches, VRE researchers have relied on being present 'in the field' to observe, record and make sense of practices with participants. The COVID-19 pandemic however, has introduced restrictions around travel and physical distancing, which has required researchers to contemplate the conduct of VRE 'at a distance', and to imagine new ways in which the methodological 'closeness' to stakeholders and their workplace contexts can be maintained when researchers cannot be on site. In this commentary, we outline the rationale for participatory methods, in the form of VRE, in pharmacy research. We describe the underlying principles of this innovative methodology, and offer examples of how VRE can be used in pharmacy research. Finally, we offer a reflexive account of how we have adapted the method for use in community pharmacy research, to adapt to physical distancing, without sacrificing its methodological principles. This paper offers not only a new methodology to examine the complexity of pharmacy work, but demonstrates also the responsiveness of VRE itself to complexity, and the potential breadth of future research applications in pharmacy both during and beyond the current pandemic.

Unraveling Motivational Profiles of Health Care Professionals for Continuing Education: The Example of Pharmacists in the Netherlands

INTRODUCTION

Continuing education (CE) can support health care professionals in maintaining and developing their knowledge and competencies. Although lack of motivation is one of the most important barriers of pharmacists' participation in CE, we know little about the quality or the quantity of motivation. We used the self-determination theory, which describes autonomous motivation (AM) as originating from within an individual and controlled motivation (CM) as originating from external factors, as a framework for this study. Our aim was to obtain insight into the quality and quantity of pharmacists' motivation for CE.

METHODS

The scores of 425 pharmacists on Academic Motivation Scale were subjected to K-means cluster analysis to generate motivational profiles.

RESULTS

We unraveled four motivational profiles: (1) good quality with high AM/low CM, (2) high quantity with high AM/high CM, (3) poor quality with low AM/high CM, and (4) low quantity with low AM/low CM. Female pharmacists, pharmacists working in a hospital pharmacy, pharmacists working for more than 10 years, and pharmacists not in training were highly represented in the good-quality profile. Pharmacists working in a community pharmacy, pharmacists working for less than 10 years, and pharmacists in training were highly represented in the high-quantity profile. Male pharmacists were more or less equally distributed over the four profiles. The highest percentage of pharmacy owners was shown in the low-quantity profile, and the highest percentage of the nonowners was shown in the good-quality profile.

DISCUSSION

Pharmacists exhibit different motivational profiles, which are associated with their background characteristics, such as gender, ownership of business, practice setting, and current training. Motivational profiles could be used to tailor CE courses for pharmacists.

Quality alone is not enough to be trustworthy

Purpose

– The aim of this paper is to argue that quality alone is not enough; pharmacies need to develop a rapport with their customers and convey sincerity. Community (retail) pharmacy is an increasingly competitive industry. Service quality has been considered one of the key factors for pharmacies to differentiate and develop competitive advantage. The customers’ perception of the sincerity of the pharmacies mediates the relationship between quality and trust.

Design/methodology/approach

– Through consumer intercept, we collected survey data from 150 customers in a western Canadian city who had filled a prescription at the pharmacy in the previous six months. Data were analyzed using structure equation modeling.

Findings

– Our data revealed that while overall service quality has a positive influence on customer trust, perception of sincerity has a more immediate impact. The relationship between quality and trust was completely mediated through sincerity perception.

Originality/value

– Service quality has been introduced to pharmacy management and produced many good results. However, the measurement of service quality has historically emphasized on physical evidence. The element of human interaction and subjective affective perceptions has been largely ignored because it is difficult to measure, hence difficult to reward and implement. Our study highlights the importance of personal interactions in the context of pharmacy quality management.

Pharmacy students' experiences in provision of community pharmacy mental health services

BACKGROUND

Little information is available describing the pharmacy student's experience working in community practice with people with lived experience of mental illness. Students' perspectives as observers, learners, technical staff and future pharmacists are important.

OBJECTIVE

To gain a better understanding of the pharmacy student experience in community pharmacy-based service provision to people with lived experience of mental illness.

METHODS

We conducted a qualitative study using interpretive description and application of the Theoretical Domains Framework. Focus groups were held with third- and fourth-year undergraduate pharmacy students from one Canadian university.

RESULTS

Two student focus groups were held in the fall of 2012 with 11 students (7 third year and 4 fourth year), 6 women and 5 men, mean age 24.5 (range, 21 to 30) years, averaging 3.2 years (range, 2 weeks to 7 years) of cumulative, mostly part-time, community pharmacy experience. Three broad themes emerged from the pharmacy student experience: (1) business tension; (2) roles, responsibilities and relationships; and (3) stigma. Students discussed their own roles, responsibilities and relationships in a pluralistic identity experience (i.e., pharmacy student, technician, future pharmacist). Application of the Theoretical Domains Framework demonstrated numerous influences on behaviour.

CONCLUSIONS

From the students' description of community pharmacy-based care of people with lived experience of mental illness, significant issues exist with current practices and behaviours. Advancing the role of pharmacists and pharmacy students to meet the needs of people with mental illness will require strategies to address multifactorial influences on behaviour.

Understanding community pharmacy intervention practice: lessons from intervention researchers

BACKGROUND

Community pharmacy (CP) is a setting with health promotion and public health potential which could include strategies with a nutrition promotion focus. Research embedded in this setting has explored and produced evidence to inform practice change to develop this potential. The experience of undertaking research in this setting may provide insight into the challenges and key features of intervention research practice. Exploring experienced-based knowledge presents as a productive area of research, extending what can be known beyond the bounds of what is measurable.

OBJECTIVES

This study aimed to understand the experience of intervention research in CP with a focus on nutrition and to develop guidance for future research practice (intervention design and implementation) in CP based on interventionists' reflections and practice wisdom.

METHODS

Semi-structured interviews were conducted with 9 researchers with experience in undertaking intervention research in CP with a nutrition component. Content analysis, constant comparison and interpretive description were used in the analysis and interpretation of interview data.

RESULTS

Five key lessons were identified - 1) utilize existing capacity; 2) navigate and utilize social power and interests; 3) personalize engagement and recruitment; 4) consider the logistics and 5) intervention type considerations. Key challenges for translating research into practice and sustaining change included financial sustainability, physical constraints, logistics, collaboration, and practice change enablers. Personal reflections on research practice identified qualities, such as determination and skills in networking, as key for researching in CP.

CONCLUSIONS

CP-embedded research is challenging given the complexity of the practice environment. The social context of CP appears central to intervention research and a nuanced understanding of the social context needs to be the basis for intervention design to inform successful implementation. Experience-based and insider knowledge is useful and needed for nuanced design and development of intervention research in CP.

Workplace stress in community pharmacies in England: associations with individual, organizational and job characteristics

OBJECTIVES

To describe the levels of workplace stress that community pharmacists perceive and to examine associations with individual, organizational and job characteristics.

METHODS

A cross-sectional mailed survey of 2000 randomly selected community pharmacists practising in England incorporating a validated organizational stress screening tool (ASSET).

RESULTS

Response rate was 48%. Community pharmacists reported significantly higher levels of stress than other health care workers for seven out of eight work-related stressors. Regression analyses demonstrated significant associations between a number of individual, organizational and job characteristics and stress. Long working days, being a pharmacy manager and working for large multiples were associated with higher reported levels of stress across a number of work-related stressors including work overload, control and the job itself. However, self-reported measures of workload (such as dispensing volume) were not associated with higher stress levels.

CONCLUSIONS

The growth in corporate ownership of community pharmacies, which is associated with more stressful working environments, together with current economic pressures could have consequences not only for the future well-being of pharmacists but also for patient safety.

British pharmacists' work-life balance – is it a problem?

Objectives

Using a validated tool, the study aimed to explore pharmacists' experiences of maintaining work/life balance in a large, nationally representative sample of pharmacists in Great Britain (GB).

Methods

A two-page postal questionnaire was sent in 2008 to all GB-domiciled pharmacists who were registered with the regulatory body for pharmacy in GB (just over 44 000 pharmacists). Demographic information, work patterns and other employment data were collected and analysed using regression techniques to explore the link between these characteristics and a validated measure of work/life balance.

Key findings

The response rate to the census was 69.6% (n = 30 517). Eighty-three per cent (n = 25 243) of respondents were working as a pharmacist and were therefore eligible to complete the work/life balance statements. The results reported here relate to 12 364 individuals who had full data for the work/life balance scale and the demographic and work variables. Findings indicate that age, ethnicity, having caring responsibilities, sector of practice, hours of work and type of job are significant predictors of work/life balance problems.

Conclusions

Pharmacy employers and government should recognise the changing demographic characteristics of the profession and consider what support might be available to the workforce to help alleviate work/life balance problems being experienced by certain groups of pharmacists.

Is franchising in health care valuable? A systematic review

BACKGROUND

Franchising is an organizational form that originates from the business sector. It is increasingly used in the healthcare sector with the aim of enhancing quality and accessibility for patients, improving the efficiency and competitiveness of organizations and/or providing professionals with a supportive working environment. However, a structured overview of the scientific evidence for these claims is absent, whereas such an overview can be supportive to scholars, policy makers and franchise practitioners.

METHODS

This article provides a systematic review of literature on the outcomes of franchising in health care. Seven major databases were systematically searched. Peer-reviewed empirical journal articles focusing on the relationship between franchising and outcomes were included. Eventually, 15 articles were included and their findings were narratively synthesized. The level of evidence was rated by using the Grading of Recommendations Assessment, Development, and Evaluation scale.

RESULTS

The review shows that outcomes of franchising in health care have primarily been evaluated in low- and middle-income countries in the reproductive health/family planning sector. Articles about high-income countries are largely absent, apart from three articles evaluating pharmacy franchises. Most studies focus on outcomes for customers/clients and less on organizations and professionals. The evidence is primarily of low quality. Based on this evidence, franchising is predominantly positively associated with client volumes, physical accessibility and some types of quality. Findings regarding utilization, customer loyalty, efficiency and results for providers are mixed.

CONCLUSIONS

We conclude that franchising has the potential to improve outcomes in healthcare practices, but the evidence base is yet too weak for firm conclusions. Extensive research is needed to further determine the value of healthcare franchising in various contexts. We advocate more research in other healthcare sectors in both low- and middle-income countries and high-income countries, on more types of outcomes with attention to trade-offs, and on what factors produce those outcomes.