Identification of major factors in Australian primary care pharmacists’ practice environment that have a bearing on the implementation of professional models of practice
John K. Jackson A B , Safeera Y. Hussainy A and Carl M. J. Kirkpatrick AA Centre for Medication Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, Vic. 3052, Australia. Email: safeera.hussainy@monash.edu; carl.kirkpatrick@monash.edu
B Corresponding author. Email: john.jackson@monash.edu
Australian Health Review 41(4) 378-383 https://doi.org/10.1071/AH16080
Submitted: 8 April 2016 Accepted: 16 June 2016 Published: 16 September 2016
Abstract
Objective The aim of the present study was to describe an environmental framework for pharmacists in primary care in Australia and determine the major factors within that environment that have the greatest bearing on their capacity to implement patient-focused models of professional practice.
Methods A draft framework for pharmacists’ practice was developed by allocating structures, systems and related factors known to the researchers or identified from the literature as existing within pharmacists’ internal, operational and external environments to one of five domains: Social, Technological, Economic, Environmental or Political [STEEP]. Focus groups of pharmacists used an adapted nominal group technique to assess the draft and add factors where necessary. Where applicable, factors were consolidated into groups to establish a revised framework. The three major factors or groups in each domain were identified. The results were compared with the enabling factors described in the profession’s vision statement.
Results Seventy-eight individual factors were ultimately identified, with 86% able to be grouped. The three dominant groups in each of the five domains that had a bearing on the implementation of professional models of practice were as follows: (1) Social: the education of pharmacists, their beliefs and the capacity of the pharmacist workforce; (2) Technological: current and future practice models, technology and workplace structures; (3) Economic: funding of services, the viability of practice and operation of the Pharmaceutical Benefits Scheme; (4) Environmental: attitudes and expectations of stakeholders, including consumers, health system reform and external competition; and (5) Political: regulation of practice, representation of the profession and policies affecting practice.
Conclusions The three dominant groups of factors in each of the five STEEP environmental domains, which have a bearing on pharmacists’ capacity to implement patient-focused models of practice, correlate well with the enabling factors identified in the profession’s vision statement, with the addition of three factors in the Environmental domain of stakeholder attitudes, health system reform and external competition.
What is known about the topic? The extensive range of patient-focused professional programs developed for application by pharmacists in primary care in Australia has yet to be widely implemented.
What does this paper add? Factors both within and beyond the pharmacists’ immediate practice environment that have a bearing on the uptake of professional programs have been identified and prioritised using a structured thematic approach.
What are the implications for practitioners? The results demonstrate the need for a multifactorial approach to the implementation of professional models of practice in this setting.
References
[1] Boxall A-M. What are we doing to ensure the sustainability of the health system? Research Paper no. 4, 2011–12 Social Policy Section. Canberra: Parliament of Australia; 2011.[2] McMillan SS, Wheeler AJ, Sav A, King MA, Whitty JA, Kendall E, Kelly F. Community pharmacy in Australia: a health hub destination of the future. Res Social Adm Pharm 2013; 9 863–75.
| Community pharmacy in Australia: a health hub destination of the future.Crossref | GoogleScholarGoogle Scholar | 23218552PubMed |
[3] Pharmaceutical Society of Australia. Better health outcomes through improved primary care: optimising pharmacy’s contribution. 2014. Available at: https://www.psa.org.au/download/submissions/6cpa-discussion-paper.pdf [verified 10 July 2015].
[4] The Pharmacy Guild of Australia. The roadmap: the strategic direction for community pharmacy. 2010. Available at: https://www.google.com.au/search?q=Guild+Roadmap&ie=utf-8&oe=utf-8&gws_rd=cr&ei=4S2bVYf5DYz98QXY1oL4BQ [verified 10 July 2015].
[5] Commission on Future Models of Care. New models of pharmacy: what is emerging and what is possible. A review of the literature. London: The Royal Pharmaceutical Society; 2013.
[6] Feletto E, Lui GW, Amor C, Saini B. Practice change in community pharmacy: using change-management principles when implementing a pharmacy asthma management service in NSW, Australia. Int J Pharm Pract 2013; 21 28–37.
| Practice change in community pharmacy: using change-management principles when implementing a pharmacy asthma management service in NSW, Australia.Crossref | GoogleScholarGoogle Scholar | 23301531PubMed |
[7] Roberts A, Hopp T, Sorensen E, Benrimoj S, Chen T, Herborg K, Williams K, Aslani R. Understanding practice change in community pharmacy: a qualitative research instrument based on organizational theory. Pharm World Sci 2003; 25 227–34.
| Understanding practice change in community pharmacy: a qualitative research instrument based on organizational theory.Crossref | GoogleScholarGoogle Scholar | 14584230PubMed |
[8] Roberts A, Benrijmo C, Dunphy D, Palmer I. Community pharmacy: strategic change management. Sydney: McGraw-Hill Australia; 2007.
[9] Doucette W, Nevins J, Gaither C, Kreling D, Mott D, Pedersen C, Schommer J. Organisational factors influencing pharmacy practice change. Res Social Adm Pharm 2012; 8 274–84.
| Organisational factors influencing pharmacy practice change.Crossref | GoogleScholarGoogle Scholar | 21958467PubMed |
[10] Tsuyuki R, Schindel T. Changing pharmacy practice: the leadership challenge. Can Pharm J 2008; 141 174–80.
| Changing pharmacy practice: the leadership challenge.Crossref | GoogleScholarGoogle Scholar |
[11] Feletto E, Wilson L, Roberts A, Benrimoj S. Flexibility in community pharmacy: a qualitative study of business models and cognitive services. Pharm World Sci 2010; 32 130–8.
| Flexibility in community pharmacy: a qualitative study of business models and cognitive services.Crossref | GoogleScholarGoogle Scholar | 20016934PubMed |
[12] Feletto E, Wilson L, Roberts A, Benrimoj S. Measuring organisational flexibility in community pharmacy: building the capacity to implement cognitive services. Res Social Adm Pharm 2011; 7 27–38.
| Measuring organisational flexibility in community pharmacy: building the capacity to implement cognitive services.Crossref | GoogleScholarGoogle Scholar | 21397879PubMed |
[13] Jackson J, Kelly B, Gilbert A, Allinson Y, Rigby D, Low J, Tassone A, Hughes J, Nunan M, Dowling H, McKay P. Building upon pharmacists’ practice in Australia – a vision for the profession. 2014. Available at: http://www.psa.org.au/download/policies/A-vision-for-the-profession.pdf [verified 10 July 2015].
[14] Fleisher C, Bensoussan B Macroenvironmental (STEEP) analysis. Strategic and competitive analysis: methods and techniques for analyzing business competition. Upper Saddle River, NJ: Prentice Hall; 2003. pp. 269–283.
[15] Dudovski J. GlaxoSmithKline PESTEL analysis. 2011. Available at: http://research-methodology.net/glaxosmithkline-pestel-analysis/ [verified 10 July 2015].
[16] Abdullah M, Shamsher R. A study on the impact of PEST analysis on the pharmaceutical sector: the Bangladesh context. J Modern Account Auditing 2011; 7 1446–56.
[17] Shaw A. A PESTEL analysis for the pharmaceutical industry. 2011. Available at: http://www.strategic-planet.com/2011/01/a-pestle-analysis-for-the-pharmaceutical-industry/ [verified 10 July 2015].
[18] Dunham R. Nominal group technique: a users’ guide. 2006. Available at: http://www.sswm.info/sites/default/files/reference_attachments/DUNHAM%201998%20Nominal%20Group%20Technique%20-%20A%20Users’%20Guide.pdf [verified 10 July 2015].
[19] Potter M, Gordon S, Hamer P. The nominal group technique: a useful consensus methodology in physiotherapy research. N Z J Physiother 2004; 32 126–30.
[20] Fakih S, Marriott J, Hussainy S. Employing the nominal group technique to explore the views of pharmacists, pharmacy assistants and women on community pharmacy weight management services and education resources. Int J Pharm Pract 2016; 24 86–96.
| Employing the nominal group technique to explore the views of pharmacists, pharmacy assistants and women on community pharmacy weight management services and education resources.Crossref | GoogleScholarGoogle Scholar | 26383046PubMed |
[21] McMillan S, Sav A, Kelly F, King M, Whitty J, Wheeler A. Is the pharmacy profession innovative enough? Meeting the needs of Australian residents with chronic conditions and their carers using the nominal group technique. BMC Health Serv Res 2014; 14 476
| 25281284PubMed |
[22] Frankel G, Austin Z. Responsibility and confidence: identifying barriers to advanced pharmacy practice. Can Pharm J 2013; 146 155–61.
| Responsibility and confidence: identifying barriers to advanced pharmacy practice.Crossref | GoogleScholarGoogle Scholar |
[23] Worley M, Schommer J, Brown L, Hadsall R, Ranelli P, Stratton T, Uden D. Pharmacists’ and patients’ roles in the pharmacist–patient relationship: are pharmacists and patients reading from the same script? Res Social Adm Pharm 2007; 3 47–69.
| Pharmacists’ and patients’ roles in the pharmacist–patient relationship: are pharmacists and patients reading from the same script?Crossref | GoogleScholarGoogle Scholar | 17350557PubMed |
[24] Blake K, Madhavan S. Perceived barriers to provision of medication therapy management services and likelihood of a pharmacist to work in a pharmacy that provides MTMS. Ann Pharmacother 2010; 44 424–31.
| Perceived barriers to provision of medication therapy management services and likelihood of a pharmacist to work in a pharmacy that provides MTMS.Crossref | GoogleScholarGoogle Scholar | 20179254PubMed |
[25] Roberts A, Benrimoj S, Chen T, Williams K, Aslani P. Implementing cognitive services in community pharmacy: a review of models and frameworks for change. Int J Pharm Pract 2006; 14 105–13.
[26] Roberts A, Benrimoj S, Chen T, Williams K, Aslani P. Implementing cognitive services in community pharmacy: a review of facilitators used in practice change. Int J Pharm Pract 2006; 14 162–70.
[27] Mehralian G, Rangchian M, Javadi A, Peiravian F. Investigation on barriers to pharmaceutical care in community pharmacy: a structural equation model. Int J Clin Pharm 2014; 36 1087–94.
| Investigation on barriers to pharmaceutical care in community pharmacy: a structural equation model.Crossref | GoogleScholarGoogle Scholar | 25168648PubMed |
