Research in Social and Administrative Pharmacy
Volume 8, Issue 1 , Pages 17-35, January 2012

New Zealand pharmacists’ alignment with their professional body’s vision for the future

Medicines Management Research Group, School of Pharmacy, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand

published online 14 April 2011.

Article Outline

Abstract 

Objective

To determine the alignment between New Zealand pharmacists’ views and the New Zealand Ten-Year Vision (TYV) document and explore factors associated with individuals’ alignment.

Methods

A postal survey of 1892 practicing pharmacists was conducted. The questionnaire included 37 attitude statements informed by analysis of 6 focus groups in which pharmacists discussed 24 statements representing 12 main vision areas. Responses are reported by proportion. Bivariate analysis compared differences in demographic characteristics and alignment with vision statements between 3 professional subgroups: community, hospital, and pharmacists working in District Health Boards or Primary Health Organizations.

Results

Nine hundred and eighty (54.6%) analyzable surveys were returned. Respondents broadly agreed with the 12 vision areas. There was a clear patient focus and strong support for extending roles to better serve patient care. Pharmacists believe that current practice and funding models need to change and want greater involvement in setting health policy. There are significant differences in agreement and level of agreement between professional subgroups. Notably, community pharmacists are more likely to put their relationship with the patient above that with the doctor, to believe that other professions would resist role extension, to support minor ailments schemes, and to indicate a shift in funding models was necessary to support innovative pharmacy practice. There are statistically significant and potentially important demographic differences between professional subgroups, including age, sex, formal postgraduate training, and experience working in health care in other countries. Further analysis is required to understand the interplay of these factors and how this may influence alignment with the TYV document.

Conclusions

Pharmacists’ responses indicated a high level of alignment with vision outlined in the TYV. Pharmacists appear receptive to practice and funding changes in order to facilitate greater contribution to patient care. Respondents demonstrated a clear desire to be involved in setting medicines-related health policy and feel underrepresented at this level.

Keywords: Pharmacists, Professional role, Primary health care, Health policy, New Zealand

 

Back to Article Outline

Introduction 

Pharmacy is a profession looking for a future or rather perhaps a profession seeking to reorientate itself to better contribute to patient care in the face of the ever-increasing complexity of health technology and health care services. Pharmacists are promoted as “the medicines experts” but, by and large, operate in the community as distributors of medicines, often being at the end, rather than being an integral part of the medication-use system.

The entry-level qualification for a pharmacist in New Zealand (NZ) is a 4-year Bachelor degree with an emphasis on applied therapeutics and patient-centered care. Having graduated, pharmacists must complete a further year of practice-based training and successfully complete a competence-based assessment before becoming eligible for registration as a pharmacist. Having registered, all pharmacists must undertake audited continuing professional development to retain their annual practising certificate (APC). Why then is the role of the community pharmacist largely associated with the technical task of filling prescriptions and making health care-associated retail sales?

At one time, pharmacists were the holders of expert knowledge and unique skill in the compounding and dispensing of pharmacological treatments. This has been eroded by the industrialization of pharmaceutical manufacturing to the point where some have argued that they are overqualified for their current role.1 Recognizing this erosion of professional status, it has been suggested that there is a need for “reprofessionalization” within pharmacy and most particularly within community pharmacy.2, 3

Internationally, there is recognition of the need to make better use of pharmacists’ knowledge and training. Specifically, there have been calls for increased integration of community pharmacy within the primary care sector. While recognizing the need for pharmacy to maintain oversight of the distribution of medicines, there has been an emphasis on role extension. These extended roles include health promotion, health screening, extended patient counseling and adherence support, comprehensive medication review, disease management, and prescribing. Internationally, the pressure to change is coming from both health policymakers4, 5, 6, 7, 8, 9, 10 and the pharmacy profession itself.11, 12, 13, 14

Health care in NZ is a mixture of public and private care, but the predominant model is government-funded socialized health care. This is delivered through a public hospital system and privately owned medical and pharmacy practices contracted to publicly funded payers. Primary care physicians predominantly work in small group practices that are affiliated with Primary Health Organizations (PHOs). District Health Boards (DHBs) provide population health services, directly manage secondary and tertiary care services, and contract with PHOs to provide primary care services to an enrolled population on a partially capitated and partially fee-for-service payment model. Community pharmacies contract directly with DHBs on a fee-for-service basis. Community pharmacy ownership is restricted to pharmacists, and owners are limited to majority shareholdings in 5 pharmacies or fewer; the dominant model is one of the independent owner-operator pharmacies.

Over the last 10 years, the NZ Government has released a series of policy documents with an emphasis on greater integration of health care providers in primary care. There has also been recognition of the importance of medicines management to optimize health outcomes.15, 16, 17

Partly in response to the NZ Primary Healthcare Strategy,15 which calls for improved access and equity of primary health care through the development of integrated multidisciplinary primary health care teams, and partly because of the perceived need to “reprofessionalize,” the Pharmaceutical Society of New Zealand (PSNZ) commissioned the development of a vision for pharmacy. This vision, Focus on the Future: The Ten Year Vision for Pharmacists in New Zealand (2004-2014), developed by the Pharmacy Sector Action Group, consists of 24 statements covering 12 key areas.18 The 12 foci of the Ten Year Vision document are shown in Panel 1.

Panel 1. Components of the Ten-Year Vision document
1. Patient focusa. The foremost role for pharmacists will be providing high quality, innovative services for patients that enhance patient care and public health.
2. Relationships with other health professionalsa. Pharmacists will work collaboratively with doctors, nurses and other healthcare professionals as integral members of the healthcare team.
b. Pharmacists’ knowledge and expertise in medicine management will be respected and sought after by other healthcare professionals, as well as patients.
c. Pharmacists and other healthcare professionals will have clearly established scopes of practice, patient advocacy roles and appropriate payment arrangements for each profession, within the healthcare team.

3. Value propositiona. Services provided by pharmacists will be proven to add value and improve patient care and health outcomes.
b. Funders, both government and private, will recognise and be willing to invest in the proven “value for money” benefits offered by specific health management programmes available from pharmacists.

4. Alignment with stated Government health strategiesa. Services provided by pharmacists will be consistent with and contribute to the development and achievement of Government’s stated health sector strategies.

5. Educationa. Pharmacists’ professional practice and services to patients will be evidence-based and research-led. Pharmacists will have a wide range of CPE and training options available which will enable a high percentage of pharmacists to achieve suitable accreditation levels which will enable them to practise and provide the wider range of medicine management services.
6. Focus on qualitya. Pharmacists will have a strong focus on quality. They will meet expected quality standards in all services they provide—directly to patients and/or in their interaction with other health professionals. They will work to standards that ensure the quality use of medicines.

7. Range of services provideda. Pharmacists will provide a health promotion and assessment service that proactively promotes good primary healthcare, identifies and treats patients’ minor ailments and health concerns, and assesses and refers to other members of the primary healthcare team as required.
b. Pharmacists will have a collaborative role in assisting doctors and nurses in prescribing decisions especially for patients with chronic or enduring illnesses. Accredited pharmacists will carry out prescribing in accordance with collaborative arrangements agreed within the healthcare team.
c. Pharmacists will provide a safe, efficient dispensing service for “prescription”, “pharmacist-only” and “pharmacy-only” medications (through their community pharmacy network and any other distribution methods which they may evolve) which promotes patient education and safety, provides education on prescribed medicines and prevents, detects and reports adverse reactions and medication error.
d. Pharmacists will provide a range of enhanced medicine management services, each with its own training/ proficiency requirements, within the scope of practice of accredited pharmacists and tailored to local patient and community priorities. These services, which will support independent living, are likely to include a range of core pharmacy services and advanced and complex services such as: patient needs assessment, information management, medicine compliance assessment and support, medicine information for patients and prescribers, disease state management services, quality use of medicines, medicine review programmes and chronic case management services.
e. Pharmacists will provide health assessment, monitoring and screening tests for patients and the general public where clinically warranted under protocols agreed within the primary healthcare team.

8. Service delivery optionsa. Health promotion, dispensing, medicine management and health assessment/monitoring/screening services will be provided by pharmacists from an evolving range of business entities—appropriate to each location and range of patients’ needs. Such entities are expected to include community pharmacies, pharmacist facilitators, multi-discipline health centres including pharmacists, or as individual clinical pharmacists and hospital/secondary care pharmacists.
9. Use of new technologya. Pharmacists will lead the recognition and introduction of innovative new technologies that improve the effectiveness of patient care and service delivery.
b. Pharmacists and other health professionals will share appropriate health information on their patients through the development of efficient IT systems, under rigorously controlled privacy conditions.
c. New drug therapies will become increasingly patient-specific, and will provide opportunities for improved patient care by pharmacists and other healthcare professionals but will also place increasing budget pressure on all funders.
d. Advances in remote sensing and communication technology will enable pharmacists to monitor, and then manage, medication compliance and the health status of high-risk patients, within a range of community settings.

10. Relationship with funding agenciesa. Pharmacists’ expertise and suggestions, for the optimum development of future medicine-related health services, will be respected and sought after by Government’s health sector policy and funding agencies.
b. Funders will have positive, effective and transparent professional interactions with the pharmacy profession and will have removed unnecessary bureaucracy which hinders teamwork and adds costs to services. This will enable pharmacists and other healthcare professionals to deliver on improved teamwork, professional satisfaction and efficiency goals.

11. Payment arrangementsa. Payment and service incentives will be aligned to ensure desired service levels and results are achieved and sustained. Pharmacists will be appropriately paid through subsidy payments from Government and other funders and payments from individual patients for the professional services they provide.
b. The move to arrangements such as capitation within the primary healthcare sector, will permit more flexible approaches to managing patients’ healthcare needs. There are likely to be specific payment arrangements for each pharmacist service, eg the health promotion and assessment service, the dispensing service and for each level of medicine management service.

12. Managing the transition to the future vision for pharmacya. Pharmacists will be actively involved in managing the transition process from current service delivery arrangements to future service arrangements through a progressive and evolving change process. All pharmacists will have the opportunity to respond to market signals and choose from a wide range of business and career options within the pharmacy profession.

The development of a vision statement is an important early step in organizational change. Vision statements outline a desired future state, often describing how the organization wants to be perceived by its customers and stakeholders. Vision statements are intended to be a source of inspiration and direction when undergoing organizational change, also providing clear decision-making criteria for achieving the envisioned future state. Vision statements do not, of course, guarantee that the future will be as envisioned. It is required to establish a need for change, develop and communicate the vision, obtain understanding and acceptance from internal and external stakeholders, and embed this vision within the culture of the organization to deliver successful change.19, 20 It is common, and usually necessary, that the future vision is developed by a small guiding coalition within an organization; however, either the vision needs to reflect the views of those needing to change or there needs to be some process of consultation, education, and buy-in. Without belief in and commitment to the future, change will not occur.19

To deliver the vision described in Ten-Year Vision for Pharmacists in New Zealand (TYV), substantial refocusing of the role of pharmacists is required to position them as primary providers, delivering services that enhance public health and improve individual patient’s health outcomes. For this change to be successful, there needs to be a high level of awareness, understanding, and agreement with the vision. No studies describing such agreement with either the TYV in NZ or similar vision documents overseas were identified.

The aim of this study was to determine pharmacists’ awareness of, and consultation on, the TYV; their attitudes to, and alignment with, the components of the vision; and their perceptions of barriers to deliver the future vision for pharmacy. Discussion of awareness, consultation, and perceived barriers to change as well as pharmacists’ agreement with the range of proposed services outlined in the vision document and their perceptions of the need for accreditation to undertake those roles has been explored in detail elsewhere.21, 22 This article describes pharmacists’ attitudes to, and alignment with, the components of the vision and factors that may influence that alignment, especially among community pharmacists.

Back to Article Outline

Methods 

The study uses a mixed method approach to understand pharmacists’ response to the TYV document. The mixed methods approach, in this case, uses qualitative methods to capture rich data on focus group participants’ understanding, interpretation, and response to the TYV document and, using quantitative survey methods, validates these views across the professional membership more widely.

The study was approved by the University of Auckland Human Participants Ethics Committee.

Questionnaire development 

Six pharmacist focus groups were undertaken between December 2005 and April 2006, with pharmacists selected from community pharmacy (4 focus groups), primary care organizations (1 focus group), and hospitals (1 focus group). To ensure heterogeneous representation within the different pharmacy sector groups, a theoretical maximum variation sampling strategy was used.23 Community pharmacist focus groups were held in 4 geographically separated locations covering both the North and South Islands and representing both metropolitan and rural areas. The Primary Health Organization (PHO) pharmacist focus group was held during a primary care conference, thereby allowing participants to be drawn from a nationally representative group. The hospital pharmacy focus group was held in Auckland and sought representation from the 4 northern DHB hospitals, representing 4 of 21 DHBs covering 37.1% (1.58 million/4.24 million) of the population of NZ.24 Although not geographically dispersed, these DHBs do represent metropolitan, urban, suburban, and rural communities as well as a diverse ethnic and socioeconomic group.

The questionnaire was developed using attitude statements generated from the focus groups in tandem with the TYV statements. The questionnaire contained the following areas: awareness; readership; consultation; alignment with, and adoption of, the 12 main foci of the document; agreement with the provision of a range of services; accreditation for provision of services; barriers to implementation; and demographics. Detailed demographic information was captured about the respondent and their practice setting to form the basis of analyses to investigate factors that may influence that alignment. Space was provided for free-text commentary both within the main sections and generally.

To test construct, face, and content validity, the questionnaire was piloted through in-depth interview with 12 members of the profession (community, hospital, PHO, and industry) to determine their understanding of the questions and format and ensure that questions adequately covered the topic. After refinement and repiloting, the final version was posted in September 2006, with 2 follow-up mail-outs to nonresponders at monthly intervals. No test-retest reliability measurement was undertaken.

Evaluation of alignment with vision 

This article reports pharmacist responses to questions evaluating the respondents’ alignment with, and adoption of, the key vision areas. The questionnaire contained 37 statements reflecting the contents of the 12 components of the TYV. The title of the agreements section was “Components of the Vision Statement.” Participants were asked the extent to which they agree with statements about the TYV, and responses were scored on a 5-point Likert-type scale of agreement.

Sample 

Pharmacists holding a current APC were sent the questionnaire if they had indicated, as part of their application to the registering body (Pharmacy Council of New Zealand [PCNZ]), a willingness to take part in research—1892 of the 2801 people who held an APC.

Data analysis 

Data entry was undertaken by a single individual, and a 5% random sample was double entered, with a 0.12% error rate. Where data entry errors were detected, either in double entry or during data cleaning procedures, the master file was corrected in accordance with the original questionnaire. Data were analyzed using SPSS v15 (Statistical Package for Social Sciences™, Chicago, IL.).

Demographic variables are presented as proportions of valid responses. Likert scale responses to attitude statements were coded as 1=strongly agree (SA) to 5=strongly disagree (SD); responses are treated as ordinal variables. Responses were recoded into a 3-point ordinal variable (SA+agree [A], neutral, and SD+disagree [D]) to compare agreement/disagreement while accounting for neutral responses. Within and between groups, comparisons were undertaken using chi-square, Fisher exact, Mann-Whitney, or Kruskal-Wallis comparisons. Statistical significance was assumed where P is lesser than or equal to .001 to allow for multiple testing.

The TYV document is intended to “… focuses, in the first instance, on the delivery of pharmacy services in primary care …”18 The analytical plan reflects this focus by primarily evaluating the responses of community pharmacists before comparison of these with the responses of hospital pharmacists and PHO/DHB pharmacists.

A series of multivariate analyses were constructed based on the results of bivariate analysis of the association between demographic and practice variables and responses to attitude statements, allowing for interactions between variables. Two types of multivariate models were constructed: ordinal regression, using the 5-point attitudinal response, and binomial logistic regression, using a dichotomous variable (SA+A and SD+D; neutral responses treated as missing).

Back to Article Outline

Results 

Response rate 

A response rate of 54.6% (1033/1892) was obtained after 3 mailings. Of these, 980 returned surveys were complete giving a final response rate of 51.8%, representing 35.0% of all pharmacists registered with the PCNZ in 2006 and holding an APC.

Of the 53 surveys that were returned uncompleted, 37 declined without stating a reason. The remaining 16 indicated lack of time (2), length of survey (2), retired from pharmacy (9), and having moved overseas (3) as the reason for not participating.

Demographics 

Respondents were predominantly female (62.1%), of NZ European ethnicity (76.0%), and working in community pharmacy (76.2%). A summary of the demographics of respondents, by self-identified main pharmacy role, is shown in Table 1.

Table 1. Respondent demographics by main role (N=980)
DemographicCommunity, n (%)Hospital, n (%)PHO/DHB,a n (%)Other,b n (%)Not stated, n (%)Pc
Number of respondents (% of respondents)747 (76.2)132 (13.5)18 (1.8)79 (8.1)4 (0.4)—

Sex
Male306 (41.0)26 (19.7)d3 (16.7)d21 (26.6)2 (50.0)<.001
Female428 (57.3)106 (80.3)15 (83.3)58 (73.4)2 (50.0)
Missing data13 (1.7)————

Main ethnicity
NZ European561 (75.1)86 (65.2)13 (72.2)63 (79.7)4 (100.0).269
Maori16 (2.1)—1 (5.6)3 (2.5)—
Cook Island Maori1 (0.1)————
Tongan—1 (0.8)———
Chinese37 (5.0)9 (6.8)1 (5.6)2 (2.5)—
Indian33 (4.4)6 (4.5)1 (5.6)2 (2.5)—
Othere92 (12.3)27 (20.5)2 (11.1)9 (11.4)—
Missing data7 (0.9)3 (2.3)—1 (1.3)—

Age (y)
Younger than 211 (0.1)————<.001
21-30143 (19.1)45 (34.1)d1 (5.6)5 (6.3)—
31-40166 (22.2)39 (29.5)9 (50.0)31 (39.2)—
41-50176 (23.6)30 (22.7)5 (27.8)25 (31.6)2 (50.0)
51-60153 (20.5)16 (12.1)1 (5.6)15 (19.0)1 (25.0)
61 or older103 (13.8)2 (1.5)2 (11.1)3 (3.8)1 (25.0)
Missing data5 (0.7)————

Country first registered
NZ602 (80.6)89 (67.4)d16 (88.9)56 (70.9)3 (75.0).002
Other145 (19.4)43 (32.6)2 (11.1)23 (29.1)1 (25.0)
Missing data—————

Postgraduate education
Yes144 (19.3)73 (55.3)d17 (94.4)d52 (65.8)1 (25.0)<.001
No586 (78.4)56 (42.4)1 (5.6)24 (30.4)2 (50.0)
Missing data17 (2.3)3 (2.3)—3 (3.8)1 (25.0)

Has practiced pharmacy outside NZ
Yes345 (46.2)79 (59.8)d11 (61.1)55 (69.6)2 (50.0)<.001
No402 (53.8)53 (40.2)7 (38.9)24 (30.4)2 (50.0)
Missing data————

Hours worked per week
0-1047 (6.3)2 (1.5)4 (22.2)d17 (21.5)1 (25.0).001
11-2076 (10.2)10 (7.6)5 (27.8)7 (8.9)1 (25.0)
21-3076 (10.2)12 (9.1)1 (5.6)10 (12.7)—
31-40169 (22.6)46 (34.8)3 (16.7)16 (20.3)1 (25.0)
41-50257 (34.4)58 (43.9)3 (16.7)19 (24.1)—
51-6083 (11.1)3 (2.3)1 (5.6)6 (7.6)—
More than 6034 (6.4)1 (0.8)1 (5.6)3 (3.8)—
Missing data5 (0.7)——1 (1.3)1 (25.0)

Proportion of time spent on clinical activities
0-20%178 (23.8)11 (8.3)d4 (22.2)56 (70.9)2 (50.0)<.001
21-40%98 (13.1)19 (14.4)3 (16.7)5 (6.3)1 (25.0)
41-60%110 (14.7)20 (15.2)3 (16.7)5 (6.3)—
61-80%175 (23.4)36 (27.3)5 (27.8)4 (5.1)—
81-100%179 (24.0)46 (34.8)3 (16.7)7 (8.9)—
Missing data7 (0.9)—— 1 (25.0)

aIncludes pharmacists working in both Primary Health Organizations and DHBs; these may be program managers, clinical advisory pharmacists, or pharmacists working directly with patients.

bIncludes pharmacists giving industrial pharmacy or publishing, academia, or other as their main pharmacy role.

cTwo-sided probability; chi-square test for nominal variables and Kruskal-Wallis test for ordinal variables.

dP<.05 for comparison with community pharmacists’ responses, 2-sided probability; chi-square test for nominal variables and Kruskal-Wallis test for ordinal variables.

eIncludes South African, African, Middle Eastern, Arabic, Eastern European, Australian, New Zealander, and British/English/Scottish.

Between-group comparisons, using groups defined by respondents’ self-identified main role, highlighted significant differences in the demographic characteristics of pharmacists working in different areas of pharmacy. These between-group differences included differences in age, sex, country of first registration as a pharmacist, attainment of formal postgraduate qualifications and experience of working in pharmacy-related jobs outside NZ, number of hours worked per week in a pharmacy-related role, and proportion of time spent on clinical activities.

Pairwise comparison, summary statistics of which are shown in Table 1, reveals that community pharmacy workforce is less predominantly female, is older, is more likely to have trained in NZ, is less likely to have formal postgraduate qualifications, is less likely to have practiced overseas, and spends less time on clinical activities.

Alignment with components of the TYV 

Table 2 summarizes the responses of all respondents to each attitude statement. Across all respondents, there was very strong support for the concept of a patient focus in the delivery of pharmacy services, at both an individual and population health level, with 97.1% (946/974) and 89.2% (867/974) of respondents rating statements regarding the importance of these roles as strongly agree or agree (SA+A), respectively. Just over two-thirds (69.2%; 667/964) of respondents believed that they were currently considered an integral part of the health care team, although only a little over half (52.8%; 510/966) felt that they were treated as an equal by doctors and other health care professionals.

Table 2. Pharmacists’ agreement with attitude statements aligned with the vision areas in the Ten-Year Vision
Attitude statementSA, n (%)Agree, n (%)Neutral, n (%)Disagree, n (%)SD, n (%)
Vision area 1: patient focus
One of my most important roles as a pharmacist is to improve the health of each patient as an individual (n=974, 99.4%)609 (62.5)337 (34.6)22 (2.3)5 (0.5)1 (0.1)
One of my most important roles as a pharmacist is to improve the health of the population as a whole, eg, through health promotion (n=972, 99.2%)334 (34.4)533 (54.8)94 (9.6)11 (1.1)0 (0.0)

Vision area 2: relationships with other health professionals
In my current role as a pharmacist, I am considered an integral part of the health care team (n=964, 98.4%)223 (22.8)444 (46.1)205 (21.3)81 (8.3)11 (1.1)
It is more important to have a good relationship with patients than with doctors (n=967, 98.7%)46 (4.8)218 (22.5)361 (37.3)311 (32.2)31 (3.2)
In general, doctors and other health care professionals treat me as an equal (n=966, 98.6%)43 (4.5)467 (48.3)257 (26.6)186 (19.3)13 (1.3)
The bureaucratic red tape gets in the way of developing good working relationships with other health care professionals (n=946, 96.5%)187 (19.8)358 (37.8)257 (27.2)136 (14.4)8 (0.8)
Other health care professionals will resist the broadening of pharmacists’ scopes of practice (n=960, 98.0%)69 (7.2)457 (47.6)288 (30.0)140 (14.6)6 (0.6)

Vision area 3: value proposition
More NZ-based research is needed to prove that pharmacists add value (n=960, 98.0%)204 (21.3)460 (47.9)187 (19.5)93 (9.7)16 (1.7)
Governments should only invest in pharmacy services that can prove “value for money” (n=964, 98.4%)25 (2.6)198 (20.5)210 (21.8)448 (46.5)83 (8.6)
Pharmacists’ professional practice and services to patients should be evidence based (n=939, 95.8%)144 (15.3)522 (55.6)189 (20.1)76 (8.1)8 (0.9)
Pharmacists’ professional practice and services to patients should be research led (n=915, 93.4%)66 (7.2)284 (42.0)360 (39.2)98 (10.7)7 (0.8)

Vision area 4: alignment with stated Government health strategies
The service that I provide in my current position is aligned with the national health care strategies (n=897, 91.5%)62 (6.9)496 (55.3)287 (32.0)50 (5.6)2 (0.2)
Adequate government funding is being provided to ensure pharmacy achieves all of its potential to deliver on the goals of national health care strategies (n=935, 95.4%)10 (1.1)22 (2.4)119 (12.7)513 (54.9)271 (29.0)
The pharmacy profession has effective representation at a senior policy-making level, eg, Ministry of Health and DHB (n=914, 93.3%)11 (1.2)111 (12.1)282 (30.9)399 (43.7)111 (12.1)

Vision area 5: education
There is an adequate range of training and continuing professional development to enable me to provide a wider range of medicines management services (n=958, 97.8%)65 (6.8)590 (61.6)145 (15.1)141 (14.7)17 (1.8)
The burden of continuing professional development and accreditation is a disincentive to providing a wider range of medicines management services (n=949, 96.8%)43 (4.5)264 (27.8)229 (24.1)373 (39.3)40 (4.2)

Vision area 6: focus on quality
It is hard to provide a high standard of care because funding is based on dispensing (n=925, 94.4%)201 (21.7)442 (45.1)158 (17.1)111 (12.0)13 (1.4)
Pharmacists should routinely review their practice to ensure they provide a high quality service (n=966, 98.6%)301 (31.2)614 (63.6)42 (4.3)9 (0.9)—

Vision area 7: range of services provided
In my current role, I am proactive in promoting good health with the patients I see on a day-to-day basis (n=933, 95.2%)183 (19.6)580 (62.2)130 (13.9)36 (3.9)—
For the most part, pharmacists are only in a position to undertake health promotion with patients who present with a pre-existing problem—as opposed to promoting improved health to the wider local community (n=955, 97.4%)47 (4.9)482 (50.5)152 (15.9)243 (25.4)31 (3.2)
The capacity of community pharmacists to manage minor ailments is underused (n=958, 97.8%)219 (22.9)515 (53.8)132 (13.8)86 (9.0)6 (0.6)
The future of pharmacy lies in collaborative prescribing roles, such as assisting doctors and nurses with prescribing decisions (n=959, 97.9%)197 (20.5)479 (49.9)218 (22.7)59 (6.2)6 (0.6)
Appropriately qualified pharmacists should be allowed to prescribe a wide range of prescription medicines independently, eg, not under the supervision of another prescriber (n=967, 98.7%)202 (20.9)452 (46.7)188 (19.4)112 (11.6)13 (1.3)

Vision area 8: service delivery options
The delivery of pharmacy services should be defined by local patient need rather than by traditional business models alone (n=946, 96.5%)181 (19.1)626 (66.2)114 (12.1)22 (2.3)3 (0.3)

Vision area 9: use of new technology
Pharmacists will lead the recognition and introduction of innovative new technologies that improve the effectiveness of patient care and service delivery (n=914, 93.3%)73 (8.0)346 (37.9)408 (44.6)81 (8.9)6 (0.7)
To improve patient care, pharmacists need access to all relevant patient health information under rigorously controlled privacy conditions (n=964, 98.4%)285 (29.4)526 (54.6)107 (11.1)44 (4.6)2 (0.2)
In my current role, I do not want the responsibility associated with having access to all relevant patient records (n=942, 96.1%)23 (2.4)147 (15.6)246 (26.1)354 (37.6)172 (18.3)

Vision area 10: relationship with funding agencies
Government does not have a long-term vision for health care that includes pharmacy (n=922, 94.1%)162 (17.6)432 (46.9)236 (25.3)89 (9.7)3 (0.3)
To optimize the development of future medicine-related health services, the pharmacy profession needs to be consulted by funders and policymakers (n=957, 97.7%)392 (41.0)515 (53.8)42 (4.4)7 (0.7)1 (0.1)
To more effectively contribute to the development of Government policy, the pharmacy profession needs to be more respected for its expertise (n=958, 97.8%)399 (41.6)503 (52.5)49 (5.1)6 (0.6)1 (0.1)
Pharmacists have the right to expect respect for their expertise in medicine-related health services (n=960, 98.0%)406 (42.3)472 (49.2)43 (4.5)31 (3.2)8 (0.8)
DHBs are adding bureaucracy that hinders teamwork and adds costs to services (n=909, 92.8%)345 (38.0)349 (38.4)190 (20.9)22 (2.4)3 (0.3)
Positive, effective, and transparent relationships between pharmacy and DHBs will enable pharmacy to deliver better services for their local populations (n=930, 94.9%)331 (35.6)510 (54.8)87 (9.4)1 (0.1)1 (0.1)

Vision area 11: payment arrangements
There is no realistic prospect of the funding and negotiation climate changing within the next 8-10y (n=875, 89.3%)101 (11.5)313 (35.8)307 (35.1)136 (15.5)18 (2.1)
The current funding model in my workplace will not support innovative pharmacy services (n=868, 88.6%)217 (25.0)394 (45.4)158 (18.2)85 (9.8)14 (1.6)
There should be specific payment arrangements for each pharmacy service, eg, health promotion, dispensing, and each level of medicines management service (n=929, 94.8%)224 (24.1)493 (53.1)173 (18.6)31 (3.3)8 (0.9)
DHBs should offer performance-related incentive payments for pharmacy services (n=913, 93.2%)134 (14.7)384 (42.1)275 (30.1)101 (11.1)19 (2.1)

SA, strongly agree; SD, strongly disagree.

Three quarters (76.6%; 734/958) of pharmacists agreed that the capacity for pharmacists to manage minor ailments was currently underused. Pharmacist prescribing was felt to be an important part of the future expansion of pharmacy services with 70.5% (676/959) supporting collaborative prescribing and 67.6% (654/967) supporting independent prescribing by appropriately qualified pharmacists. Four-fifths (81.8%; 763/933) of pharmacists reported that they were currently involved in proactive health promotion activities; although 55.4% (529/955) reported that, for the most part, pharmacists were only in a position to undertake health promotion with patients who had previously identified health problems rather than at a community-wide level.

Two-thirds (62.2%; 558/897) of pharmacists reported that their practice was aligned with government health policy. However, 64.4% (594/922) of respondents felt that government did not have a long-term vision for pharmacy. Respondents strongly felt that the pharmacy profession needed to be consulted by policymakers and funders to ensure optimal development of future medicines-related health services (94.8%; 907/957). Furthermore, they felt that pharmacy needed to be more respected for its expertise (94.2%; 902/958) and had the right to expect this (91.5%; 878/960). More than half of the respondents (55.8%; 510/914) disagreed that pharmacy had effective representation at a policy-making level.

Differences between respondents by practice setting 

Table 3 summarizes the difference in response by professional subgroup. The table highlights the significant differences in both agreement and the magnitude of agreement between community pharmacists and either hospital or PHO/DHB pharmacists.

Table 3. Proportion of pharmacists agreeing with attitude statements by professional subgroup
Attitude statementCommunity pharmacists, n (%)Hospital pharmacists, n (%)DHB/PHO pharmacists, n (%)
Vision area 1: patient focus
One of my most important roles as a pharmacist is to improve the health of each patient as an individual727 (97.7)129 (97.7)18 (100.0)
One of my most important roles as a pharmacist is to improve the health of the population as a whole, eg, through health promotion655 (88.3)118 (89.4)18 (100.0)

Vision area 2: relationships with other health professionals
In my current role as a pharmacist, I am considered an integral part of the health care team505 (68.1)111a, b (84.1)12 (66.7)
It is more important to have a good relationship with patients than with doctors237 (32.1)15a, b (11.5)0a, b (−)
In general, doctors and other health care professionals treat me as an equal367 (49.9)84b (63.6)13 (72.2)
The bureaucratic red tape gets in the way of developing good working relationships with other health care professionals452 (62.4)55a, b (42.6)8 (47.1)
Other health care professionals will resist the broadening of pharmacists’ scopes of practice422 (57.7)57a, b (43.8)10 (55.6)

Vision area 3: value proposition
More NZ-based research is needed to prove that pharmacists add value498 (68.0)93 (71.5)17 (94.4)
Governments should only invest in pharmacy services that can prove “value for money”162 (22.0)31 (23.7)8 (44.4)
Pharmacists’ professional practice and services to patients should be evidence based470 (66.0)118a, b (90.1)18b (100.0)
Pharmacists’ professional practice and services to patients should research led306 (44.2)85a, b (64.4)13b (76.5)

Vision area 4: alignment with stated Government health strategies
The service that I provide in my current position is aligned with the national health care strategies409 (59.6)89 (72.4)17b (100.0)
Adequate government funding is being provided to ensure pharmacy achieves all of its potential to deliver on the goals of national health care strategies26 (3.6)5 (3.9)0 (−)
The pharmacy profession has effective representation at a senior policy-making level, eg, Ministry of Health and DHB102 (14.5)11 (9.1)1 (5.9)

Vision area 5: education
There is an adequate range of training and continuing professional development to enable me to provide a wider range of medicines management services527 (71.3)81 (63.3)10 (58.8)
The burden of continuing professional development and accreditation is a disincentive to providing a wider range of medicines management services264 (36.2)21a, b (16.4)5 (29.4)

Vision area 6: focus on quality
It is hard to provide a high standard of care because funding is based on dispensing520 (71.5)75 (64.1)7 (46.7)
Pharmacists should routinely review their practice to ensure they provide a high quality service692 (93.6)128b (97.7)18b (100.0)

Vision area 7: range of services provided
In my current role, I am proactive in promoting good health with the patients I see on a day-to-day basis627 (84.7)95a (76.0)12 (75.0)
For the most part, pharmacists are only in a position to undertake health promotion with patients who present with a pre-existing problem—as opposed to promoting improved health to the wider local community441 (60.0)59 (47.2)6 (33.3)
The capacity of community pharmacists to manage minor ailments is underused585 (78.9)77a, b (63.1)12 (66.7)
The future of pharmacy lies in collaborative prescribing roles, such as assisting doctors and nurses with prescribing decisions493 (67.5)105b (79.5)17a, b (94.4)
Appropriately qualified pharmacists should be allowed to prescribe a wide range of prescription medicines independently, eg, not under the supervision of another prescriber490 (66.4)88 (67.2)13 (72.2)

Vision area 8: service delivery options
The delivery of pharmacy services should be defined by local patient need rather than by traditional business models alone619 (85.5)112 (87.5)16 (88.9)

Vision area 9: use of new technology
Pharmacists will lead the recognition and introduction of innovative new technologies that improve the effectiveness of patient care and service delivery337 (47.9)56 (44.8)6 (37.5)
To improve patient care, pharmacists need access to all relevant patient health information under rigorously controlled privacy conditions601 (81.7)124b (93.9)16 (88.9)
In my current role, I do not want the responsibility associated with having access to all relevant patient records161 (22.0)0a, b (−)0b (−)

Vision area 10:relationship with funding agencies
Government does not have a long-term vision for health care that includes pharmacy482 (67.8)67b (57.3)6b (35.3)
To optimize the development of future medicine-related health services, the pharmacy profession needs to be consulted by funders and policymakers695 (95.1)124 (96.1)16 (88.9)
To more effectively contribute to the development of Government policy, the pharmacy profession needs to be more respected for its expertise698 (95.4)119 (90.8)16 (88.9)
Pharmacists have the right to expect respect for their expertise in medicine-related health services682 (93.2)114 (87.0)15 (83.3)
DHBs are adding bureaucracy that hinders teamwork and adds costs to services578 (82.8)72a, b (58.1)8b (50.0)
Positive, effective and transparent relationships between pharmacy and DHBs will enable pharmacy to deliver better services for their local populations652 (91.4)110 (87.3)16 (88.9)

Vision area 11: payment arrangements
There is no realistic prospect of the funding and negotiation climate changing within the next 8-10y371 (54.2)28a, b (24.6)1a, b (6.3)
The current funding model in my workplace will not support innovative pharmacy services531 (78.1)60b (49.6)3a, b (20.0)
There should be specific payment arrangements for each pharmacy service, eg, health promotion, dispensing, and each level of medicines management service560 (78.2)96 (76.2)15 (83.3)
DHBs should offer performance-related incentive payments for pharmacy services389 (55.3)79 (62.2)11 (68.8)

aP≤.001 for comparison with community pharmacist’s responses, 2-sided probability; chi-square test for 3-point scale (SA+Agree/Neutral/Disagree+SD).

bP≤.001 for comparison with community pharmacist’s responses, 2-sided probability; Mann-Whitney test for ordinal response.

Hospital pharmacists, compared with community pharmacists, were more positive about their integration and acceptance as part of the health care team and less likely to believe that other professions would resist extension of pharmacists’ roles. They were also more positive about the need for services to be research led, routine review of practice, and the importance of collaborative prescribing as a future role. Access to patient health information was considered very important, and there were no concerns about the responsibility associated with access. Finally, hospital pharmacists were more positive about changes in the funding environment and the ability to innovate in their current workplace.

PHO/DHB pharmacists, compared with community pharmacists, were more supportive of evidence-based and research-led practice. They were clear that their current practice reflected health policy and that pharmacists needed to routinely review their practice. They felt more strongly that collaborative prescribing was important to the future of pharmacy and that access to patient health information was important. Like hospital pharmacists, they expressed no concerns about access to patient health information. They were more positive about the existence of a Government future vision for pharmacy, were much more positive about the prospect of funding models changing during the period of the TYV document, and believed that the current funding model did support innovative practice.

Back to Article Outline

Discussion 

The apparent gap in the literature in the evaluation of pharmacists’ agreement with professional bodies’ visions for the future is surprising. The present study is the first to formally evaluate pharmacists’ agreement with a vision document put forward by a professional pharmacy body. As previously outlined, the pharmacy professions in many countries have been through a process of envisioning change to “reprofessionalize” in recent years.11, 12, 13, 18 In commonly accepted change models such as that of Kotter,19 it is usual to form a “guiding coalition” from within the organization, in this case profession, to assist with developing the vision, which is then communicated before implementing the changes that are intended to deliver the future vision. However, in selecting and implementing a change strategy, it is important to understand the organization’s response to the vision, that is, to identify misunderstandings and lack of belief in the vision as well as to understand where resistance to change exists; failure to understand these things risk selecting poor strategies to introduce and embed change.25 Roberts et al26 describe 3 essential dimensions to be addressed for successful change; content (what is to be changed), context (internal and external factors), and process (actions required to effect change). The assumption made by researchers, to date, is that there is agreement regarding content, but to date the only evidence for this is the consistency of exhortation from pharmacy academics and professional bodies.

This article reports NZ pharmacists’ level of agreement or disagreement with attitude statements developed to reflect pharmacists’ views of the “Ten-Year Vision for Pharmacists.”18 Perhaps unsurprisingly, the results show clear alignment across the profession with central elements of the vision including patient-centered delivery of pharmaceutical care, the role of pharmacists in health promotion and the management of minor ailments, pharmacists as an integral part of the health care team, and the provision of new services, including collaborative prescribing. The study provides a formal validation that the profession-at-large sees its future role as being one of patient-centered delivery of health care at an individual-patient level and with recognition of a role in population health.

Perhaps more interestingly, the study reveals some of the areas that need to be addressed if the vision is to be delivered. The results also show that there are concerns about relationships with key stakeholders, primary care professionals, and funders. These concerns are particularly prevalent among community pharmacists. This corroborates findings of previous studies of the barriers and facilitators to the delivery of cognitive services in community pharmacy. The sizable body of literature that explores barriers and facilitators to implement new services might be viewed as research on change management or enacting aspects of a vision27, 28, 29, 30, 31, 32, 33; these are discussed in more detail in an earlier article addressing the barriers reported in this survey.21

In terms of community pharmacists’ current positioning to develop the envisioned relationships with other health professionals, most respondents felt that they were an integral part of the team but significantly fewer agreed that they participated in the team on an equal footing. Likewise, there was a belief that other health professionals would resist pharmacists’ role expansion. This is a potential threat to both future pharmacists’ role and relationships within the primary health care team. The magnitude of difference in agreement with this statement between hospital and community pharmacists possibly reflects the lack of a collaborative relationship between pharmacists and doctors in primary care that has become the norm in hospital. This difficulty in establishing collaborative working relationships with general practitioners has been described in the literature, and this can be seen by pharmacists as a barrier to new service provision.34, 35 Of potential relevance to the development of collaborative working relationships is the time spent on clinical activities. There was a bimodal distribution of responses to this question, one being around the 0-20% category and the other being around the 80-100% category. One interpretation of the higher rating is that community pharmacists perceive all of their activities as relating to patient care and, therefore, categorize them as “clinical.” The lower rating is similar to what is reported consistently over time and between countries.36, 37, 38, 39, 40, 41, 42 It is also important to note that a high proportion of community pharmacists also expressed concern that high standards of care were compromised by the dispensing-orientated funding model. Studies from the United States indicate a disconnect between the time community pharmacists believe they should spend on patient consultations and the time they actually do.43

There was widespread agreement that pharmacy services should be evidence based and more NZ-based research was needed to show that pharmacists add value to the health care team. In contrast, there was ambivalence—at best—about the view that only services that could demonstrate value for money should be funded. This may reflect a belief that there are intangible or unmeasurable benefits from the pharmacist-patient relationship surrounding dispensing and counseling services. An alternative explanation is wariness of health economic research, perhaps because of lack of familiarity with research methods.

One hypothesis for the present study, derived from observations of qualitative differences in responses between focus groups held to inform the development of the survey, was that different professional subgroups would respond differently to the TYV document. This hypothesis was confirmed by the data from the survey; what is unclear are the factors driving these differences. Martin,44 an organizational scientist, describes the existence of subcultures within organizations, in this case a profession. The subgroups or subcultures seen in this study may be organized along the lines of job role or may be explained by the associations seen between demographic variables and responses to the attitude statements. The complexity of interactions between demographic variables confounded simple regression models. Drawing conclusions about the independence of demographic factors as predictors of response is difficult. Professional subgroup appeared in those models to be the strongest predictor of response, but whether it is independent of the characteristics of the individuals who constitute the group is unclear. More work is needed to better understand these associations and their relevance to practice and practice change.

Limitations 

The results of this study need to be considered in the context of the study limitations. First, the response rate in this study was 51.8%. Comparison of responder versus nonresponder characteristics was not possible; however, it was possible to compare responders with the results from a national workforce survey.45 This comparison illustrates a similar proportion of women, people of NZ of European descent, and those employed primarily in community pharmacy. Notwithstanding this, there is a potential for nonresponder bias, limiting the generalizability of the findings. Bias may take 1 of 2 opposing poles. At one end of the spectrum, the views of people who are not interested in the subject of the survey may be underrepresented,46 thereby overestimating the agreement of the profession-at-large with the vision. At the other end of the spectrum, 60% of respondents did not recall being consulted during the development of the vision document21 and may, therefore, overrepresent negative views of a disaffected group who feel that this is their opportunity to “have their say.”

As previously reported, despite the high level of awareness, few respondents had read the TYV before receiving the questionnaire.21 The design of the questionnaire was such that respondents did not need to have read the TYV document; they were simply asked to rate their agreement with attitude statements. As a result, their lack of familiarity with the TYV is not believed to have affected the findings. Finally, the survey instrument was developed after conducting focus groups with pharmacists and interviews with other stakeholders such as funders. The attitude statements that were developed did not reflect a 1:1 relationship with the vision document. To this end, the survey does not directly measure agreement with the vision statements, rather an alignment with components of the TYV, informed by focus group participant’s interpretation of the statements. Thus the research does not measure “buy-in” with each element of the vision individually.

Implications for policy and practice 

This study has implications for pharmacy professional bodies as well as policymakers and funders. It provides important insights into pharmacists’ view of the future contribution of pharmacy and how this might be moved forward.

First, it is clear that there is a desire for change and role expansion. Pharmacists see that their contribution to patient care can be increased through better use of minor ailments services; there is also a desire for greater access to patient records to enhance pharmaceutical care and for the development of collaborative prescribing rights. There is perceived resistance from other health professionals, and this is felt most strongly by community pharmacists. This is not unfounded; there is ample evidence from the literature that although pharmacists do not see role expansion as usurping other practitioner’s roles, the other professions often perceive this as role encroachment.1, 29, 30, 47, 48, 49, 50

There was recognition among pharmacists that the current model of practice and funding are barriers to implement patient-centered cognitive services but little expectation that it will change. Interestingly, DHB/PHO pharmacists, who work most closely with the contracting and funding bodies, did not have this perception. Health funding and planning organizations might also note that pharmacists are generally supportive of the idea of tiered payment for service and incentive-based funding models.

There is an almost unanimous view among pharmacists that Government lacks a clear plan for pharmacy and that the profession needs to be consulted by policymakers to optimize medicines-related health services. At the same time, pharmacists do not believe that they are effectively represented at a senior policy level. This is something that needs to be recognized both by the Government and the professional bodies. Pharmacists clearly appear to feel that they can and should be able to contribute to policy and do not feel they do so at present.

Of interest to policymakers will be the indication that pharmacists believe that the current funding model is not compatible with the changing role of pharmacy. Further, that they are open to considering alternative models including specific payment arrangements for from Vol. 14 Supp 2 different levels of medicines management service and performance-related incentive payments; these mechanisms are both commonplace in general practice in NZ. Funders and policymakers might also take note that discrete choice models have demonstrated that pharmacists may be prepared to forgo income to secure a role that delivers their desired roles.51

Pharmacy in NZ is primed for change but like in other countries, that change has been slow. The poor level of awareness of the contents of the TYV should be of concern to the PSNZ and others who are attempting to catalyze change. One of the main causes of failure in organizational change is the failure to communicate the future vision.19 This article highlights levels of both alignment and misalignment with the TYV document, in conjunction with previously identified barriers to adoption; this helps highlight where structural or behavioral change is needed to move forward. The physical, structural, and organizational separation of pharmacist has been identified as an important challenge in system redesign.52 Many of these issues remain; fundamental changes are required if pharmacy is to move forward.

The model of community pharmacy practice in NZ is similar in many countries. The organization of care in NZ is very similar to that in Australia, the United Kingdom, Canada, and parts of Europe; however, the generalizability of these findings to other countries is unknown. Each country is unique because of its political climate, organizational relationships, funding models, and, to a degree, social integration of pharmacists as a professional group with shared ideals.

Back to Article Outline

Conclusion 

As a profession, NZ pharmacists demonstrate a high degree of alignment with the Ten-Year Vision for Pharmacy published by the Pharmaceutical Society. However, there are notable differences in alignment between professional subgroups; more research is needed to understand the relationships between workforce demographics, organizational culture, and the vision of future roles for pharmacy. Pharmacists in NZ appear supportive of the proposed changes to practice including possible changes to funding structures to increase the pharmacy professions’ contribution to patient care. The profession, represented here by the views of individual pharmacists, wants greater recognition and involvement in the process of developing medicines-related health policy.

Back to Article Outline

Acknowledgments 

The survey was funded in part by the New Zealand Pharmacy Education and Research Foundation and in part by the School of Pharmacy, The University of Auckland. Neither funding body had any influence over the study design; the collection, analysis, or interpretation of data; the writing of the report; or the decision to submit the article for publication.

Shane Scahill is the recipient of a University of Auckland Senior Health Research Scholarship.

Back to Article Outline

References 

  1. Mesler MA. Boundary encroachment and task delegation: clinical pharmacists on the medical team. Sociol Health Ill. 1991;13:310–331
  2. Holloway SWF, Jewson ND, Mason DJ. ‘Reprofessionalization’ or ‘occupational imperialism’?: some reflections on pharmacy in Britain. Soc Sci Med. 1986;23:323–332
  3. Birenbaum A. Reprofessionalization in pharmacy. Soc Sci Med. 1982;16:871–878
  4. Commonwealth Government of Australia; Pharmacy Guild of Australia. The Fourth Community Pharmacy Agreement. Canberra (Australia): Australian Government, Department of Health and Aging; 2005;Available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/F7FBDB333D030BFFCA2570C000003A44/$File/4cpacompilation.pdfAccessed 20.01.11.
  5. Department of Health. Pharmacy in the future: a vision for pharmacy in the new NHS. London (England): Department of Health; 2000;
  6. Department of Health. Pharmacy in the future: a vision for pharmacy in the new NHS. London (England): Department of Health; 2000;
  7. United States Government. Pharmacy Affairs and 340B Drug Pricing Program. Rockville, MD: US Dept of Health and Human Services; 2008;
  8. The Medicare Prescription Drug, Improvement and Modernization Act of 2003. Department UST, Trans; 2003;
  9. Department of Health. Pharmacy in England: building on strengths - delivering the future. London (England): HM Government, The Stationary Office; 2008;ISBN 9780101734127
  10. Commonwealth Government of Australia; Pharmacy Guild of Australia. The Fifth Community Pharmacy Agreement. Canberra (Australia): Australian Government, Department of Health and Aging; 2010;Available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/C3DB799DB360AF0CCA25772000249FA8/$File/5CPA%20Agreement%2005%20August%202010.pdfAccessed 20.01.11
  11. Task Force on a Blueprint for Pharmacy. Blueprint for pharmacy: the vision for pharmacy. Ottawa (ON): Canadian Pharmacists Association; 2008;Available at: http://www.pharmacists.ca/content/about_cpha/whats_happening/cpha_in_action/pdf/BlueprintVision.pdfAccessed 20.01.11
  12. Tsuyuki R, Schindel TJ. Leading Change in Pharmacy Practice: Fully Engaging Pharmacists in Patient-Oriented Healthcare. Edmonton, Canada: COMPRIS, University of Alberta; 2004;
  13. Anonymous . A vision of pharmacy’s future roles, responsibilities, and manpower needs in the United States. American College of Clinical Pharmacy. Pharmacotherapy. 2000;20:991–1020
  14. Patel H. How the Pharmacy 2020 vision is lighting the way for pharmacy’s future. Pharm J. 2007;279:131–132
  15. Ministry of Health . New Zealand Primary Health Care Strategy. New Zealand Ministry of Health; 2001;
  16. Ministry of Health . Towards a Medicines Strategy. Wellington, New Zealand: Ministry of Health; 2006;
  17. Ministry of Health . New Zealand Medicines Strategy. Wellington, New Zealand: Ministry of Health; 2007;
  18. Pharmacy Sector Action Group . Focus on the future: ten-year vision for pharmacists in New Zealand. [Portable Document Format] Available at: http://psnz.org.nz/public/home/documents/10_yea_plan.pdfAccessed 06.12.10
  19. Kotter JP. Leading change: why transformation efforts fail. Harv Bus Rev. 1995;73:59–67
  20. In:  Graetz F,  Rimmer M,  Lawrence A,  Smith A editor. Managing Organisational Change. Milton, Australia: John Wiley & Sons; 2002;
  21. Scahill S, Harrison J, Sheridan J. The ABC of New Zealand’s ten year vision for pharmacists: awareness, barriers and consultation. Int J Pharm Pract. 2009;17:135–142
  22. Scahill S, Harrison J, Sheridan J. Pharmacy under the spotlight: New Zealand pharmacists’ perceptions of current and future roles and the need for accreditation. Int J Pharm Pract. 2010;18:59–62
  23. Teddlie C, Tashakkori A. Foundations of Mixed Methods Research: Integrating Quantitative and Qualitative Approaches in the Social and Behavioral Sciences. Thousand Oaks, CA: SAGE Publications, Inc.; 2009;
  24. Ministry of Health, Wellington, New Zealand . District Health Boards: frequently asked questions [webpage]. Available at: http://www.moh.govt.nz/moh.nsf/indexmh/dhb-faqAccessed 04.10.10
  25. Kotter JP, Schlesinger LA. Choosing strategies for change. Harv Bus Rev. 2008;86:130–139
  26. Roberts AS, Benrimoj SI, Chen TF, Williams KA, Hopp TR, Aslani P. Understanding practice change in community pharmacy: a qualitative study in Australia. Res Social Adm Pharm. 2005;1:546–564
  27. Bryant L. Evaluation of the Barriers to and Implementation of Comprehensive Pharmaceutical Care in New Zealand. Auckland, New Zealand: General Practice and Primary Health Care, University of Auckland; 2006;
  28. Bush J, Langley CA, Jesson JK, Wilson KA. Perceived barriers to the development of community pharmacy’s public health function: a survey of the attitudes of directors of public health and chief pharmacists in UK primary care organisations. Int J Pharm Pract. 2006;2:B68–B69
  29. Elvey R, Bradley F, Ashcroft D, Noyce P. Implementing medication usage reviews through the new community pharmacy contract: key drivers and barriers. Int J Pharm Pract. 2006;14(suppl 2):B32–B33
  30. Hall J, Smith I. Barriers to medicines use reviews: comparing the views of pharmacists and PCTs. Int J Pharm Pract. 2006;14(suppl 2):B51–B52
  31. Roberts AS, Benrimoj SI, Chen TF, Williams KA, Aslani P. Implementing cognitive services in community pharmacy: a review of facilitators used in practice change. Int J Pharm Pract. 2006;14:163–170
  32. Hopp TR, Sorensen EW, Herborg H, Roberts AS. Implementation of cognitive pharmaceutical services (CPS) in professionally active pharmacies. Int J Pharm Pract. 2005;13:21–31
  33. Van Mil JWF, De Boer WO, Tromp TFJ. European barriers to the implementation of pharmaceutical care. Int J Pharm Pract. 2001;9:163–168
  34. Lounsbery J, Green C, Bennett M, Pedersen CA. Evaluation of pharmacists’ barriers to the implementation of medication therapy management services. J Am Pharm Assoc (2003). 2009;49:51–58
  35. Snyder ME, Zillich AJ, Primack BA, et al. Exploring successful community pharmacist-physician collaborative working relationships using mixed methods. Res Social Adm Pharm. 2010;6(4):307–323
  36. McCann L, Hughes CM, Adair CG. A self-reported work-sampling study in community pharmacy practice: a 2009 update. Pharm World Sci. 2010;32:536–543
  37. Berbatis CG, Sunderland VB, Joyce A, Bulsara M, Mills C. Characteristics of Australia’s community pharmacies: National Pharmacy Database Project. Int J Pharm Pract. 2007;15:265–271
  38. Schommer JC, Pedersen CA, Gaither CA, Doucette WR, Kreling DH, Mott DA. Pharmacists’ desired and actual times in work activities: evidence of gaps from the 2004 National Pharmacist Workforce Study. J Am Pharm Assoc. 2006;46:340–347
  39. Doucette WR, Kreling DH, Schommer JC, Gaither CA, Mott DA, Pedersen CA. Evaluation of community pharmacy service mix: evidence from the 2004 National Pharmacist Workforce Study. J Am Pharm Assoc. 2006;46:348–355
  40. Schommer JC, Pedersen CA, Doucette WR, Gaither CA, Mott DA. Community pharmacists’ work activities in the United States during 2000. J Am Pharm Assoc. 2002;42:399–406
  41. Bell HM, McElnay JC, Hughes CM. A self-reported work sampling study in community pharmacy practice. Pharm World Sci. 1999;21:210–216
  42. Pronk MC, Blom LT, Jonkers R, Rogers EM, Bakker A, de Blaey KJ. Patient oriented activities in Dutch community pharmacy: diffusion of innovations. Pharm World Sci. 2002;24:154–161
  43. Midwest Pharmacy Workforce Research Consortium. Final report of the 2009 National Sample Survey of the Pharmacist Workforce to Determine Contemporary Demographic and Practice Characteristics. Paper presented at: Pharmacy Manpower Project, Inc.; March 1, 2010; Alexandria, VA.
  44. Martin J. Cultures in Organisations: Three Perspectives. 1st ed.. New York, NY: Oxford University Press; 1992;
  45. Pharmacy Council of New Zealand . Pharmacy Council of New Zealand Workforce Demographics Survey. Wellington, New Zealand: Pharmacy Council (NZ); 2007;
  46. Oppenheim A. Questionnaire Design, Interviewing and Attitude Measurement. London, UK: Pinter; 1992;
  47. Edmunds J, Calnan MW. The reprofessionalisation of community pharmacy? An exploration of attitudes to extended roles for community pharmacists amongst pharmacists and general practitioners in the United Kingdom. Soc Sci Med. 2001;53:943–955
  48. Adamcik BA, Ransford HE, Oppenheimer PR, Brown JF, Eagan PA, Weissman FG. New clinical roles for pharmacists: a study of role expansion. Soc Sci Med. 1986;23:1187–1200
  49. Bryant LJM, Coster G, Gamble GD, McCormick RN. General practitioners’ and pharmacists’ perceptions of the role of community pharmacists in delivering clinical services. Res Social Adm Pharm. 2009;5:347–362
  50. McDonald R, Cheraghi-Sohi S, Sanders C, Ashcroft D. Professional status in a changing world: the case of medicines use reviews in English community pharmacy. Soc Sci Med. 2010;71:451–458
  51. Scott A, Bond C, Inch J, Grant A. Preferences of community pharmacists for extended roles in primary care—a survey and discrete choice experiment. Pharmacoeconomics. 2007;25:783–792
  52. Cooksey JA, Knapp KK, Walton SM, Cultice JM. Challenges to the pharmacist profession from escalating pharmaceutical demand. Health Aff. 2002;21:182–188

PII: S1551-7411(10)00168-3

doi:10.1016/j.sapharm.2010.12.001

Research in Social and Administrative Pharmacy
Volume 8, Issue 1 , Pages 17-35, January 2012

Article Tools