Community pharmacists' readiness to take action to improve working conditions.

OBJECTIVE: The objective of this study was to assess pharmacists' readiness to take actions resulting in change at the individual level or systemic level. DESIGN/SETTING AND PARTICIPANTS/OUTCOME MEASURES: An online survey was distributed via pharmacy-related social media pages and several state pharmacy association newsletters and e-mail listservs. Fifteen items assessed participants' readiness to pursue change using a 5-point scale based on the transtheoretical model of behavior change (1 = Do not plan on doing, 2 = Plan to take in the next 6 months, 3 = Plan to take in the next month, 4 = Took in the past 6 months, 5 = Took more than 6 months ago). Categorical principal components analysis (CATPCA) was used as a data reduction technique to identify underlying components of the 15 items assessing readiness to improve working conditions. Component scores for each component were calculated and used as dependent variables in multivariable linear regression models to test associations between the components and sociodemographic and work-related predictors. RESULTS: CATPCA revealed a 12-item scale with 2 components accounting for 39.97% of the total variance. Pharmacists working in independent pharmacies had a significantly higher willingness than chain pharmacists to pursue actions with potential to result in systemic-level changes, such as contacting or joining an organization to attempt to improve their current working conditions (regression coefficient = 0.623, P < 0.001). Pharmacists working in independent pharmacies had a significantly lower willingness than chain pharmacists to pursue actions resulting in individual-level changes, such as changing their current job or quitting (regression coefficient = -0.485, P < 0.001). CONCLUSION: Pharmacists working in national chains may be less willing than independent pharmacists to pursue systemic-level changes owing to fear of discipline from employers. Future research should examine the effect of interventions intended to increase pharmacists' motivation and readiness to pursue changes to improve working conditions.

Determining and regulating scope of practice for health care professionals: A participatory, multiple stakeholder approach.

BACKGROUND: Scope of practice varies between health professions and states. OBJECTIVE: To explore stakeholders' preferences for determining and regulating health care professionals' scopes of practice. METHODS: Stakeholders in medicine, nursing, and pharmacy, including practitioners, leaders of professional associations, regulatory board members, and healthcare executives, were recruited via professional organizations, social media, and snowball sampling. Stakeholder preferences were collected using concept mapping, an integrated mixed methods approach which includes 1) brainstorming of statements and 2) sorting and rating of statements. Multidimensional scaling, hierarchical cluster analysis, and Mann Whitney-U tests were used for analysis. RESULTS: Thirty participants generated and sorted statements regarding preferences for scope of practice, creating eight clusters: 1) accountability to prioritize patient safety, 2) standardization, 3) collaborative regulation, 4) intra-professional regulation, 5) federal versus state, 6) role of non-health care professionals, 7) prioritization of patient outcomes, and 8) health care professional training and education. Fifty-seven participants rated statements in terms of importance and feasibility. Physicians and non-physicians held similar views on 68.5% (n = 37) and 81.5% (n = 44) of statements, respectively for importance and feasibility. The statements in the standardization and health care professional training and education clusters were perceived as the most important and feasible across stakeholder types.

Students' Reflections on Learning Experiences in Federally Qualified Health Centers.

Introduction: Final year pharmacy students participate in advanced pharmacy practice experiences in multiple settings. Each practice setting offers different opportunities for student learning and growth. Experiences at Federally Qualified Health Centers (FQHCs) allow student pharmacists to work with patients with unique health and socioeconomic challenges. Objective: The objective of this study was to examine the impact of an ambulatory care rotation at an FQHC on pharmacy students' learning. Methods: Final year pharmacy students submitted weekly reflections about their experiences at an FQHC using the Driscoll method of reflection. They reflected on activities, examined their effects on learning and growth, and discussed the impact the experiences would have on future practice. Qualitative analysis of students' reflections was conducted to identify themes related to learning and professional growth. Results: Pharmacy students (N = 11) reflected upon a variety of topics during their rotations at an FQHC. Fifteen themes and 11 sub-themes were identified by the reviewers within 43 reflections. Reflections covered three general areas: types of experiences students participate in at an FQHC, current and future effects of those experiences on student learning or patients' health, and students' emotional reactions during the experiences. Conclusions: Student reflections demonstrated that rotation experiences contributed to their growth and learning in communication, collaboration, and empathy. Additionally, students indicated that they gained confidence and skills throughout the rotation. By identifying the meaning students attributed to their learning experiences, reflections can be used to assess rotation activities for modification or continued inclusion.