Perceptions of working conditions and safety concerns in community pharmacy.

BACKGROUND/OBJECTIVE: Working conditions within community pharmacy can impact pharmacists and their ability to provide safe patient care. The objective of this study was to determine pharmacists' perceptions of working conditions while controlling for respondent (years of experience, degree, work status) and workplace variables (prescription volume, type of community setting). METHODS: This mixed-methods study used a cross-sectional survey to investigate community pharmacists' perceptions of company climate (at the store level, corporate level, as well as fear of discipline), workflow issues, and career satisfaction. Items utilized a seven-point Likert-type response format (1 = strongly disagree to 7 = strongly agree). Linear regression was used to assess relationships between perceptions and years of experience, degree, work status, prescription volume, and type of community setting. A free-response question captured perceptions of safety concerns. An adapted version of the Agency for Healthcare Research and Quality integrative model of health care working conditions on organizational climate and safety was used as a framework for this analysis. RESULTS: Respondents working in national chains had significantly more fear of being disciplined for following policies to promote safety and addressing patient safety concerns than respondents in independent (P < 0.001) and grocery and big box stores (P < 0.001), when controlling for years of experience in community pharmacy, degree, and prescription volume. Most participants (n = 805, 96.9%) indicated organizational or company level factors were the most substantial threat to safety, with work design and quality emphasis being the second most frequently mentioned hazards. CONCLUSION: Company climate and workflow were perceived negatively in all community settings but were perceived the most negatively by those working in chain pharmacies. A majority of pharmacists feared being disciplined for addressing safety concerns with management, which may be detrimental to patient safety. Further research on how to improve working conditions is warranted.

Policy solutions to address community pharmacy working conditions.

OBJECTIVE: Increasing attention has been drawn to poor working conditions in community pharmacy, the impact on patient safety, and the role of pharmacy benefit managers (PBMs) in the United States. This study assessed community pharmacists' perceptions of potential solutions to improve working conditions. METHODS: This mixed-methods, survey-based study explored pharmacists' proposed solutions for improving working conditions. The participants' perceptions of solutions at the company and state or national levels were assessed using a 7-point Likert-type response format (from 1 = strongly disagree to 7 = strongly agree). Multiple regression assessed the relationships between participant perceptions and pharmacy type (e.g., national chain, grocery, or independent), pharmacy degree, age, average number of prescriptions processed daily (prescription volume), and years of experience. The participants' perceptions of how to improve working conditions were explored to provide more depth and nuance to the understanding of these issues. RESULTS: The sample size was 1222 participants. Respondents working for national chains were statistically significant more in favor of limiting the number of prescriptions verified per pharmacist and less in favor of addressing reimbursement issues than those working for grocery or big-box stores (P = 0.001 and P = 0.006, respectively) and independent pharmacies (P < 0.001 and P < 0.001, respectively), when controlling for years of experience, degree, and prescription volume. Although addressing staffing issues and changing corporate priorities were immediate concerns, the participants felt that regulating PBM reimbursement practices should be the first priority. CONCLUSION: Identifying solutions from employee stakeholders may be an effective way to inform actions that both employers and extraorganizational entities can take to improve pharmacist working conditions and patient care. Restricting PBMs was the most preferred solution, followed by direct and indirect reimbursement for nondispensing services. However, working conditions in community pharmacy are influenced by multiple factors that often are dependent on one another. Thus, a multifaceted approach will likely be required to improve working conditions.

Faculty perceptions of a tobacco cessation train-the-trainer workshop and experiences with implementation: A qualitative follow-up study.

BACKGROUND: Between 2003 and 2005, pharmacy faculty members (n = 191) participated in a national train-the-trainer workshop designed to equip faculty with the necessary knowledge and skills to implement a shared curriculum, Rx for Change: Clinician-Assisted Tobacco Cessation, at pharmacy schools across the United States. OBJECTIVE: To conduct a long-term, qualitative follow-up study of faculty participants to describe (a) perceptions of the train-the-trainer workshop, and (b) subsequent experiences with curricular implementation. Results of this investigation will inform a national survey of all train-the-trainer participants. METHODS: Participants were selected via random sampling from the group of 191 faculty members who participated in the workshop. Semi-structured telephone interviews with participants were audio-recorded and transcribed, and qualitative thematic analysis was conducted. RESULTS: Eighteen (62%) of 29 invited individuals participated in the interviews. All participants reported implementing components of Rx for Change at their institution. The analysis yielded eight major themes pertaining to faculty perceptions and experiences with implementation: (1) accessibility to tools for teaching, (2) increased confidence and skills, (3) flexibility delivering the curriculum, (4) factors facilitating implementation and challenges encountered by faculty, (5) enhancement in treating tobacco users in clinical practice, (6) students' confidence and cognizance of the pharmacists' role as a public health advocate, (7) networking and career development opportunities, and (8) useful background for research. CONCLUSION: Participation in the train-the-trainer workshop increased self-reported confidence for teaching tobacco cessation, and faculty valued access to useful, updated tools for teaching. Furthermore, their newly acquired counseling skills were deemed helpful for treating patients' tobacco use and dependence in clinical practice. Participants also perceived improved pharmacy students' confidence and beneficial networking opportunities. Results can help future trainers understand faculty experiences with implementing a shared, national curriculum and inform faculty participants of some of the potential long-term outcomes as a result of participation.