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Variation in autonomy within community pharmacy workforce found in new survey
Contractor pharmacists feel more able to make independent clinical decisions than employee or locum community pharmacists. So conclude researchers, who, with the help of a focus group of pharmacists from a variety of backgrounds, developed a tool to analyse how pharmacists would react to different clinical scenarios.
The researchers say that since one of the defining characteristics of professionals is their ability to exercise autonomy in the immediate work setting, the credibility of community pharmacy as a profession depends upon evidence that pharmacists can do so.
A survey was sent to a random sample of 2,000 community pharmacists in England who were asked to indicate how they would respond to a number of scenarios including “action in light of unacceptable quality of parallel imported drugs”, “introduce a scheme to check patient compliance and need for repeat prescriptions”, and “agree to dispense a methadone prescription to an addict”.
Possible responses were “act”, “act and justify decision to those in authority”, “seek permission from those in authority to act” or “decide not to seek permission from those in authority since it was unlikely that it would be granted”.
To help validate the results, respondents were also asked whether or not they had actually experienced such a situation and how they rated the importance of each scenario with respect to their ability to make an authoritative clinical decision.
The researchers analysed the 626 valid responses returned, and found that contractor pharmacists were much more likely to make independent decisions than were employees or locums.
Additionally, pharmacists working full-time considered themselves to be more autonomous than those working part-time. Gender, size of employing organisation and length of time qualified were not found to have an impact on decision making.
The researchers say that these results may, in part, be explained by the extent to which organisational and managerial constraints operate.
They say that these variations may suggest that pharmacists are not always able to apply their clinical expertise to the full. “In extremis this can be said to undermine the professional standing of community pharmacists.” The researchers suggest that in the interests of patient care, factors causing these variations should be addressed.
They conclude that these results should be taken into account to safeguard pharmacists’ professional standing, especially considering the move towards an enhanced role for community pharmacists (International Journal of Pharmacy Practice 2004;12:223 and 231).
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Citation: The Pharmaceutical Journal