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).
Broad spectrum p812
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