title: Practice change in community pharmacy: quantification of facilitators.
abstract: BACKGROUND
  There has been an increasing international trend toward the delivery of cognitive pharmaceutical services (CPS) in community pharmacy. CPS have been developed and disseminated individually, without a framework underpinning their implementation and with limited knowledge of factors that might assist practice change. The implementation process is complex, involving a range of internal and external factors.
  
  
  OBJECTIVE
  To quantify facilitators of practice change in Australian community pharmacies.
  
  
  METHODS
  We employed a literature review and qualitative study to facilitate the design of a 43-item "facilitators of practice change" scale as part of a quantitative survey instrument, using a framework of organizational theory. The questionnaire was pilot-tested (n = 100), then mailed to a random sample of 2000 community pharmacies, with a copy each for the pharmacy owner, employed pharmacist, and pharmacy assistant. The construct validity and reliability of the scale were established using exploratory factor analysis and Cronbach's alpha, respectively.
  
  
  RESULTS
  A total of 735 (37%) pharmacies responded, with 1303 individual questionnaires. Factor analysis of the scale yielded 7 factors, explaining 48.8% of the total variance. The factors were: relationship with physicians (item loading range 0.59-0.85; Cronbach's alpha 0.90), remuneration (0.52-0.74; 0.82), pharmacy layout (0.52-0.79; 0.81), patient expectation (0.52-0.85; 0.82), manpower/staff (0.49-0.66; 0.80), communication and teamwork (0.37-0.65; 0.77), and external support/assistance (0.47-0.69; 0.74).
  
  
  CONCLUSIONS
  All of the factors demonstrated good reliability and construct validity and explained approximately half of the variance. Implementing CPS requires support not only with the clinical aspects of service delivery, but also for the process of implementation itself, and remuneration models must reflect this. The identified facilitators should be used in a multilevel strategy to integrate professional services into the community pharmacy business, engaging pharmacists and their staff, policy makers, educators, and researchers. Further research is required to determine additional factors impacting the capacity of community pharmacies to implement change.
authors.affiliation: The University of Sydney, New South Wales, Australia. roberts_alison@bigpond.com
authors.forename: Alison S
authors.initials: AS
authors.lastname: Roberts
authors.forename: Shalom I
authors.initials: SI
authors.lastname: Benrimoj
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Chen
authors.forename: Kylie A
authors.initials: KA
authors.lastname: Williams
authors.forename: Parisa
authors.initials: P
authors.lastname: Aslani
mesh_terms: D001315:Australia; D003142:Communication; D003157:Community Pharmacy Services / Q000458:organization & administration*; D005160:Facility Design and Construction; D005163:Factor Analysis, Statistical; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D009936:Organizational Innovation; D017060:Patient Satisfaction; D010595:Pharmacists / Q000458:organization & administration*; D015203:Reproducibility of Results; D012456:Salaries and Fringe Benefits; D000078329:Workforce