Community pharmacists' prescription intervention practices--exploring variations in practice in Norwegian pharmacies.
BACKGROUND
Evidence suggests that prescription intervention frequencies have been found to vary as much as 10-fold among Norwegian pharmacies and among pharmacists within the same pharmacy.


OBJECTIVE
To explore community pharmacists' perceptions of how their prescription intervention practices were influenced by their working environment, their technological resources, the physical and social structures of the pharmacies, their relations with colleagues, and to the individual pharmacist's professional skills.


METHODS
Two focus groups consisting of 14 community pharmacists in total, from urban and rural areas in Norway, discussed their working procedures and professional judgments related to prescription interventions. Organizational theories were used as theoretical and analytical frameworks in the study. A framework based on Leavitt's organizational model was to structure our interview guide. The study units were the statements of the individual pharmacists. Recurrent themes were identified and condensed.


RESULTS
Two processes describing variations in the dispensing workflow including prescription interventions were derived--an active dispensing process extracting information about the patient's medication from several sources and a fast dispensing process focusing mainly on the information available on the prescription. Both workflow processes were used in the same pharmacies and by the same pharmacist but on different occasions. A pharmacy layout allowing interactions between pharmacist and patients and a convenient organization of technology, layout, pharmacist-patient and pharmacist-coworker transactions at the workplace was essential for detecting and solving prescription problems. Pharmacists limited their contact with general practitioners when they considered the problem a formality and/or when they knew the answers themselves. The combined use of dispensing software and the Internet was a driving force toward more independent and cognitively advanced prescription interventions.


CONCLUSIONS
Implementation of a general organizational model made it easier to analyze and interpret the pharmacists' intervention practices. Working environment, technology, management and professional skills may all contribute to variations in pharmacists' prescription intervention practices in and between community pharmacies.
Mandt
Ingunn
I
Institute for Pharmacy Practice Research, Box 5070 Majorstuen, NO-0301 Oslo, Norway. ingunnma@online.no
Horn
Anne Marie
AM
Ekedahl
Anders
A
Granas
Anne Gerd
AG
D001291:Attitude of Health Personnel; D020811:Biomedical Technology / Q000379:methods; D002983:Clinical Competence; D003157:Community Pharmacy Services / Q000458:organization & administration*; D005160:Facility Design and Construction; D017144:Focus Groups; D006801:Humans; D007400:Interprofessional Relations; D017146:Models, Organizational; D009664:Norway; D010595:Pharmacists / Q000458:organization & administration* / Q000523:psychology; D010865:Pilot Projects; D024382:Professional Role; D011369:Professional-Patient Relations; D019035:Rural Health Services; D013997:Time Factors; D019037:Urban Health Services; D057188:Workflow