title: Forward and backward transitions in pharmacy-based immunization services.
abstract: BACKGROUND
  Community pharmacies can engage in immunization services by contracting with an external workforce (outsourced mechanism) or staff pharmacists (in-house mechanism) to deliver the services. Because an outsourced mechanism generally requires lower organizational commitment, pharmacies often start with an outsourced mechanism. Later, these pharmacies can have 1 of the following transitions: sit on a fence by continuing with an outsourced mechanism, move backward by abandoning any immunization services, or move forward by implementing an in-house mechanism.
  
  
  OBJECTIVE
  Using Rogers' Diffusion of Innovations model and Behavioral Theory of the Firm as guidance, this study identified the associations between perceived characteristics of immunization services and backward/forward transitions.
  
  
  METHODS
  A cross-sectional mail survey was conducted to collect data from key informants of Washington State community pharmacies during May-July 2004 (response rate=46.9%). A total of 106 pharmacies were included in the analysis. Based on pharmacy's immunization service transitions, these pharmacies were identified as Fence sitters, Backward movers, or Forward movers. Relationships between these transitions, pharmacy characteristics, and perceived characteristics of immunization services were analyzed using bivariate and multinomial logistic regression techniques.
  
  
  RESULTS
  Backward and Forward movers had less positive assessments of outsourced services when compared with Fence sitters. Backward and Forward movers differed in their perceptions of in-house services; Backward movers generally perceived no differences between these 2 services, whereas Forward movers generally perceived in-house services to be superior to outsourced services. Furthermore, the odds of being a Forward mover increased as perceived technical and social benefits of outsourced services decreased, perceived compatibility of in-house services increased, and perceived complexity of in-house services decreased.
  
  
  CONCLUSIONS
  Perceived characteristics of outsourced and in-house innovations were associated with backward and forward transitions. Findings can be used to guide the development of strategies for facilitating organizational change and preventing the abandonment of immunization services.
authors.affiliation: Pharmacy Care Systems, Harrison School of Pharmacy, Auburn University, 207 Dunstan Hall, Auburn, AL 36849, USA. westrsc@auburn.edu
authors.forename: Salisa C
authors.initials: SC
authors.lastname: Westrick
mesh_terms: D003157:Community Pharmacy Services / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D003625:Data Collection; D004059:Diffusion of Innovation; D005260:Female; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration*; D016015:Logistic Models; D008297:Male; D017146:Models, Organizational; D020416:Outsourced Services / Q000458:organization & administration; D010595:Pharmacists / Q000458:organization & administration* / Q000523:psychology; D024382:Professional Role; D014861:Washington