title: A qualitative assessment of a community pharmacy cognitive pharmaceutical services program, using a work system approach.
abstract: BACKGROUND
  Although lack of time, trained personnel, and reimbursement have been identified as barriers to pharmacists providing cognitive pharmaceutical services (CPS) in community pharmacies, the underlying contributing factors of these barriers have not been explored. One approach to better understand barriers and facilitators to providing CPS is to use a work system approach to examine different components of a work system and how the components may impact care processes.
  
  
  OBJECTIVE
  The goals of this study were to identify and describe pharmacy work system characteristics that pharmacists identified and changed to provide CPS in a demonstration program.
  
  
  METHODS
  A qualitative approach was used for data collection. A purposive sample of 8 pharmacists at 6 community pharmacies participating in a demonstration program was selected to be interviewed. Each semistructured interview was audio recorded and transcribed, and the text was analyzed in a descriptive and interpretive manner by 3 analysts. Themes were identified in the text and aligned with 1 of 5 components of the Systems Engineering Initiative for Patient Safety (SEIPS) work system model (organization, tasks, tools/technology, people, and environment).
  
  
  RESULTS
  A total of 21 themes were identified from the interviews, and 7 themes were identified across all 6 interviews. The organization component of the SEIPS model contained the most (n=10) themes. Numerous factors within a pharmacy work system appear important to enable pharmacists to provide CPS. Leadership and foresight by the organization to implement processes (communication, coordination, planning, etc.) to facilitate providing CPS was a key finding across the interviews. Expanding technician responsibilities was reported to be essential for successfully implementing CPS.
  
  
  CONCLUSIONS
  To be successful in providing CPS, pharmacists must be cognizant of the different components of the pharmacy work system and how these components influence providing CPS.
authors.affiliation: Division of Social and Administrative Sciences, University of Wisconsin-Madison, School of Pharmacy, 777 Highland Avenue, 2513 Rennebohm Hall, Madison, WI 53705, USA. mchui@pharmacy.wisc.edu
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Chui
authors.forename: David A
authors.initials: DA
authors.lastname: Mott
authors.forename: Leigh
authors.initials: L
authors.lastname: Maxwell
mesh_terms: D001071:Appointments and Schedules; D001291:Attitude of Health Personnel; D001292:Attitude to Computers; D002983:Clinical Competence; D003071:Cognition; D003142:Communication; D003157:Community Pharmacy Services / Q000458:organization & administration*; D003199:Computer Systems; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D007722:Health Knowledge, Attitudes, Practice; D006302:Health Services Research; D006801:Humans; D007407:Interviews as Topic; D007857:Leadership; D054539:Medication Therapy Management / Q000458:organization & administration*; D017146:Models, Organizational; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration*; D010595:Pharmacists / Q000458:organization & administration* / Q000523:psychology; D024382:Professional Role; D011369:Professional-Patient Relations; D015397:Program Evaluation; D036301:Qualitative Research; D019984:Quality Indicators, Health Care / Q000458:organization & administration; D017748:Time Management / Q000458:organization & administration; D057188:Workflow; D017132:Workplace / Q000458:organization & administration