title: Organizational factors influencing pharmacy practice change.
abstract: BACKGROUND
  Some pharmacists have changed the focus of their practice from solely dispensing. Emerging services they have added include medication therapy management and other pharmacy services.
  
  
  OBJECTIVE
  To assess the effect of entrepreneurial orientation, resource adequacy, and pharmacy staffing on pharmacy practice change.
  
  
  METHODS
  A total of 1847 licensed U.S. pharmacists received 2 mail surveys as part of a larger national pharmacist survey. The core survey collected information about practice setting, prescription volume, and staffing. The supplemental survey assessed how the pharmacy had changed over the past 2 years to enable the delivery of pharmacy services. The amount of change was assessed by 12 items, which were summed to provide an aggregate change index. Five variables from organizational change literature were assessed as influences on practice change: proactiveness, risk taking, autonomy, work ethic, and adequacy of resources. In addition, the associations of pharmacist and technician staffing with practice change were assessed. A multiple linear regression analysis was performed with the aggregate change index as the dependent variable and the 7 potential influences on change as the independent variables.
  
  
  RESULTS
  Four hundred usable surveys were analyzed. At least some level of practice change was reported in 60% of pharmacies surveyed. The linear regression analysis of the model was significant (P<.001) with an R-square value of 0.276. Significant influences on change were 2 dimensions of entrepreneurial orientation-proactiveness and autonomy-as well as adequacy of resources and pharmacy technician staffing.
  
  
  CONCLUSIONS
  Many pharmacies reported that some aspects of their practice have changed, such as collecting patient information and documenting care. Few reported changes in asking patients to pay for pharmacy services. These findings support previous results, which show that the capacity for organizational change can be augmented by increasing proactiveness, autonomy among employees, and the availability of adequate and appropriate resources.
authors.affiliation: Division of Clinical and Administrative Pharmacy, College of Pharmacy, University of Iowa, Iowa City, IA 52242, USA. william-doucette@uiowa.edu
authors.forename: William R
authors.initials: WR
authors.lastname: Doucette
authors.forename: Justin C
authors.initials: JC
authors.lastname: Nevins
authors.forename: Caroline
authors.initials: C
authors.lastname: Gaither
authors.forename: David H
authors.initials: DH
authors.lastname: Kreling
authors.forename: David A
authors.initials: DA
authors.lastname: Mott
authors.forename: Craig A
authors.initials: CA
authors.lastname: Pedersen
authors.forename: Jon C
authors.initials: JC
authors.lastname: Schommer
mesh_terms: D001291:Attitude of Health Personnel; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration*; D011307:Drug Prescriptions; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006302:Health Services Research; D006801:Humans; D016018:Least-Squares Analysis; D016014:Linear Models; D054539:Medication Therapy Management / Q000458:organization & administration; D009936:Organizational Innovation; D009937:Organizational Objectives; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration; D010593:Pharmaceutical Services / Q000191:economics / Q000458:organization & administration*; D010595:Pharmacists / Q000191:economics / Q000458:organization & administration* / Q000523:psychology; D010596:Pharmacy Technicians / Q000458:organization & administration; D020399:Practice Management / Q000191:economics / Q000458:organization & administration*; D017009:Professional Autonomy; D012309:Risk-Taking; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States; D000078329:Workforce