title: Factors influencing pharmacists' adoption of prescribing: qualitative application of the diffusion of innovations theory.
abstract: BACKGROUND
  In 2007, Alberta became the first Canadian jurisdiction to grant pharmacists a wide range of prescribing privileges. Our objective was to understand what factors influence pharmacists' adoption of prescribing using a model for the Diffusion of Innovations in healthcare services.
  
  
  METHODS
  Pharmacists participated in semi-structured telephone interviews to discuss their prescribing practices and explore the facilitators and barriers to implementation. Pharmacists working in community, hospital, PCN, or other settings were selected using a mix of random and purposive sampling. Two investigators independently analyzed each transcript using an Interpretive Description approach to identify themes. Analyses were informed by a model explaining the Diffusion of Innovations in health service organizations.
  
  
  RESULTS
  Thirty-eight participants were interviewed. Prescribing behaviours varied from non-adoption through to product, disease, and patient focused use of prescribing. Pharmacists' adoption of prescribing was dependent on the innovation itself, adopter, system readiness, and communication and influence. Adopting pharmacists viewed prescribing as a legitimization of previous practice and advantageous to instrumental daily tasks. The complexity of knowledge required for prescribing increased respectively in product, disease and patient focused prescribing scenarios. Individual adopters had higher levels of self-efficacy toward prescribing skills. At a system level, pharmacists who were in practice settings that were patient focused were more likely to adopt advanced prescribing practices, over those in product-focused settings. All pharmacists stated that physician relationships impacted their prescribing behaviours and individual pharmacists' decisions to apply for independent prescribing privileges.
  
  
  CONCLUSIONS
  Diffusion of Innovations theory was helpful in understanding the multifaceted nature of pharmacists' adoption of prescribing. The characteristics of the prescribing model itself which legitimized prior practices, the model of practice in a pharmacy setting, and relationships with physicians were prominent influences on pharmacists' prescribing behaviours.
authors.affiliation: Faculty of Pharmacy and Pharmaceutical Sciences, 3-171 Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB T6G 1C9, Canada. lisa.guirguis@ualberta.ca.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Makowsky
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Guirguis
authors.forename: Christine A
authors.initials: CA
authors.lastname: Hughes
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Sadowski
authors.forename: Nese
authors.initials: N
authors.lastname: Yuksel
mesh_terms: D000416:Alberta; D004059:Diffusion of Innovation; D011307:Drug Prescriptions; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D010595:Pharmacists / Q000523:psychology*; D010818:Practice Patterns, Physicians'; D024382:Professional Role; D036301:Qualitative Research
references.citation: Res Social Adm Pharm. 2011 Sep;7(3):246-56
references.pmid: 21272547
references.citation: Soc Sci Med. 2011 Aug;73(3):375-82
references.pmid: 21737195
references.citation: J Pharm Pharm Sci. 2005 Aug 04;8(2):217-25
references.pmid: 16124933
references.citation: J Am Pharm Assoc (Wash). 2000 May-Jun;40(3):384-91
references.pmid: 10853540
references.citation: Int J Pharm Pract. 2011 Feb;19(1):5-12
references.pmid: 21235654
references.citation: Int J Pharm Pract. 2009 Feb;17(1):39-46
references.pmid: 20218028
references.citation: Am J Health Syst Pharm. 2006 Feb 1;63(3):244-53
references.pmid: 16434783
references.citation: Milbank Q. 2004;82(4):581-629
references.pmid: 15595944
references.citation: Pharm World Sci. 2003 Oct;25(5):227-34
references.pmid: 14584230
references.citation: Patient Educ Couns. 2001 Feb;42(2):115-21
references.pmid: 11118777
references.citation: Res Social Adm Pharm. 2010 Dec;6(4):307-23
references.pmid: 21111388
references.citation: Am J Health Syst Pharm. 2008 Nov 15;65(22):2126-32
references.pmid: 18997141
references.citation: Health Place. 2009 Mar;15(1):315-22
references.pmid: 18675577
references.citation: Int J Pharm Pract. 2011 Dec;19(6):381-2
references.pmid: 22060232
references.citation: Int J Pharm Pract. 2010 Feb;18(1):29-36
references.pmid: 20405593
references.citation: Res Social Adm Pharm. 2012 Jan-Feb;8(1):36-46
references.pmid: 21454138
references.citation: J Health Serv Res Policy. 2008 Oct;13(4):215-21
references.pmid: 18806179
references.citation: Int J Pharm Pract. 2009 Apr;17(2):89-94
references.pmid: 20214256
references.citation: Pharm World Sci. 2007 Dec;29(6):628-34
references.pmid: 17380422
references.citation: JAMA. 2003 Apr 16;289(15):1969-75
references.pmid: 12697800
references.citation: Res Social Adm Pharm. 2010 Mar;6(1):18-31
references.pmid: 20188325
references.citation: Int J Pharm Pract. 2011 Feb;19(1):70-8
references.pmid: 21235661
references.citation: Res Social Adm Pharm. 2005 Dec;1(4):483-507
references.pmid: 17138492
references.citation: Sociol Health Illn. 2009 Apr;31(3):406-21
references.pmid: 19055585
references.citation: Res Social Adm Pharm. 2009 Dec;5(4):319-26
references.pmid: 19962675
references.citation: Pharm World Sci. 2006 Apr;28(2):76-90
references.pmid: 16791716