title: Pharmacists' perceptions of pay for performance versus fee-for-service remuneration for the management of hypertension through pharmacist prescribing.
abstract: OBJECTIVE
  As pharmacists expand their roles as patient care providers, remuneration must be offered for patient care activities apart from dispensing. Most jurisdictions paying for such services utilize the fee-for-service (FFS) model, while little is known about the role of pay for performance (P4P) within the pharmacy profession. This study aimed to elicit the experience of pharmacists practicing under both models within the Alberta Clinical Trial in Optimizing Hypertension (RxACTION) study in Alberta, Canada.
  
  
  METHODS
  Pharmacist participants in RxACTION caring for at least one patient under FFS and under P4P were interviewed about their experiences until data saturation was reached. Interviews were conducted in June-July 2015, with responses audio recorded, transcribed and coded to identify key themes.
  
  
  RESULTS
  Eight pharmacists were interviewed, with three key themes identified: a perceived comfort with the existing FFS model particularly due to its ease related to business planning, the transformative effect of the study on their practices and a preference for future models to consider a blend of both service count- and performance-driven metrics. The degree of influence pharmacists feel they can have on outcomes achieved by patients, the perceptions of patients and other healthcare professionals on outcome-based payment, and concerns with the impact of variable remuneration on the pharmacy business model are concerns raised with P4P in pharmacy practice.
  
  
  CONCLUSIONS
  This study reveals a hesitation to radically transform payment for pharmacists' patient care services towards a P4P model. Efforts to implement P4P should therefore be gradual and accompanied with a robust evaluation plan.
authors.affiliation: School of Pharmacy, The University of Mississippi, University, MS, USA.
authors.forename: Meagen M
authors.initials: MM
authors.lastname: Rosenthal
authors.affiliation: Faculty of Science, University of Waterloo, Waterloo, ON, Canada.
authors.forename: Nimisha
authors.initials: N
authors.lastname: Desai
authors.affiliation: School of Pharmacy, University of Waterloo, Waterloo, ON, Canada.
authors.forename: Sherilyn K D
authors.identifier: http://orcid.org/0000-0001-5084-4357
authors.initials: SKD
authors.lastname: Houle
mesh_terms: D000416:Alberta; D001291:Attitude of Health Personnel; D018588:Fee-for-Service Plans / Q000191:economics*; D006801:Humans; D006973:Hypertension / Q000628:therapy; D010595:Pharmacists / Q000191:economics* / Q000523:psychology*; D024382:Professional Role; D012052:Reimbursement, Incentive / Q000191:economics*; D060926:Remuneration
keywords: community pharmacy; prescribing; professional practice; remuneration