Factors influencing pharmacists’ adoption of prescribing: qualitative application of the diffusion of innovations theory

Abstract

BackgroundIn 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.MethodsPharmacists 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.ResultsThirty-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.ConclusionsDiffusion 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.

What supports hospital pharmacist prescribing in Scotland? – A mixed methods, exploratory sequential study

“…This was in agreement with other studies which stated that pharmacists 'recognised the need and expressed desire' to have management support to take prescribing forward. 12,21 Pharmacy managers set and promote the culture towards education and training in their hospitals and act as role models for colleagues. Their leadership in establishing direction, motivating and supporting their staff are all important both during the PLP and for future service delivery.…”

“…There were similar conclusions in previous studies which found that pharmacists who networked with other colleagues and networks had more active prescribing practices. 12,21 Active PIPs were more likely to have felt well supported by the MDT during their PLP than those not prescribing (p < 0.05). It is important that there is support from the MDT during the PLP to ensure successful implementation of prescribing.…”

“…It is important that there is support from the MDT during the PLP to ensure successful implementation of prescribing. 12,19,21 In a previous study pharmacists acknowledged that team member support was crucial to their prescribing success and the physicianprescriber relationship was often a primary consideration for pharmacists deciding to prescribe. 21 Pharmacists expressed a reluctance to prescribe if they believed the physician was not supportive of pharmacist prescribing but this was not evident from our study.…”

“…12,19,21 In a previous study pharmacists acknowledged that team member support was crucial to their prescribing success and the physicianprescriber relationship was often a primary consideration for pharmacists deciding to prescribe. 21 Pharmacists expressed a reluctance to prescribe if they believed the physician was not supportive of pharmacist prescribing but this was not evident from our study. This previous study also found that in the hospital or ambulatory clinic setting, some pharmacists did not feel there was a need to prescribe themselves as they were well integrated into inter-professional teams where they had sufficient input on prescribing decisions.…”

“…A further study found that pharmacists' adoption of prescribing was dependent on 'the pharmacist, system readiness, communication and influence (management).' 21 However this study did not examine the infrastructure required to support hospital pharmacist prescribing. A Canadian study suggested that certain personality traits of some pharmacists (e.g.…”