Original Research
Over-the-counter prescribing and pharmacists' adoption of new medicines: Diffusion of innovations

https://doi.org/10.1016/j.sapharm.2012.05.001Get rights and content

Abstract

Background

More than 90 medicines in the United Kingdom alone have been reclassified from “prescription only” to “pharmacy” availability, and many of these have further been deregulated to “general sales” status. Pharmacist perspectives of reclassified medicines adoption into practice are important to inform future reclassifications.

Objectives

The aim of this research was to explore the factors associated with adoption into practice of newly reclassified medicines by community pharmacists based on the theoretical framework of diffusion of innovations.

Methods

Focus groups and qualitative interviews with 20 community pharmacists selected randomly from 4 Health Boards in Scotland were conducted. Results were analyzed using a framework method for thematic analysis.

Results

Factors associated with pharmacists' decision making regarding adoption into practice of newly reclassified medicines related to pharmacists' perceived attributes of newly reclassified medicines such as evidence of benefits and risks to patients (ie, efficacy and safety); organizational contextual factors such as sources of information and training; external factors, such as support from wider stakeholders; and adopter characteristics such as pharmacists' perception toward adopting new behaviors. Many newly reclassified medicines were highlighted by participants to have been highly adopted into practice or were less/not adopted based on these diverse factors. Decisions at organizational level to stock new medicines did not necessarily translate into adoption at practitioner level.

Conclusions

Pharmacists' decision making regarding adoption of newly reclassified medicines is a complex and multidimensional process. This is the first study of this sort, and results of this qualitative study will aid development of a research instrument aimed at quantifying the importance of the factors identified.

Introduction

Enhanced community pharmacy-led management of health care problems, mainly of minor ailments, is a key priority of recent UK and international health policies.1, 2, 3 General practice-led management of minor ailments in the United Kingdom is estimated to cost the UK National Health Service around £2 billion a year, with 80% of the cost accounted for physician time spent on approximately 57 million consultations.4 Enhanced management of diseases through community pharmacy, apart from bringing financial savings, is also deemed to be contributing to community pharmacists' professional development.5

To meet such political agendas, there has been an ongoing reclassification of medicines from “prescription only” to “pharmacy” and “general sales” availability, the latter 2 categories also referred to as over the counter (OTC) (Box 1). In the United Kingdom, the Medicines Act 19686 regulates the supply of these medicines.

More than 90 medicines in the United Kingdom alone have been reclassified from POM to P availability.7 In the past, most reclassifications were aimed for the management of acute conditions, but more recently, medicines for long-term use such as simvastatin for the prevention of coronary events have also been reclassified.7 Pharmacists in the United Kingdom can now supply medicines for conditions such as irritable bowel syndrome, migraine, Chlamydia, and arthritis.8 Medicines from therapeutic classes such as angiotensin-converting enzyme inhibitors, inhaled corticosteroids, short- and long-acting β2-adrenergic agonists, β-blockers, diuretics, calcium channel blockers, and bisphosphonates have been listed to be potential candidates for reclassification.8 Similar reclassifications of medicines are also taking place in the rest of Europe and the United States.9

Knowledge of pharmacists' perspectives on adoption into practice of reclassified medicines is imperative to identify factors associated with the decision-making process. Understanding of these factors, in turn, is important for future reclassification decisions and to identify barriers and facilitators to pharmacists' adoption processes. Factors associated with doctors' adoption of new medicines have received more attention in recent years. A review of factors associated with the uptake of new medicines in secondary care (ie, hospitals) reflected the interplay of several factors including evidence of medicine efficacy and safety and the support and decision-making structures within an organization.10 A review of the uptake of new medicines by medical practitioners in primary care settings (eg, general practices) drew similar conclusions revealing efficacy and safety being paramount to the cost of prescribing.11 Hospital doctors, pharmaceutical representatives, and prescribing advisers were all found to be influential.11 Despite the steady stream of reclassified medicines brought into community pharmacy, there has been no previous qualitative study in this area. This research aims to address this gap.

Section snippets

Objectives

The aim of this research was to explore the factors associated with adoption into practice of newly reclassified medicines by community pharmacists based on the theoretical framework of diffusion of innovations. The specific objectives were to

  • 1.

    Investigate community pharmacists' views on the ongoing reclassification of medicines

  • 2.

    Evaluate the process-related aspects of innovation adoption from community pharmacists' perspectives

  • 3.

    Identify factors associated with adoption into practice of reclassified

Theoretical framework

Understanding decision-making processes regarding innovation adoption and investigation of the associated factors is an area of diffusion research.12 Innovation here relates to newly reclassified medicines. Rogers'13 diffusion model defines diffusion as a “process through which an innovation is communicated through certain channels over time among the members of social system.” The key elements in the diffusion process are the innovation, its adopter, communication channels, time, the social

Participants

A total of 20 community pharmacists took part, including 11 in the 2 focus groups (n = 5 and n = 4; 2 focus groups that were planned resulted in one-to-one face-to-face interviews because of low participation) (Table 2). Data saturation led to no further recruitment.

Contribution of new medicines and services to professional role development

New services allowing pharmacists to move away from routine dispensing roles were deemed to be benefiting pharmacists' professional role development in general. The ongoing reclassification of medicines was identified as one of these.

I

Opinions toward ongoing reclassification

Ongoing reclassification of medicines was identified by participants to be contributing to pharmacists' professional role development in general by enabling them to move away from the routine dispensing role. Specific examples of anticipated future reclassifications were identified. Of the suggested medicines, naproxen has been reclassified to “pharmacy” status.20 Adoption into practice of the newly reclassified medicines was found to be associated with many factors, and these related to those

Conclusion

The ongoing reclassification of medicines aimed at enhanced minor ailment management was identified by the participants of this study to be contributing in general to pharmacists' role development and professional image in society. However, highly individual and diverse experiences of changes were identified where individuals perceived the need as well as the current pace of changes differently. A wide range of factors associated with decision making were identified such as those related to

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