Community pharmacists' prescription intervention practices--exploring variations in practice in Norwegian pharmacies.

BACKGROUND: Evidence suggests that prescription intervention frequencies have been found to vary as much as 10-fold among Norwegian pharmacies and among pharmacists within the same pharmacy. OBJECTIVE: To explore community pharmacists' perceptions of how their prescription intervention practices were influenced by their working environment, their technological resources, the physical and social structures of the pharmacies, their relations with colleagues, and to the individual pharmacist's professional skills. METHODS: Two focus groups consisting of 14 community pharmacists in total, from urban and rural areas in Norway, discussed their working procedures and professional judgments related to prescription interventions. Organizational theories were used as theoretical and analytical frameworks in the study. A framework based on Leavitt's organizational model was to structure our interview guide. The study units were the statements of the individual pharmacists. Recurrent themes were identified and condensed. RESULTS: Two processes describing variations in the dispensing workflow including prescription interventions were derived--an active dispensing process extracting information about the patient's medication from several sources and a fast dispensing process focusing mainly on the information available on the prescription. Both workflow processes were used in the same pharmacies and by the same pharmacist but on different occasions. A pharmacy layout allowing interactions between pharmacist and patients and a convenient organization of technology, layout, pharmacist-patient and pharmacist-coworker transactions at the workplace was essential for detecting and solving prescription problems. Pharmacists limited their contact with general practitioners when they considered the problem a formality and/or when they knew the answers themselves. The combined use of dispensing software and the Internet was a driving force toward more independent and cognitively advanced prescription interventions. CONCLUSION: Implementation of a general organizational model made it easier to analyze and interpret the pharmacists' intervention practices. Working environment, technology, management and professional skills may all contribute to variations in pharmacists' prescription intervention practices in and between community pharmacies.

[Communication about prescription interventions between pharmacists and general practitioners]. / Samhandling mellom allmennleger og apotek ved korreksjon av resepter.

BACKGROUND: Pharmacists intervene on about 2 % of prescriptions dispensed in Norwegian community pharmacies. The aim of this study was to explore how general practitioners (GPs) and community pharmacists communicate and document prescription interventions, and to discuss what both professions consider to be best practice. MATERIAL AND METHODS: Five GPs, five community pharmacists and two medical secretaries were recruited, from two regions in Norway, to form two focus groups. The groups were invited to discuss 12 real examples of prescription interventions (from a former study of pharmacy practice) from six intervention categories. Statements from the focus groups were analyzed and recurrent themes identified. RESULTS: The GPs and pharmacists described varying management of the pharmacists' prescription interventions. Both expected the other profession to file these interventions and would only file a selection themselves. Correction of prescription interventions was not a well-established functionality of the GPs' electronic medical record systems. Lack of guidelines caused individual variations in both GP and pharmacist handling of such interventions. In general, the pharmacists prioritized to contact GPs for the clinically relevant interventions. GPs wanted more feedback than that provided by the pharmacists. INTERPRETATION: Joint guidelines for use in pharmacies and GP surgeries, are needed on communication, documentation, and priorities of prescription interventions. IT-software should be developed to facilitate real-time communication between the parties.

[Prescription changes in pharmacies]. / Endring av resepter i apotekene.

BACKGROUND: Prescriptions must sometimes be changed or clarified before dispensing in order to provide a safe and professional service. The aims of this study were to gain insight into the types of prescription interventions performed by pharmacists, to explore the reason behind the interventions and to describe to which extent and how interventions are documented and communicated to the prescribers. MATERIAL AND METHODS: Prescription interventions (N = 1,084) performed at a community pharmacy in Norway from January 2002 to September 2004 were categorised. Two focus groups were used to validate the categories. The pharmacists in these groups were invited to discuss working procedures and professional judgements related to prescription interventions. RESULTS: The prescription interventions were grouped into seven categories. The two largest categories were "drugs not available" (37%) and "clarification of drug choice and dosage" (22%). Many interventions are not communicated to the prescribers. In principal, the pharmacists felt that interventions should be communicated to the prescriber even if this is often not the case. CONCLUSION: Pharmacists intervene on a range of prescription issues that are not communicated to the prescribers. Feedback requires time and resources for all involved. By ensuring that computer systems used by general practitioners comply with reimbursement legislation and technical requirements for prescriptions, the demand for many prescription interventions will be reduced. There is a need for a joint professional discussion on differentiation and standardisation of feedback on prescription interventions.