Between intention and behavior: an application of community pharmacistsʹ assessment of pharmaceutical care

A new practice philosophy for pharmacists, pharmaceutical care, encourages pharmacists to ensure that medication-related health outcomes are optimized. However, its adoption by community pharmacists has been slow due to numerous barriers including the economic structure of retail pharmacy, interprofessional conflicts, information limitations, gaps in pharmacy training and uneven patient demand. The specific study objectives were to (1) describe self-efficacy, beliefs, evaluations and perceived behavioral control in the provision of pharmaceutical care, (2) quantify intention and behavior to provide pharmaceutical care in a period of two weeks and (3) examine the relationships between intention and behavior. A 20% sample of Alberta community pharmacists received an attitude survey followed in two weeks by a behavior survey. Both surveys were developed for this study. Of the 320 pharmacists receiving the attitude survey, 230 completed surveys were obtained (71.9%). The behavior survey was received from 182 of those completing the attitude survey (79.1%). A causal model was constructed predicting pharmaceutical care behavior/s from pharmacistsʹ self-efficacy, beliefs, evaluations and behavioral control. Behavioral control exerted its effect upon behavior via three pathways and its direct effect on belief was strongest. The only direct predictor of behavior was self-efficacy. The χ2 measure indicated that the model was not a perfect fit (χ2=99.24, df=67, p<0.006), but the goodness of fit index (0.931), adjusted goodness of fit index (0.876), and root mean squared error (0.067) fall within acceptable ranges. Thus, it appears that pharmaceutical care implementation programs which address individual factors singly in providing pharmaceutical care will not be successful. The control pharmacistsʹ perceive over their patient care behaviors in their practice environment is critical. Programs which help pharmacists assess their work environment and determine strategies to impact or reconstruct their environments are required.