Role orientation and community pharmacists' participation in a project to improve patient care

Community pharmacists are being assigned increased responsibility in assuring the appropriateness and effectiveness of drug therapy. This increased responsibility is reflected in recently passed legislation (OBRA '90) in the United States that requires pharmacists to counsel patients about prescriptions received and to engage in prospective drug use review for Medicaid recipients. The potential impact of this legislation is unclear due to a dearth of research evaluating the effects of community pharmacists' activities on medication use. In addition, there is little research on pharmacists' willingness to assume increased responsibility. Research that would demonstrate the effectiveness of community pharmacists in improving therapeutic outcomes is hampered by problems inherent in conducting experimentally designed research in field settings. This paper examines two issues of concern in such studies--namely, the extent to which those who agree to participate in a demonstration project differ from those who decline to participate and the extent to which differential dropout from treatment and control conditions compromise the comparability of the two groups. Specifically, this report examines pharmacist characteristics related to participation in a demonstration project to improve the care of elderly patients. Community pharmacists in Florida who had earlier been asked to participate in a demonstration project (N = 418) were sent mail questionnaires to assess their attitudinal, demographic and employment characteristics. In particular, researchers were interested in the role orientation of pharmacists in regard to patient counseling and physician consultation, satisfaction with current jobs and career choices, employment settings and treatment vs control group assignment as predictors of participation in the research project. Demographic characteristics were also examined as possible predictors of participation. Approximately 86% of those who did participate (N = 102) in the demonstration project and 62% of those who did not participate (N = 316) responded to the questionnaire. Logistic regression analysis was used to model participation (vs non-participation) as a function of pharmacist counselor role orientation, job and career satisfaction, type of pharmacy setting (independent vs chain), group assignment and pharmacist and demographic characteristics. Controlling for all other variables in the model, those pharmacists who were assigned to the control group, had more positive attitudes toward the counseling role of pharmacists and had more positive feelings about their current jobs were more likely to participate in the project. No demographic or employment variables were found to be important. When comparing treatment and control groups among the participants, no differences were found between the two groups on demographic characteristics, pharmacy setting characteristics, counselor role orientation scores, job satisfaction, or confidence in fulfilling expanded patient care roles. Thus there was no indication that drop out from the experimental and control groups after random assignment compromised the comparability of the two groups, at least on the variables examined.