Farris K B, Schopflocher D P
Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Canada.
Soc Sci Med. 1999 Jul;49(1):55-66. doi: 10.1016/s0277-9536(99)00078-7.
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 pharmacists' 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 chi2 measure indicated that the model was not a perfect fit (chi2 = 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 pharmacists' 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.
药剂师的一种新的执业理念——药学服务，鼓励药剂师确保与药物相关的健康结果得到优化。然而，由于包括零售药店的经济结构、跨专业冲突、信息限制、药学培训差距以及患者需求不均衡等众多障碍，社区药剂师对其采用速度一直较慢。具体研究目标为：（1）描述在提供药学服务过程中的自我效能感、信念、评价和感知行为控制；（2）量化两周内提供药学服务的意向和行为；（3）研究意向与行为之间的关系。艾伯塔省20%的社区药剂师样本接受了态度调查，两周后进行行为调查。两项调查均为本研究专门设计。在320名接受态度调查的药剂师中，获得了230份完整的调查问卷（71.9%）。在完成态度调查的人中，有182人收到了行为调查（79.1%）。构建了一个因果模型，根据药剂师的自我效能感、信念、评价和行为控制来预测药学服务行为。行为控制通过三条途径对行为产生影响，其对信念的直接影响最强。行为的唯一直接预测因素是自我效能感。卡方检验表明该模型并非完全拟合（卡方 = 99.24，自由度 = 67，p<0.006），但拟合优度指数（0.931）、调整后拟合优度指数（0.876）和均方根误差（0.067）均在可接受范围内。因此，看来在提供药学服务时单独解决个体因素的药学服务实施项目不会成功。药剂师在其实践环境中对其患者护理行为的感知控制至关重要。需要有助于药剂师评估其工作环境并确定影响或重构其环境的策略的项目。
