Barnes J M, Riedlinger J E, McCloskey W W, Montagne M
Massachusetts College of Pharmacy and Allied Health Sciences, Boston, USA.
Ann Pharmacother. 1996 Oct;30(10):1101-5. doi: 10.1177/106002809603001006.
To identify which barriers have been most significant to community pharmacists in their ability to comply with the Omnibus Budget Reconciliation Act of 1990 (OBRA'90) regulations during its first year of implementation.
Mailing of a two-page survey in April 1994.
Four hundred randomly selected community pharmacies in the Commonwealth of Massachusetts.
Of 400 pharmacies surveyed, 156 surveys were completed and returned for analysis.
Barriers that were considered most significant to pharmacies surveyed in their ability to implement OBRA'90 regulations were excessive workload, lack of financial compensation, and patients' attitudes. Of least significance were inadequate knowledge about drugs, inadequate references, and store layout. Almost half the responding pharmacists indicated that OBRA'90 regulations had not affected or changed their practice, one-quarter of the pharmacists believed their practice was less rewarding after OBRA'90, and about one-fifth believed it was more rewarding.
Community pharmacists in Massachusetts are making an attempt to comply with OBRA'90, but there are specific barriers that are affecting their ability to do so. The OBRA'90 regulations appear to have had little impact on the practice of most community pharmacies. Community pharmacy management needs to examine (1) expanded roles of supportive personnel to give pharmacists more time to spend counseling patients, (2) reimbursement mechanisms for cognitive service, and (3) approaches to educating patients about these changes in the pharmacy profession.
确定在1990年《综合预算协调法案》（OBRA'90）实施的第一年，哪些障碍对社区药剂师遵守该法案的规定影响最大。
1994年4月邮寄一份两页的调查问卷。
在马萨诸塞州随机挑选400家社区药房。
在调查的400家药房中，156份调查问卷被填好并返回用于分析。
对于接受调查的药房而言，被认为对其实施OBRA'90规定的能力影响最大的障碍是工作量过大、缺乏经济补偿以及患者的态度。影响最小的是对药品知识了解不足、参考文献不足以及店铺布局。几乎一半做出回应的药剂师表示OBRA'90规定并未影响或改变他们的业务，四分之一的药剂师认为在OBRA'90之后他们的业务回报减少，约五分之一的药剂师认为回报增加。
马萨诸塞州的社区药剂师正在努力遵守OBRA'90，但存在一些特定障碍影响他们这样做的能力。OBRA'90规定似乎对大多数社区药房的业务影响不大。社区药房管理需要审视：（1）扩大辅助人员的职责，以便药剂师有更多时间为患者提供咨询；（2）认知服务的报销机制；（3）就药房行业的这些变化对患者进行教育的方法。
