ROLE-ORIENTATION AND COMMUNITY PHARMACISTS PARTICIPATION IN A PROJECTTO IMPROVE PATIENT-CARE

Community pharmacists are being assigned increased responsibility in a ssuring the appropriateness and effectiveness of drug therapy. This in creased responsibility is reflected in recently passed legislation (OB RA '90) in the United States that requires pharmacists to counsel pati ents about prescriptions received and to engage in prospective drug us e review for Medicaid recipients. The potential impact of this legisla tion is unclear due to a dearth of research evaluating the effects of community pharmacists' activities on medication use. In addition, ther e is little research on pharmacists' willingness to assume increased r esponsibility. Research that would demonstrate the effectiveness of co mmunity pharmacists in improving therapeutic outcomes is hampered by p roblems inherent in conducting experimentally designed research in fie ld settings. This paper examines two issues of concern in such studies -namely, the extent to which those who agree to participate in a demon stration project differ from those who decline to participate and the extent to which differential dropout from treatment and control condit ions compromise the comparability of the two groups. Specifically, thi s report examines pharmacist characteristics related to participation in a demonstration project to improve the care of elderly patients. Co mmunity pharmacists in Florida who had earlier been asked to participa te in a demonstration project (N = 418) were sent mail questionnaires to assess their attitudinal, demographic and employment characteristic s. In particular, researchers were interested in the role orientation of pharmacists in regard to patient counseling and physician consultat ion, satisfaction with current jobs and career choices, employment set tings and treatment vs control group assignment as predictors of parti cipation in the research project. Demographic characteristics were als o examined as possible predictors of participation.Approximately 86% o f those who did participate (N = 102) in the demonstration project and 62% of those who did not participate (N = 316) responded to the quest ionnaire. Logistic regression analysis was used to model participation (vs non-participation) as a function of pharmacist counselor role ori entation, job and career satisfaction, type of pharmacy setting (indep endent vs chain), group assignment and pharmacist and demographic char acteristics. Controlling for all other variables in the model, those p harmacists who were assigned to the control group, had more positive a ttitudes toward the counseling role of pharmacists and had more positi ve feelings about their current jobs were more likely to participate i n the project. No demographic or employment variables were found to be important. When comparing treatment and control groups among the part icipants, no differences were found between the two groups on demograp hic characteristics, pharmacy setting characteristics, counselor role orientation scores, job satisfaction, or confidence in fulfilling expa nded patient care roles. Thus there was no indication that drop out fr om the experimental and control groups after random assignment comprom ised the comparability of the two groups, at least on the variables ex amined.