Between intention and behavior: an application of community pharmacists' 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 numer ous barriers including the economic structure of retail pharmacy, interprof essional conflicts, information limitations, gaps in pharmacy training and uneven patient demand. The specific study objectives were to (1) describe s elf-efficacy, beliefs, evaluations and perceived behavioral control in the provision of pharmaceutical care, (2) quantify intention and behavior to pr ovide pharmaceutical care in a period of two weeks and (3) examine the rela tionships between intention and behavior. A 20% sample of Alberta community pharmacists received an attitude survey followed in two weeks by a behavio r survey. Both surveys were developed for this study. Of the 320 pharmacist s receiving the attitude survey, 230 completed surveys were obtained (71.9% ). The behavior survey was received from 182 of those completing the attitu de 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 dir ect predictor of behavior was self-efficacy. The chi(2) measure indicated t hat the model was not a perfect fit (chi(2) = 99.24, df = 67, p < 0.006), b ut 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 succ essful. 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 recons truct their environments are required. (C) 1999 Elsevier Science Ltd. All r ights reserved.