Billing for cognitive services: Understanding Quebec pharmacists' behavior

BACKGROUND: There is growing evidence that pharmacists' interventions to so lve drug-related problems are effective and cost-saving. Since 1978 under t he Quebec provincial drug plan, payment for two cognitive services, the pha rmaceutical opinion and the refusal to dispense a prescription, has been di sbursed to community pharmacists. However, the number of claims for these s ervices lags far behind expectations. OBJECTIVE: To identify factors influencing Quebec community pharmacists in the billing for a pharmaceutical opinion or for a refusal to dispense. METHODS: Questions on predisposing, enabling, and reinforcing factors poten tially related to pharmacists' behavior were included in a self-administere d questionnaire sent to all 3517 community pharmacists practicing in the pr ovince of Quebec during 1996. Using multivariate logistic regression, model s were built to explain billing for an opinion and billing for a refusal. RESULTS: According to our models, the typical pharmacist who billed for opi nions or refusals in Quebec is <45 years of age, has attended a continuing education program on this topic, and believes that billing for intervention s is important. This typical pharmacist handles a mean daily volume of 100- 250 prescriptions, uses a decision-support computer program, and has suffic ient technical staff assistance. This pharmacist believes that intervention s can be billed rapidly adn are paid by the province's drug plan. CONCLUSIONS: In order to increase the billing of pharmaceutical care in com munity pharmacies, tailored educational programs should be offered to pharm acists. There is also a need to improve working conditions in pharmacies.