Barriers to pharmacy practice change

Abstract

The practice of pharmacy has seen major changes in the past decade. Today, pharmacists from coast to coast can extend prescriptions and make therapeutic substitutions. 1 Many pharmacists can also provide influenza vaccinations and in some cases initiate drug therapies (i.e., prescribe). How-ever, it has also been well established that the integration of many of these services by pharmacists into practice has been slow and incomplete. 2 As pharmacy regulatory and advocacy groups continue to push for pharmacists' larger role within the health care system, these efforts are hampered by the lack of widespread adoption and integration of these services within practice. Therefore, we need to more carefully consider why pharmacy practice change has been so challenging. In 2010, we wrote a commentary titled " Are Pharmacists the Ultimate Barrier to Pharmacy Practice Change? " 3 In that arti-cle, we suggested that pharmacists' personality traits, including lack of confidence, fear of new responsibility, paralysis in the face of ambiguity, need for approval and risk aversion, were the heretofore unspoken barriers to practice change. Using this commentary as a starting point, the purpose of this editorial is to discuss the issue of whether it is our innate personality traits (" nature ") or our professional pharmacy culture (" nurture ") that holds us back. Is it our nature—Are we selecting the wrong people for pharmacy? A recent study from an Australian pharmacy school found that for the vast majority of student respondents (80 of 82), pharmacy was not their first career choice; rather, they ended up in pharmacy by default. 4 Furthermore, most student respondents had little idea of the nature of current pharmacy practice. 4 Despite the fact that recruitment and selection processes for schools of pharmacy are becoming increas-ingly stringent and refined, this study leaves us questioning whether or not we are getting the right kind of individuals applying for pharmacy. To answer this question, we must start with pharmacists currently in practice. We have examined pharmacists' person-ality traits and the connection between these traits and behav-iours in pharmacy practice and found that most respondents identified with the traits of agreeableness, conscientiousness and openness. 5 Interestingly, positive relationships between traits and behaviours were noted between respondents who identified with the trait of extroversion and the number of immunizations provided and the traits of agreeableness and openness and the number of medication reviews completed.