Skip to main content
SpringerLink
Log in

Investigation on barriers to pharmaceutical care in community pharmacies: a structural equation model

  • Research Article
  • Published:
International Journal of Clinical Pharmacy Aims and scope Submit manuscript

Abstract

Objective The concept of pharmaceutical care (PhC) has been popular in pharmacy during past decades. However, in some countries, including Iran, it does not seem to mature. Aim of the study To identify and prioritize barriers to the provision of PhC in Iranian community pharmacies, based on the perceptions of community pharmacists in Tehran. Method Between August and November 2013, a cross-sectional descriptive study was performed using an anonymous questionnaire asking the pharmacists’ perceptions on the implementation of PhC. Of the 2000 invited community pharmacists, 505 pharmacists responded. A descriptive analysis, was conducted, and the data were also analyzed through structural equation modeling. Main outcome measure Priorities of barriers to the implementation of PhC in Iran. Results Five major dimensions included in the survey instrument were confirmed by confirmatory factor analysis. According to the model developed based on pharmacists’ opinions, lack of pharmacists’ skills and lack of appropriate regulation and environment are the two most important barriers of the provision of PhC, and the least important is lack of resources. Conclusion The results show that the main barriers to PhC in Iran are the lack of skills and of appropriate regulation and environment. These main barriers are different from those mentioned in studies conducted in other countries.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Cranor CW, Bunting BA, Christensen DB. The Asheville Project: long-term clinical and economic outcomes of a community pharmacy diabetes care program. J Am Pharm Assoc. 2003;43:173–84.

    Article  Google Scholar 

  2. Cranor CW, Christensen DB. The Asheville Project: short-term outcomes of a community pharmacy diabetes care program. J Am Pharm Assoc. 2012;52:838–50.

    Article  Google Scholar 

  3. Curtiss FR, Fry RN, Avey SG. Framework for pharmacy services quality improvement—a bridge to cross the quality chasm. J Manag Care Pharm. 2004;10:60–78.

    PubMed  Google Scholar 

  4. Giberson S, Yoder S, Lee M. Improving patient and health system outcomes through advanced pharmacy practice. A Report to the US Surgeon General Office of the Chief Pharmacist US Public Health Service 2011. http://www.usphs.gov/corpslinks/pharmacy/documents/2011AdvancedPharmacyPracticeReporttotheUSSG.pdf. Accessed 26 Jun 2014.

  5. Isetts BJ, Brown LM, Schondelmeyer SW, Lenarz LA. Quality assessment of a collaborative approach for decreasing drug-related morbidity and achieving therapeutic goals. Arch Intern Med. 2003;163:1813–20.

    Article  PubMed  Google Scholar 

  6. McLean W, Gillis J, Waller R. The BC Community Pharmacy Asthma Study: a study of clinical, economic and holistic outcomes influenced by an asthma care protocol provided by specially trained community pharmacists in British Columbia. Can Respir J. 2003;10:195–202.

    PubMed  Google Scholar 

  7. Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47:533–43.

    PubMed  CAS  Google Scholar 

  8. Carter BL, Malone DC, Billups SJ, Valuck RJ, Barnette DJ, Sintek CD, et al. Interpreting the findings of the IMPROVE study. Am J Health Syst Pharm. 2001;58:1330–7.

    PubMed  CAS  Google Scholar 

  9. Ellis SL, Carter BL, Malone DC, Billups SJ, Okano GJ, Valuck RJ, et al. Clinical and economic impact of ambulatory care clinical pharmacists in management of dyslipidemia in older adults: the IMPROVE study. Pharmacotherapy. 2000;20:1508–16.

    Article  PubMed  CAS  Google Scholar 

  10. Aguiar PM, Balisa-Rocha BJ, Brito GDC, da Silva WB, Machado M, Lyra DP Jr. Pharmaceutical care in hypertensive patients: a systematic literature review. Res Soc Adm Pharm. 2012;8:383–96.

    Article  Google Scholar 

  11. Roughead E, Semple S, Vitry A. Pharmaceutical care services: a systematic review of published studies, 1990 to 2003, examining effectiveness in improving patient outcomes. Int J Pharm Pract. 2005;13:53–70.

    Article  Google Scholar 

  12. Stergachis A, Gardner JS, Anderson MT, Sullivan SD. Improving pediatric asthma outcomes in the community setting: does pharmaceutical care make a difference? J Am Pharm Assoc. 2002;42:743–52.

    Article  Google Scholar 

  13. Hepler CD. Pharmaceutical care. Pharm World Sci. 1996;18:233–5.

    Article  PubMed  CAS  Google Scholar 

  14. Hepler CD, Grainger-Rousseau TJ. Pharmaceutical care versus traditional drug treatment. Drugs. 1995;49:1–10.

    Article  PubMed  CAS  Google Scholar 

  15. Adamcik BA, Ransford HE, Oppenheimer PR, Brown JF, Eagan PA, Weissman FG. New clinical roles for pharmacists: a study of role expansion. Soc Sci Med. 1986;23:1187–200.

    Article  PubMed  CAS  Google Scholar 

  16. Erah PO, Nwazuoke JC. Identification of standards for pharmaceutical care in Benin City. Trop J Pharm Res. 2002;1:55–66.

    Google Scholar 

  17. Farris KB, Fernandez-Llimos F, Benrimoj SC. Pharmaceutical care in community pharmacies: practice and research from around the world. Ann Pharmacother. 2005;39:1539–41.

    Article  PubMed  Google Scholar 

  18. Van Mil JWF, Boer W, Tromp T. European barriers to the implementation of pharmaceutical care. Int J Pharm Pract. 2001;9:163–8.

    Article  Google Scholar 

  19. Sánchez M, de las Mercedes A. The opportunities and challenges to introduce pharmaceutical care in Cuba. Afr J Pharm Pharmacol. 2013;7:1236–41.

    Article  Google Scholar 

  20. Dunlop JA, Shaw JP. Community pharmacists’ perspectives on pharmaceutical care implementation in New Zealand. Pharm World Sci. 2002;24:224–30.

    Article  PubMed  Google Scholar 

  21. Rossing C, Hansen EH, Krass I. Barriers and facilitators in pharmaceutical care: perceptions and experiences among Danish community pharmacists. J Soc Adm Pharm. 2002;19:55–64.

    Google Scholar 

  22. Bell H, McElnay J, Hughes C, Woods A. A qualitative investigation of the attitudes and opinions of community pharmacists to pharmaceutical care. J Soc Adm Pharm. 1998;15:284–95.

    Google Scholar 

  23. Mangan MN, Powers MF, Lengel AJ. Student Pharmacists’ Perceptions of Barriers to Medication Adherence Counseling. J Pharm Pract. 2013;26:376–81.

    Article  PubMed  Google Scholar 

  24. Sreelalitha N, Vigneshwaran E, Narayana G, Reddy YP, Reddy MR. Review of pharmaceutical care services provided by the pharmacists. Int Res J Pharm. 2012;3:78–9.

    Google Scholar 

  25. AbuRuz S, Al-Ghazawi M, Snyder A. Pharmaceutical care in a community-based practice setting in Jordan: Where are we now with our attitudes and perceived barriers? Int J Pharm Pract. 2012;20:71–9.

    Article  PubMed  Google Scholar 

  26. Jones EJ, MacKinnon NJ, Tsuyuki RT. Pharmaceutical care in community pharmacies: practice and research in Canada. Ann Pharmacother. 2005;39:1527–33.

    Article  PubMed  Google Scholar 

  27. Ngorsuraches S, Li SC. Thai pharmacists’ understanding, attitudes, and perceived barriers related to providing pharmaceutical care. Am J Health Syst Pharm. 2006;63:2144–50.

    Article  PubMed  Google Scholar 

  28. Simmons-Yon A, Roth MT, Vu M, Kavalieratos D, Weinberger M, Rao JK. Understanding pharmacists’ experiences with advice-giving in the community pharmacy setting: a focus group study. Patient Educ Couns. 2012;89:476–83.

    Article  PubMed  Google Scholar 

  29. Dadfar H, Brege S. Differentiation by improving quality of services at the last touch point: the case of Tehran pharmacies. Int J Qual Serv Sci. 2012;4:345–63.

    Google Scholar 

  30. Mehralian GH, Rangchian M, Rasekh HR. Customers’ priorities and satisfaction with community pharmacies: the case of Tehran. Int J Clin Pharm. 2014;36:707–15.

    Article  PubMed  Google Scholar 

  31. Gholami K, Najmeddin F. Barriers to pharmaceutical care in Iran. J Pharm Care. 2013;1:39–40.

    Google Scholar 

  32. Mosadegh M. Revision of Iranian pharmacy education, an idea or a necessity? Iran J Pharm Res. 2002;1:1–3.

    Google Scholar 

  33. Salamzadeh J. Clinical pharmacy in Iran: Where do we stand? Iran J Pharm Res. 2004;3:1–2.

    Google Scholar 

  34. Foroughi Moghadam MJ, Peiravian F, Naderi A, Rajabzadeh A, Rasekh HR. An analysis of job satisfaction among Iranian pharmacists through various Job. Iran J Pharm Res. 2014;13:1087–96.

  35. Van Mil JWF, Schulz M. A review of pharmaceutical care in community pharmacy in Europe. Harv Health Policy Rev. 2006;7:155–68.

    Google Scholar 

  36. Waheed KA, Jaleel M, Laeequddin M. Prescription loyalty behavior of physicians: an empirical study in India. Int J Pharm Healthc Mark. 2011;5:279–98.

    Article  Google Scholar 

  37. Hughes CM, Hawwa AF, Scullin C, Anderson C, Bernsten CB, Björnsdóttir I, et al. Provision of pharmaceutical care by community pharmacists: a comparison across Europe. Pharm World Sci. 2010;32:472–87.

    Article  PubMed  Google Scholar 

  38. Hair JFJ, Anderson RE, Tatham RL, Black WC, editors. Multivariate data analysis. New York: Macmillan Publishing Company; 1992.

    Google Scholar 

  39. Schreiber JB. Core reporting practices in structural equation modeling. Res Soc Adm Pharm. 2008;4:83–97.

    Article  Google Scholar 

  40. Faris RJ, MacKinnon GE, MacKinnon NJ, Kennedy PL. Perceived importance of pharmacy management skills. Am J Health Syst Pharm. 2005;62:1067–72.

    PubMed  Google Scholar 

  41. Hanafi S, Poormalek F, Torkamandi H, Hajimiri M, Esmaili M, Khooie SH, et al. Evaluation of Community Pharmacists’ Knowledge, Attitude and Practice towards Good Pharmacy Practice in Iran. J Pharm Care. 2013;1:19–24.

    Google Scholar 

  42. Latif A, Pollock K, Boardman HF. The contribution of the Medicines Use Review (MUR) consultation to counseling practice in community pharmacies. Patient Educ Couns. 2011;83:336–44.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

No financial support was obtained for this study.

Conflicts of interests

Authors report no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Vali-e Asr Ave., Niayesh Junction, Tehran, Iran

    Gholamhossein Mehralian, Maryam Rangchian & Farzad Peiravian

  2. School of Pharmacy, Azad University, Tehran, Iran

    Athar Javadi

Authors
  1. Gholamhossein Mehralian
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maryam Rangchian
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Athar Javadi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Farzad Peiravian
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gholamhossein Mehralian.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mehralian, G., Rangchian, M., Javadi, A. et al. Investigation on barriers to pharmaceutical care in community pharmacies: a structural equation model. Int J Clin Pharm 36, 1087–1094 (2014). https://doi.org/10.1007/s11096-014-9998-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11096-014-9998-6

Keywords

Search

Navigation