Pharmacy World & Science

, Volume 31, Issue 1, pp 32–39 | Cite as

Facilitators for practice change in Spanish community pharmacy

  • Miguel A. GastelurrutiaEmail author
  • S. I. Charlie Benrimoj
  • Carla C. Castrillon
  • María J. Casado de Amezua
  • Fernando Fernandez-Llimos
  • Maria J. Faus
Research Article


Objective To identify and prioritise facilitators for practice change in Spanish community pharmacy. Setting Spanish community pharmacies. Method Qualitative study. Thirty-three semi-structured interviews were conducted with community pharmacists (n = 15) and pharmacy strategists (n = 18), and the results were examined using the content analysis method. In addition, two nominal groups (seven community pharmacists and seven strategists) were formed to identify and prioritise facilitators. Results of both techniques were then triangulated. Main outcome measures Facilitators for practice change. Results Twelve facilitators were identified and grouped into four domains (D1: Pharmacist; D2: Pharmacy as an organisation; D3: Pharmaceutical profession; D4: Miscellaneous). Facilitators identified in D1 include: the need for more clinical education at both pre- and post-graduate levels; the need for clearer and unequivocal messages from professional leaders about the future of the professional practice; and the need for a change in pharmacists’ attitudes. Facilitators in D2 are: the need to change the reimbursement system to accommodate cognitive service delivery as well as dispensing; and the need to change the front office of pharmacies. Facilitators identified in D3 are: the need for the Spanish National Professional Association to take a leadership role in the implementation of cognitive services; the need to reduce administrative workload; and the need for universities to reduce the gap between education and research. Other facilitators identified in this study include: the need to increase patients’ demand for cognitive services at pharmacies; the need to improve pharmacist-physician relationships; the need for support from health care authorities; and the need for improved marketing of cognitive services and their benefits to society, including physicians and health care authorities. Conclusion Twelve facilitators were identified. Strategists considered clinical education and pharmacists’ attitude as the most important, and remuneration of little importance. Community pharmacists, in contrast, considered remuneration as the most important facilitator for practice change.


Change management Change strategy Cognitive pharmacy services Community pharmacy Pharmacists Qualitative analysis Spain 



We gratefully acknowledge the contributions of the participating pharmacists, both in the interviews and in nominal groups.


This study received no external funding.

Conflicts of Interest

None of the authors has a conflict of interest that could affect the study and its results.


  1. 1.
    Cipolle RJ, Strand LM, Morley PC. Pharmaceutical care practice. New York: McGraw-Hill Companies; 1998. ISBN 0-07-012046-3.Google Scholar
  2. 2.
    Martín Calero MJ, Machuca M, Murillo MD, Cansino J, Gastelurrutia MA, Faus MJ. Structural process and implementation programs of pharmaceutical care in different countries. Curr Pharm Des. 2004;10:3969–85. doi: 10.2174/1381612043382549.PubMedCrossRefGoogle Scholar
  3. 3.
    Rogers EM. Diffusion of innovations. 5th ed. New York: Free Press; 2003. ISBN 0-7432-2209-1.Google Scholar
  4. 4.
    Odedina FT, Segal R, Hepler CD, Lipowski E, Kimberlin C. Changing pharmacists’ practice pattern: pharmacists’ implementation of pharmaceutical care factors. J Soc Adm Pharm. 1996;13:74–88.Google Scholar
  5. 5.
    Bell HM, McElnay JC, Hughes CM, 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
  6. 6.
    van Mil JWF, de Boer WO, Tromp ThFJ. European barriers to implementation of pharmaceutical care. Int J Pharm Practice. 2001;9:163–8.Google Scholar
  7. 7.
    Rossing C, Hansen EH, Krass I. Barriers and facilitators in pharmaceutical care: perceptions and experiences among Danish community pharmacies. J Soc Adm Pharm. 2001;19:55–64.Google Scholar
  8. 8.
    Plaza L, Herrera J. The new challenge of pharmaceutical care: the search of an agreement among professionals. Pharm Care Esp. 2003; 5:160–5.Google Scholar
  9. 9.
    Hidalgo J, Cámara D, Baena MI, Fajardo PC, Martínez-Martínez F. Barriers for implementing pharmacotherapy follow-up in community pharmacies from Granada (Spain). Seguimiento Farmacoterapeutico. 2005; 3(3):144–9.Google Scholar
  10. 10.
    Gastelurrutia MA, Fernandez-Llimos F, Benrimoj SI, Castrillon CC, Faus MJ. Barriers for the implementation of cognitive services in Spanish community pharmacies. Aten Primaria. 2007; 39(9):465–72.Google Scholar
  11. 11.
    Roberts AS, Hopp T, Sorensen EW, Benrimoj SI, Chen TF, Herborg H, et al. Understanding practice change in community pharmacy: a qualitative research instrument based on organisational theory. Pharm World Sci. 2003; 25(5):227–34. doi: 10.1023/A:1025880012757.Google Scholar
  12. 12.
    Hopp T, Sørensen EW, Herborg H, Roberts AS. Implementation of cognitive pharmaceutical services in Danish community pharmacies—perceptions of strategists and practitioners. Int J Pharm Pract. 2006;14:37–49. doi: 10.1211/ijpp.14.1.0006.CrossRefGoogle Scholar
  13. 13.
    Roberts AS, Benrimoj SIC, Chen TF, Williams KA, Hopp TR, Aslani P. Understanding practice change in community pharmacy: a qualitative study in Australia. Res Social Adm Pharm. 2005;1:546–564. doi: 10.1016/j.sapharm.2005.09.003.PubMedGoogle Scholar
  14. 14.
    Gastelurrutia MA, Fernández-Llimós F, García Delgado P, Gastelurrutia P, Faus MJ, Benrimoj SI. Barriers and facilitators to the dissemination and implementation of cognitive services in Spanish community pharmacies. Seguimiento Farmacoterapeutico. 2005;3(2):65–77.Google Scholar
  15. 15.
    Weber RP. Basic content analysis. 2nd ed. Newbury Park, CA: Sage; 1990. ISBN 0-8039-3863-2.Google Scholar
  16. 16.
    Gastelurrutia MA, Faus MJ, Fernandez-Llimos F. Providing patient care in community pharmacies in Spain. Ann Pharmacother. 2005;39:2105–10. doi: 10.1345/aph.1G121.PubMedCrossRefGoogle Scholar
  17. 17.
    Pickard AS. Towards supporting scholarship in research by clinical pharmacy faculty. Pharm Pract. 2006;4(4):191–4.Google Scholar
  18. 18.
    Andrés Iglesias JC, Andrés Rodríguez NF, Fornos Pérez JA. Community pharmacy-based research in Spain (1995–2005): a bibliometric study. Pharm Pract. 2007;5(1):21–30.Google Scholar
  19. 19.
    Armour C, Brillant M, Krass I. Pharmacists’ views on involvement in pharmacy practice research: strategies for facilitating participation. Pharm Pract. 2007;5(2):59–66.Google Scholar
  20. 20.
    Baena MI, Faus MJ, Marín R, Zarzuelo A, Jiménez-Martín J, Martínez-Olmos J. Problemas de salud relacionados con los medicamentos en un servicio de urgencias hospitalario. Med Clin (Barc). 2005;124:250–5.Google Scholar
  21. 21.
    Ernst FR, Grizzle AJ. Drug-related morbidity and mortality: updating the cost-of-illness model. J Am Pharm Assoc. 2001;41:192–9.Google Scholar
  22. 22.
    Aguas Y, De Miguel E, Fernandez-Llimos F. Pharmacotherapy follow-up as an innovation in community pharmacies of Badajoz (Spain). Seguimiento Farmacoterapeutico. 2005;3:10–6.Google Scholar
  23. 23.
    Fernandez-Llimos F, Faus MJ. From “drug related problems” to “negative clinical outcomes”. Am J Health Syst Pharm. 2005;62:2348–50. doi: 10.2146/ajhp050358.PubMedCrossRefGoogle Scholar
  24. 24.
    Anonymous. Simpodader 07. Botika XXI. 2007; 10:1–20.Google Scholar
  25. 25.
    Huyghebaert T, Farris KB, Volume CI. Barriers to pharmaceutical care. Perceptions of Alberta Community Pharmacists. Can Pharm J. 1999;132(2):36–42.Google Scholar
  26. 26.
    Cordina M, McElnay JC, Hugues CM. The importance that community pharmacists in Malta place on the introduction of pharmaceutical care. Pharm World Sci. 1999;21:69–73. doi: 10.1023/A:1008658726755.PubMedCrossRefGoogle Scholar
  27. 27.
    Dunlop JA, Shaw JP. Community pharmacists’ perspectives on pharmaceutical care implementation in New Zealand. Pharm World Sci. 2002;24:224–30. doi: 10.1023/A:1021526425458.PubMedCrossRefGoogle Scholar
  28. 28.
    Anonimous. [Spanish Medical Association rejects the role of Pharmaceutical Care in National Health Plan]. El Global. 2005; 28-Feb. to 6-Mar.Google Scholar
  29. 29.
    Anonimous. [73% of physicians consider that Pharmacy should only be involve in dispensing activities]. El Global. 2004; 13-Dec to 19-Dec.Google Scholar
  30. 30.
    Berringer R, Shibley MC, Cary CC, Pugh CB, Powers PA, Rafi JA. Outcomes of a community pharmacy-based diabetes monitoring program. J Am Pharm Assoc. 1999;39:791–7.Google Scholar
  31. 31.
    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. doi: 10.1001/archinte.163.15.1813.PubMedCrossRefGoogle Scholar
  32. 32.
    Castrillon CC, Gil de San Vicente O, Erauncetamurgil O, Gastelurrutia MA. Influence of facilitating activities taken by members of the staff of a community pharmacy to the implementation of the medication follow-up service. Pharm Pract. 2007;5(supl 1):25–41.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  • Miguel A. Gastelurrutia
    • 1
    • 2
    Email author
  • S. I. Charlie Benrimoj
    • 3
  • Carla C. Castrillon
    • 1
  • María J. Casado de Amezua
    • 2
  • Fernando Fernandez-Llimos
    • 2
    • 4
  • Maria J. Faus
    • 2
  1. 1.Community PharmacistSan SebastianSpain
  2. 2.Pharmaceutical Care Research GroupUniversity of GranadaGranadaSpain
  3. 3.Department of Pharmacy PracticeUniversity of SydneySydneyAustralia
  4. 4.Department of Social PharmacyUniversity of LisbonLisbonPortugal

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