Pharmacy World & Science

, Volume 31, Issue 2, pp 174–182 | Cite as

Psychosocial and behavioural determinants of the implementation of Pharmaceutical Care in Spain

  • Emma Zardaín
  • María Olivo del Valle
  • María Isabel Loza
  • Eduardo García
  • Alberto Lana
  • Wolfgang A. Markham
  • María Luisa LópezEmail author
Research Article


Objective We aimed to gain greater understanding of the implementation of the Pharmaceutical Care (PhC) initiative in Spain. Our investigation was underpinned by Prochaska and Di Clemente’s stages of change model. We also used the A.S.E. (Attitude, Social influence and self-Efficacy) Model to identify the psychosocial determinants of this professional behaviour. Setting Spanish community pharmacists. Method A validated questionnaire was sent to all community pharmacists registered on a national database and 1,977 (10.3%) responded. The questionnaire assessed stage of change regarding the implementation of PhC and the psychosocial determinants of this professional behaviour. Data were analyzed using descriptive statistics. Kruskal–Wallis and Mann–Whitney U tests were used to compare psychosocial determinants according to stage of change. The profile of community pharmacists who had implemented PhC was identified through logistic regression analysis. Main outcome measures: attitude, social influence, self-efficacy, motivations, needs and stages of change to perform PhC. Results Some respondents (n = 228; 11.8%) had adopted PhC, and were, thus, in the action or maintenance stage. The mean A.S.E. determinants scores increased significantly by stage i.e. from “precontemplation” to “action”: attitude (0.28 vs. 0.99), social influence of people (2.61 vs. 3.07), and self-efficacy (2.74 vs. 3.61). Conversely, most needs were highlighted by precontemplators (3.66 vs. 347.). Variables significantly associated with the probability of implementing PhC were: having undertaken appropriate training (OR: 13.92; CI 95%: 5.37–36.08); self-efficacy (OR: 3.19; CI 95%: 2.38–4.28), having assistant pharmacists (OR: 1.70; CI 95%: 1.02–2.80) and positive attitude (OR: 1.03; CI 95%: 1.01–1.04). The A.S.E. determinants were the best predictors of PhC implementation according to the regression model. Conclusion The implementation of PhC among Spanish community pharmacists appears to be relatively low. Strategies to move pharmacists should be adapted to stage: focussed on emphasizing advantages at initial stages and facilitating training courses, guidelines and communication to professionals at intermediate and advanced stages.


Pharmacy Models Pharmacists Professional role Questionnaire Spain Community pharmacists Pharmaceutical care Psychosocial determinants Training Pharmacies 



We are grateful to all pharmacists who responded to the ‘SeFar España’ survey.


This study was funded by the Fondo de Investigaciones Sanitarias (F.I.S.), ref. 04-PI030416.

Conflict of interest



  1. 1.
    Brodie DC, Parish PA, Poston JW. Societal needs for drugs and drug-related services. Am J Pharm Educ. 1980;44:276–8.PubMedGoogle Scholar
  2. 2.
    Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47:533–43.PubMedGoogle Scholar
  3. 3.
    World Health Organization. The role of the pharmacist in the health care system. Report of a WHO Consultative Group, New Delhi (India), 13–16 December 1988. Geneva: World Health Organization; 1994. WHO/PHARM/94.569.Google Scholar
  4. 4.
    Farris KB, Fernandez-Llimos F, Benrimoj SI. Pharmaceutical care in community pharmacies: practice and research from around the world. Ann Pharmacother. 2005;39:1539–41. doi: 10.1345/aph.1G049.PubMedCrossRefGoogle Scholar
  5. 5.
    Berenguer B, La CC, de la Matta MJ, Martin-Calero MJ. Pharmaceutical care: past, present and future. Curr Pharm Des. 2004;10:3931–46. doi: 10.2174/1381612043382521.PubMedCrossRefGoogle Scholar
  6. 6.
    Martin-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
  7. 7.
    Gastelurrutia MA, Faus MJ, Fernández-Llimós F. Providing patient care in community pharmacies in Spain. Ann Pharmacother. 2005;39:2105–10. doi: 10.1345/aph.1G121.PubMedCrossRefGoogle Scholar
  8. 8.
    Ministerio de Sanidad y Consumo (Spain). Consenso sobre Atención Farmacéutica [Consensus on Pharmaceutical Care]. Madrid: Ministerio de Sanidad y Consumo; 2002. ISBN: 351-02-018-0 (Spanish).Google Scholar
  9. 9.
    Roberts AS, Benrimoj SI, Chen TF, Williams KA, Aslani P. Implementing cognitive services: a review of models and frameworks for change. Int J Pharm Pract. 2006;14:105–13. doi: 10.1211/ijpp.14.2.0004.CrossRefGoogle Scholar
  10. 10.
    Roberts AS, Benrimoj SI, Chen TF, Williams KA, Aslani P. Implementing cognitive services: a review of facilitators used in practice change. Int J Pharm Pract. 2006;14:163–70. doi: 10.1211/ijpp.14.3.0002.CrossRefGoogle Scholar
  11. 11.
    Plaza L. El nuevo reto de la Atención Farmacéutica: la búsqueda del acuerdo entre profesionales [The new challenge of pharmaceutical care: the search for agreement between professionals] [dissertation]. Sevilla, Spain: University of Sevilla; 2001 (Spanish).Google Scholar
  12. 12.
    Gastelurrutia MA. Elementos facilitadores y dificultades para la diseminación e implantación de servicios cognitivos del farmacéutico en la farmacia comunitaria española [Facilitators and barriers for the dissemination and implantation of the pharmacist’s cognitive services in the Spanish community pharmacy] [dissertation]. Granada, Spain: University of Granada; 2005 (Spanish).Google Scholar
  13. 13.
    Zardain E, López ML. Categorización de los factores psicosociales del seguimiento farmacoterapéutico en el modelo A.S.E., en farmacéuticos de oficina de farmacia [Categorization of the ASE model psychosocial factors’ for pharmacotherapy follow-up in community pharmacists]. Pharm Care Esp. 2003;5:216–25 (Spanish).Google Scholar
  14. 14.
    Aguas Y. Análisis de la efectividad de las acciones de un centro de información de medicamentos en la implantación del seguimiento farmacoterapéutico en farmacias comunitarias [Effectivity analysis of the actions of a Drug Information Centre in the implantation of pharmacotherapy follow-up in the community pharmacies] (dissertation). Granada, Spain: University of Granada; 2005 (Spanish).Google Scholar
  15. 15.
    Prochaska JO, DiClemente CC. The transtheoretical approach: crossing traditional boundaries of therapy. Homewood (Illinois): Dow Jones-Irwin; 1984. ISBN: 087094438X.Google Scholar
  16. 16.
    Prochaska JO, Velicer WF, Rossi JS, Goldstein MG, Marcus BH, Rakowski W, et al. Stages of change and decisional balance for 12 problem behaviors. Health Psychol. 1994;13:39–46. doi: 10.1037/0278-6133.13.1.39.PubMedCrossRefGoogle Scholar
  17. 17.
    Johnson SS, Grimley DM, Prochaska JO. Prediction of adherence using the Transtheoretical Model: implications for pharmacy care practice. J Soc Adm Pharm. 1998;15:135–48.Google Scholar
  18. 18.
    Prochaska JM, Prochaska JO, Levesque DA. A transtheoretical approach to changing organizations. Adm Policy Ment Health. 2001;28:247–61. doi: 10.1023/A:1011155212811.PubMedCrossRefGoogle Scholar
  19. 19.
    Berger BA, Grimley D. Pharmacists’ readiness for rendering pharmaceutical care. J Am Pharm Assoc Wash. 1997;NS37:535–42.PubMedGoogle Scholar
  20. 20.
    de Vries H, Dijkstra M, Kuhlman P. Self-efficacy: third factor besides attitude and subjective norm as a predictor of behavioral intentions. Health Educ Res. 1988;3:273–82. doi: 10.1093/her/3.3.273.CrossRefGoogle Scholar
  21. 21.
    de Vries H, Backbier E, Kok G, Dijkstra M. The impact of social influences in the context of attitude, self-efficacy, intention and previous behaviour as predictors of smoking onset. J Appl Soc Psychol. 1995;25:237–57. doi: 10.1111/j.1559-1816.1995.tb01593.x.CrossRefGoogle Scholar
  22. 22.
    López ML, Iglesias JM, del Valle MO, Comas A, Fernández JM, de Vries H, et al. Impact of a primary care intervention on smoking, drinking, diet, weight, sun exposure, and work risk in families with cancer experience. Cancer Causes Control. 2007;18:525–35. doi: 10.1007/s10552-007-0124-0.PubMedCrossRefGoogle Scholar
  23. 23.
    Tiemessen IJ, Hulshof CT, Frings-Dresen MH. The development of an intervention programme to reduce whole-body vibration exposure at work induced by a change in behaviour: a study protocol. BMC Public Health. 2007;15:329. doi: 10.1186/1471-2458-7-329.CrossRefGoogle Scholar
  24. 24.
    Bolman C, de Vries H, Mesters I. Factors determining cardiac nurses’ intentions to continue using a smoking cessation protocol. Heart Lung. 2002;31:15–24. doi: 10.1067/mhl.2002.119834.PubMedCrossRefGoogle Scholar
  25. 25.
    Uema SA, Vega EM, Armando PD, Fontana D. Barriers to pharmaceutical care in Argentina. Pharm World Sci. 2008;30:211–5. doi: 10.1007/s11096-007-9167-2.PubMedCrossRefGoogle Scholar
  26. 26.
    Montgomery AT, Kälvemark-Sporrong S, Henning M, Tully MP, Kettis-Lindblad A. Implementation of a pharmaceutical care service: prescriptionists’, pharmacists’ and doctors’ views. Pharm World Sci. 2007;29:593–602. doi: 10.1007/s11096-006-9072-0.PubMedCrossRefGoogle Scholar
  27. 27.
    Zardain E, del Valle MO, Lopez ML, Garcia E. Validación de un cuestionario para medir factores psicosociales asociados al seguimiento farmacoterapéutico en farmacéuticos españoles [Validation of a questionnaire for measuring psychosocial factors associated with pharmaceutical care in Spanish community pharmacists]. Psicothema. 2006;18:778–84 (Spanish).Google Scholar
  28. 28.
    Consejo General de Colegios Oficiales de Farmacéuticos. Informe Libro Blanco: La aportación del farmacéutico a la calidad de la asistencia sanitaria en España [White book report; pharmacist’s contribution to health care quality in Spain]. Madrid: Consejo General de Colegios Oficiales de Farmacéuticos; 1997. ISBN: 84-89731-13-6 (Spanish).Google Scholar
  29. 29.
    Consejo General de Colegios Oficiales de Farmacéuticos. Valoración del consejo sanitario de las oficinas de farmacia [Health counseling evaluation in community pharmacies]. Madrid: Acción Médica; 2003 (Spanish).Google Scholar
  30. 30.
    Zardain E. Determinantes psicosociales del ejercicio del seguimiento farmacoterapéutico en farmacéuticos asturianos [Psychosocial determinants of pharmacotherapy follow-up in Asturian pharmacists]. Seguim Farmacoter. 2004;2(Suppl 1):20 (Spanish).Google Scholar
  31. 31.
    Álvarez E, García L, Flores M. Estado de situación de la atención farmacéutica de los colegiados de Cádiz. Resultados de una encuesta [Status report of pharmaceutical care of cadiz registered pharmacists. Results of a survey]. Pharm Care Esp. 2003;5:93–4 (Spanish).Google Scholar
  32. 32.
    van Mil JW, Schulz M, Tromp TF. Pharmaceutical care, European developments in concepts, implementation, teaching, and research: a review. Pharm World Sci. 2004;26:303–11. doi: 10.1023/B:PHAR.0000018612.03124.aa.PubMedCrossRefGoogle Scholar
  33. 33.
    Lopez ML, Comas A, del Valle MO, Lopez S, Garcia JB, Cueto-Espinar A. Psychosocial factors associated with cancer behavioural risk in relatives of cancer patients. Eur J Cancer Prev. 2004;13:105–11. doi: 10.1097/00008469-200404000-00003.PubMedCrossRefGoogle Scholar
  34. 34.
    Lopez ML, Herrero P, Comas A, Leijs I, Cueto A, Charlton A, et al. Impact of cigarette advertising on smoking behaviour in Spanish adolescents as measured using recognition of billboard advertising. Eur J Public Health. 2004;14:428–32. doi: 10.1093/eurpub/14.4.428.PubMedCrossRefGoogle Scholar
  35. 35.
    Latif DA. Situational factors as determinants of community pharmacists’ clinical decision making behavior. J Am Pharm Assoc Wash. 1998;38:446–50.PubMedGoogle Scholar
  36. 36.
    Odedina FT, Hepler CD, Segal R, Miller D. The Pharmacists’ Implementation of Pharmaceutical Care (PIPC) model. Pharm Res. 1997;14:135–44. doi: 10.1023/A:1012032223328.PubMedCrossRefGoogle Scholar
  37. 37.
    Aguas Y, De Miguel E, Fernandez-Llimós F. El seguimiento farmacoterapéutico como innovación en las farmacias comunitarias de Badajoz (España) [Pharmacotherapy follow-up as an innovation in community pharmacies of Badajoz (Spain)]. Seguim Farmacoter. 2005;3:10–6 (Spanish).Google Scholar
  38. 38.
    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 organizational theory. Pharm World Sci. 2003;25:227–34. doi: 10.1023/A:1025880012757.PubMedCrossRefGoogle Scholar
  39. 39.
    Dunphy D, Palmer I, Benrimoj SI, Roberts A. Change management and community pharmacy project. Final report. [Internet]. Sidney: The Pharmacy Guild of Australia; 2004. Available from Cited 12 April 2008.
  40. 40.
    Sabater D, Silva MM, Faus MJ. Método DADER—Guía de seguimiento farmacoterápico [DADER’s method—guide for pharmacotherapy follow-up]. Granada: University of Granada; 2007. ISBN: 978-84-608-0604-2 (Spanish).Google Scholar
  41. 41.
    Gómez MA, Malo M, Escudero P, Gracia L, Franco A. Motivación de los farmacéuticos para hacer seguimiento farmacoterapéutico [Pharmacists motivation to perform pharmacotherapy follow-up]. Pharm Care Esp. 2003;5:79 (Spanish).Google Scholar
  42. 42.
    Hidalgo J, Cámara D, Baena MI, Fajardo PC, Martínez F. Barreras para la implantación del seguimiento farmacoterapéutico en las farmacias comunitarias de Granada (España) [Barriers for implementing pharmacotherapy follow-up in community pharmacies from Granada (Spain)]. Seguim Farmacoter. 2005;3:144–9 (Spanish).Google Scholar
  43. 43.
    Rossing C, Hansen EH, Traulsen JM, Krass I. Actual and perceived provision of pharmaceutical care in Danish community pharmacies: the pharmacists’ opinions. Pharm World Sci. 2005;27:175–81. doi: 10.1007/s11096-004-1732-3.PubMedCrossRefGoogle Scholar
  44. 44.
    Farris KB, Kassam R, Cox CE, Volume CI. Evaluation of a practice enhancement program to implement pharmaceutical care. Am J Pharm Educ. 1999;63:277–84.Google Scholar
  45. 45.
    Ruston A. Achieving re-professionalisation: Factors that influence the adoption of an extended role by community pharmacists. A national survey. J Soc Adm Pharm. 2001;18:103–10.Google Scholar
  46. 46.
    Tully MP, Seston EM, Cantrill JA. Motivators and barriers to the implementation of pharmacist-run prescription monitoring and review services in two settings. Int J Pharm Pract. 2000;8:188–97.Google Scholar
  47. 47.
    Williams SE, Bond CM, Menzies C. A pharmaceutical needs assessment in a primary care setting. Br J Gen Pract. 2000;50:95–9.PubMedGoogle Scholar
  48. 48.
    Farris KB, Schopflocher DP. Between intention and behavior: an application of community pharmacists’ assessment of pharmaceutical care. Soc Sci Med. 1999;49:55–66. doi: 10.1016/S0277-9536(99)00078-7.PubMedCrossRefGoogle Scholar
  49. 49.
    Holm K, Kremers SP, de Vries H. Why do Danish adolescents take up smoking? Eur J Public Health. 2003;13:67–74. doi: 10.1093/eurpub/13.1.67.PubMedCrossRefGoogle Scholar
  50. 50.
    Armitage CJ, Conner M. Distinguishing perceptions of control from self-efficacy: predicting consumption of a low-fat diet using the theory of planned behavior. J Appl Soc Psychol. 1999;29:72–90. doi: 10.1111/j.1559-1816.1999.tb01375.x.CrossRefGoogle Scholar
  51. 51.
    de Vries H, Backbier E. Self-efficacy as an important determinant of quitting among pregnant women who smoke: the phi-pattern. Prev Med. 1994;23:167–74. doi: 10.1006/pmed.1994.1023.PubMedCrossRefGoogle Scholar
  52. 52.
    Roberts A, Benrimoj SI, Chen TF, Williams KA, Aslani P. Quantification of facilitators to accelerate uptake of cognitive pharmaceutical services (CPS) in community pharmacy. Executive summary. [Internet]. Sidney: University of Sidney; 2004. Available from Cited 7 March 2008.
  53. 53.
    Roberts AS. The constant crossroads—change management in community pharmacy. Aust Pharmacist. 2007;26:200–5.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  • Emma Zardaín
    • 1
  • María Olivo del Valle
    • 1
  • María Isabel Loza
    • 1
  • Eduardo García
    • 1
  • Alberto Lana
    • 1
  • Wolfgang A. Markham
    • 1
  • María Luisa López
    • 1
    Email author
  1. 1.University of OviedoOviedoSpain

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