Organizational Factors and Clinical Pharmacy Outcomes

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Last week’s Tip examined a network of pharmacies in how how a payer might view them when incenting them or designing pay for performance contracts. This week’s Tip looks at a very compelling study from England evaluating a number of pharmacy-centric outcomes measures and the factors affecting pharmacy performance.

This study was carried out by Jacobs et al.1 The authors describe how service provision varies across community pharmacies may depend on organizational characteristics, such as ownership, staffing and skill mix. Thus, they sought to explore variation in clinical productivity (levels of service delivery and service quality) in pharmacies and identify the organizational factors associated with this variation. They employed a mixed-methods approach: a community pharmacy survey, administrative data analysis, a patient survey, and stakeholder interviews. They selected 9 socioeconomically diverse geographical areas where pharmacies would participate. This involved 39 pharmacies from these regions, with approximately 30 patients each following their receipt of dispensing and medicines use review (MUR) services. They examined patient satisfaction, satisfaction with information about medicines, and medication adherence. The community pharmacy questionnaire included data such as ownership type, organizational culture, staffing and skill mix, working patterns, management structure, safety climate, and pharmacy–general practice integration. Thirty pharmacy and 10 commissioning representatives (somewhat akin to U.S. state board representatives) were interviewed face-to-face or by telephone. The research found that pharmacy clinical productivity was associated with pharmacy ownership type, organizational culture, staffing and skill mix, and pharmacy–general practice relationships. Extra-organizational associations included local area deprivation, age profile and health needs, pharmacy location, public perceptions and expectations, supply chain problems, levels of remuneration and legal/regulatory constraints.

Pharmacy managers might increasingly be responsible for global pharmacy outcomes in regard to potential revenues. The research highlighted here showed that a strong organizational culture supportive of employees and ensuring adequate staffing (in number an in quality) was highly indicative of clinical pharmacy performance. It also demonstrated the need for pharmacy managers to have adequate and tight control over supply chain issues to prevent shortages that exacerbate staff and patient stress. Moreover, as was the case in last week’s Tip, regulatory issues (eg, scope of practice, and pharmacist:technician ratios), and the socioeconomic and health status of the patients served will impact their outcomes regardless of how effective the pharmacy is in providing services. This behooves pharmacy owners/managers to be knowledgeable of such factors when negotiating collaborative agreements and contracts. In other words, there are things in the manager’s control to which they should attend, and hings not in their direct control about which they should be cognizant rather than ignorant.

Additional information about The “Management” in Medication Therapy Management and Organizational Structure and Behavior can be found in Pharmacy Management: Essentials for All Practice Settings, 5e. If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to Pharmacy Management: Essentials for All Practice Settings, 5e. If your institution does not provide access, ask your medical librarian about subscribing.

1Jacobs S, Bradley F, Elvey R, et al. Investigating the organizational factors associated with variation in clinical productivity in community pharmacies: a mixed-methods study. Health Services and Delivery Research. 2017. Available at: https://www.ncbi.nlm.nih.gov/books/NBK458849/.

Shane Desselle

Professor of Social and Behavioral Pharmacy, Touro University California