Practitioners' and public's perspectives of Portuguese community pharmacy: The role of job satisfaction and professionalism in actual and expected practice.

摘要

Community pharmacy in Portugal is a health care profession in transition. Many initiatives have been forwarded to practitioners from educational and professional organizations to extend the role of community pharmacists. However, changes have been slowly implemented in practice and public's service opinions are not well known. The overall objective of this research was to investigate public and professionals' attitudes in relation to present and potential practice in primary care. It was aimed to address professionals' needs for an enhanced role. Materials and Methods This research was divided into two arms. One aimed at exploring perceptions and attitudes of community pharmacy customers and their expectations of the service. This was achieved qualitatively, through group interviews, and quantitatively via a national telephone survey. The second arm aimed to evaluate Portuguese community pharmacists' professional attitudes and job satisfaction, through a preliminary and a main postal survey. The Kimberlin & Barnett job satisfaction instrument, as well as Schack & Hepler professionalism scale, were piloted to adapt to the Portuguese context and then used to survey a national sample of Portuguese community pharmacists. Results and Discussion Qualitative results showed users' weak conceptualization of the community pharmacist role, mainly centred in product dispensing and with no emphasis on pharmacists' cognitive services. The vague expectations for an extended intervention were essentially based on convenient access to products. Although 3/4 of the population agrees with practitioners' treatment intervention, 1/3 reported communication problems and 1/2 could not recognise the pharmacist amongst staff, in particular if economically inactive and with a chronic condition. Results from the preliminary survey validated instruments and confirmed that low levels of community pharmacists' job and career satisfaction were associated with poorer professional attitudes, including a significantly lower motivation and autonomy for the employed pharmacist (t tests, p<0.05). Results from the main survey revealed an 'independent' practice, giving high importance to OTC skills (96%) while disbelieving patient medication records (64.0%) to ensure a rational therapy. Employed practitioners, with the current degree and in the first decade of practice (46.2%), were significantly less satisfied but more prepared to adopt a clinical role than pharmacy owners (t tests, p<0.05). Job satisfaction and professional motivation were explained by ownership status (14% impact), by the opportunity to provide individualised patient care (5% impact) and by less time on management (2% impact), with continuous professional development having a non-significant influence. Recommendations It seems important to tackle the 'inner' practice, to improve labour conditions for the development of the clinical role, thus increasing practitioners' job satisfaction and profession belief. Effective continuous education can contribute to motivate Portuguese community pharmacists, improving practice and public's perception of practitioners. Ultimately, it is desired an active contribution to the advance of patients' outcomes in primary health care.