| Little theory-based research has been done, despite the decade-old pharmaceutical care paradigm shift, to assess pharmacists' reasons for adoption or rejection of pharmaceutical care. Using Rogers' Diffusion of Innovation model, pharmacist innovation-decision stage and perceptions of pharmaceutical care were assessed. Pharmaceutical care cannot be provided without physician support, therefore physician attitudes and experience with pharmacists' expanded roles were obtained. Comparing pharmacist and physician perceptions allows identification of perceived barriers and attitude differences toward pharmacist roles. A questionnaire, mailed to 1,200 randomly selected pharmacists and physicians in Minnesota and Idaho, contained questions evaluating aspects of the model. Response rate was 29.2 percent (n = 350), including 153 pharmacists and 146 physicians. Thirty-five percent of pharmacists reported adoption, while 36 percent were undecided and 29 percent had rejected pharmaceutical care. Lack of personnel resources (65%) and lack of reimbursement (61%) were the two most often cited reasons for rejection. Pharmacists mean assessments of the benefits of pharmaceutical care on the five scales of the model (relative advantage, complexity, compatibility, observability, and trialability) ranged from 3.07–3.80 (range 1–5, 5 = strongly agree). Physicians were consistently more negative (p ≤ .01) toward pharmacists providing clinical pharmacy, pharmaceutical care, and collaborative practice agreements then were pharmacists. Attitudes toward 33 pharmacy services (traditional, expanded and pharmaceutical care) yielded significant differences (p ≤ .01) between the two professions for 30 items. Regression analyses found perceived compatibility, year of graduation, attending continuing education on pharmaceutical care, and reading institutionally related journals to be significant predictor variables for pharmacist adoption of pharmaceutical care. Variables influencing physician support of pharmacist provision of pharmaceutical care included perception of contact with clinical pharmacists and pharmacists in general, perception of pharmaceutical care services, and frequency of seeking additional information from a retail pharmacist. This study demonstrates usefulness of the model in understanding factors associated with adoption of pharmaceutical care. Additionally, findings suggest the significant perceptual differences between pharmacists and physicians regarding the value of pharmaceutical care. |
