Over-the-counter prescribing and pharmacists' adoption of new medicines: diffusion of innovations

BACKGROUND: More than 90 medicines in the United Kingdom alone have been reclassified from "prescription only" to "pharmacy" availability, and many of these have further been deregulated to "general sales" status. Pharmacist perspectives of reclassified medicines adoption into practice are important to inform future reclassifications.

OBJECTIVES: The aim of this research was to explore the factors associated with adoption into practice of newly reclassified medicines by community pharmacists based on the theoretical framework of diffusion of innovations.

METHODS: Focus groups and qualitative interviews with 20 community pharmacists selected randomly from 4 Health Boards in Scotland were conducted. Results were analyzed using a framework method for thematic analysis.

RESULTS: Factors associated with pharmacists' decision making regarding adoption into practice of newly reclassified medicines related to pharmacists' perceived attributes of newly reclassified medicines such as evidence of benefits and risks to patients (ie, efficacy and safety); organizational contextual factors such as sources of information and training; external factors, such as support from wider stakeholders; and adopter characteristics such as pharmacists' perception toward adopting new behaviors. Many newly reclassified medicines were highlighted by participants to have been highly adopted into practice or were less/not adopted based on these diverse factors. Decisions at organizational level to stock new medicines did not necessarily translate into adoption at practitioner level.

CONCLUSIONS: Pharmacists' decision making regarding adoption of newly reclassified medicines is a complex and multidimensional process. This is the first study of this sort, and results of this qualitative study will aid development of a research instrument aimed at quantifying the importance of the factors identified.