Pharmacy owner and manager perceptions of pharmacy adaptation services in British Columbia

Introduction: As of January 2009, pharmacists in British Columbia ( BC) have been able to adapt prescriptions to provide renewals; change the dosage, formulation or regimen; and substitute therapeutically equivalent therapies for reasons of cost or continuity of care. Objectives: To describe and characterize pharmacy manager and owner perceptions of pharmacy adaptation services in BC. Methods: Over a 1-month period, pharmacy owners, dispensary managers and regional managers from "high-adapter" pharmacies (>60 adaptations/month) and "low-adapter" pharmacies (<10 adaptations/month) were interviewed. During the semi-structured interviews, participants were asked to comment on uptake, cost, revenue and general perceptions of adaptation services. All data were assessed using content analysis. Results: Very few capital costs were incurred. Those costs included additional human resource costs (training and staff), updating computer software to produce physician notification forms, fax machine upgrades, additional physical storage and paper. The other emerging themes from the interviews included sustainability, patient and physician knowledge of the program, perceived benefits of the program, suggested changes to the program, high-adapting pharmacies as being champions of pharmacy adaptation services and potential barriers to adoption within a pharmacy. Discussion: In general, few changes were made as a result of the adaptation program and minimal capital costs were incurred. The documentation stage was the most labour-intensive aspect of adapting prescriptions. Perceived benefits related to providing the patient with continuity of care. Most of the suggested changes involved reducing restrictions on the program and providing greater opportunities for pharmacists to exercise their clinical judgment.