Research in Social and

Administrative Pharmacy j (2014) j–j

Original Research

Prescribing by pharmacists in Alberta and its relationto culture and personality traits

Meagen M. Rosenthal, M.A.a,*, Sherilyn K.D. Houle, Ph.D.b,Greg Eberhart, B.Sc. Pharm.c, Ross T. Tsuyuki, Pharm.D.a

aEPICORE Centre/COMPRIS, Department of Medicine, University of Alberta, Edmonton, Alberta, CanadabSchool of Pharmacy, University of Waterloo, Kitchner-Waterloo, Ontario, Canada

cAlberta College of Pharmacists, Edmonton, Alberta, Canada

Abstract

Background: As evidence for the efficacy of pharmacists’ interventions, governments worldwide are

developing legislation to formalize new practice approaches, including independent prescribing bypharmacists. Pharmacists in Alberta became the first in Canada availed of this opportunity; however,uptake of such has been slow. One approach to understanding this problem is through an examination of

pharmacists who have already gained this ability.Objectives: The primary objective of this study was to gain descriptive insight into the culture andpersonality traits of innovator, and early adopter, Alberta pharmacists with Additional PrescribingAuthorization using the Organizational Culture Profile and Big Five Inventory.

Methods: The study was a cross-sectional online survey of Alberta pharmacists who obtained AdditionalPrescribing Authorization (independent prescribing authority), in the fall of 2012. The survey containedthree sections; the first contained basic demographic, background and practice questions; the second section

contained the Organizational Culture Profile; and the third section contained the Big Five Inventory.Results: Sixty-five survey instruments were returned, for a response rate of 39%. Respondents’ mean agewas 40 (SD 10) years. The top reason cited by respondents for applying for prescribing authority was to

improve patient care. The majority of respondents perceived greater value in the cultural factors ofcompetitiveness, social responsibility, supportiveness, performance orientation and stability, and may bemore likely to exhibit behavior in line with the personality traits of extraversion, agreeableness,conscientiousness and openness. Inferential statistical analysis revealed a significant linear relationship

between Organizational Culture Profile responses to cultural factors of social responsibility andcompetitiveness and the number of prescription adaptations provided.Conclusions: This insight into the experiences of innovators and early adopter pharmacist prescribers can

be used to develop more specific and targeted knowledge implementation studies to improve the uptakeand integration of prescribing by pharmacists.� 2014 Elsevier Inc. All rights reserved.

Keywords: Pharmacist prescribing; Early adopters; Culture; Personality

* Corresponding author. EPICORE Centre, Suite 4000, Research Transition Facility, 8308–114 Street, NW,

University of Alberta, Edmonton, AB T6G 2V2, Canada. Tel.: þ1 780 934 8810 (mobile), þ1 780 492 6059.

E-mail address: meagen.rosenthal@ualberta.ca (M.M. Rosenthal).

1551-7411/$ - see front matter � 2014 Elsevier Inc. All rights reserved.

http://dx.doi.org/10.1016/j.sapharm.2014.09.004

2 Rosenthal et al. / Research in Social and Administrative Pharmacy j (2014) 1–11

Background

Evidence based practice has become the

cornerstone of patient care for most health careprofessionals. While the application of this term inpractice has been criticized as being overzealous,and lacking practicality, it remains the driving

force behind how practices of many health careprofessionals are shaped and judged.1–3 Withinthe profession of pharmacy, legislation is rapidly

changing to recognize the valuable contributionof pharmacists’ drug therapy expertise to patientcare, and health outcomes.4–6 For example, phar-

macists in a number of jurisdictions now have theability to perform non-medical prescribing.

Pharmacist prescribing has been implementedin the United States (US) and United Kingdom

(UK) in various forms and with varying degrees ofsuccess for quite some time.6,7 Alberta became thefirst province in Canada where independent pre-

scribing by pharmacists was introduced on aprofession-wide basis in 2009.8 Alberta has 2 typesof prescribing: prescription adaptation and initial

access prescribing. Under prescription adaptation,pharmacists can alter a dosage, formulation,regimen, or duration of a prescription initiated

by another prescriber, provided they have accessto the original prescription.9 All licensed pharma-cists can perform this activity.

Initial access prescribing is the prescription of

a new medication by a pharmacist based on eithertheir assessment of the patient at the initial pointof care, the recommendation of another pre-

scriber, or in consultation with another healthprofessional.9 To provide initial access prescrip-tions, pharmacists must successfully complete a

comprehensive application demonstrating theirability to implement, and adhere to, the AlbertaCollege of Pharmacists’ Standards of Practicefor Pharmacist Prescribing.10 The successful

completion of this application is referred to as ob-taining Additional Prescribing Authorization(APA). While the number of pharmacists with

APA has increased dramatically over time, atthe time of the study, fewer than 10% of theroughly 4000 pharmacists practicing in the

province had obtained this ability.11–13 Thesepharmacists work in a variety of settings includingcommunity pharmacies, hospitals, ambulatory

clinics, and primary care clinics with general prac-titioners (see Table 3).

While evidence of the value of this level ofintervention was scant at the time of its introduc-

tion, there is increasing evidence demonstrating

the value of pharmacists’ active management ofpatient medications through prescribing.15–17

More specifically, one systematic review found

that when pharmacists were allowed to prescribefor patients with diabetes mellitus, interventionpatients attained a greater reduction in A1c thanpatients receiving usual care that did not involve

pharmacist prescribing.15 Another study foundthat a prescribing pharmacist effectively manageda group of patients suffering from chronic non-

cancer related pain.16 Furthermore, in a reportdeveloped for the Department of Health in theUK, pharmacist prescribing was also found to

be generally safe and effective.17

If it is assumed for the moment that pharma-cist prescribing represents the latest in evidencebased practice, it becomes important to under-

stand why so few Alberta pharmacists have inte-grated it into practice. Traditional research intoslow adoption of evidence into practice has largely

focused on barriers to practice change.18 Whilethis work has identified important systemic bar-riers such as lack of time, an alternative approach

is to examine the characteristics of those practi-tioners who have already adopted the newpractice.

Everett Rogers, in the Diffusion of InnovationTheory, posits 5 adopter groups, which can beidentified when examining the uptake of aninnovation, such as pharmacist prescribing.19

These groups, in order of adoption of the innova-tion, are the “innovators”, “early adopters”,“early majority”, “late majority” and “lag-

gards.”19 In terms of group characteristics, inno-vators are more likely to take risks, are generallyof the highest social class, have access to greater

financial resources, and have the closest socialcontact with scientific sources.19 Early adoptersare individuals with a high degree of self-consciously developed opinion leadership and so-

cial status.19 The early majority is characterizedby an average social status and some contactwith early adopters. Finally, Rogers suggests

that the late majority have high degree of skepti-cism and the laggards have low opinionleadership.19

Previous work examining the general adoptercategories within health care settings has foundthat they are consistent with work applying the

theory of Diffusion of Innovations in otherfields.20 Furthermore, work with physicians,21

in hospitals,22 and in nursing homes,23 focusingon the characteristics of innovators and

early adopters has found that there are notable

3Rosenthal et al. / Research in Social and Administrative Pharmacy j (2014) 1–11

differences between those groups and the otheradopter categories. However, one criticism hasbeen that this work has failed to understand thedecision behind why a particular innovation was

adopted.24 In particular, authors suggest thatmore research is needed investigating “individualinterpretations” (p. 1431) of innovations by po-

tential adopters.24

In an effort to address this criticism, and extendour understanding of the adoption of APA using

Rogers’ theory, the question of “why?” will beginto be addressed through an examination of pro-fessional culture. Professional culture can be un-

derstood as, “[groupings] of people that sharecommon socialization, education, and knowledgeto perform a specific task, and have control overthat knowledge” (p. 290).25 This definition of cul-

ture can also be extended to encompass “patternsof [subjective] interpretation” (p. 330).26 Unlikeother definitions, which have envisioned culture

as a monolithic structure,27 the focus of this defini-tion is on how individual group members makesense of their profession. This alternative perspec-

tive on culture is particularly meaningful as it en-ables culture to be viewed as malleable. Overtime, individual experiences will influence interpre-

tations, and therefore, change the manifestation ofculture.26 This malleability has important implica-tions for the possibility of improving uptake of newinnovations in the future.

The influence of culture in health care pro-fessions has yet to be fully examined, despite a fewstudies in medicine, nursing, social work and

pharmacy, which have begun the process ofcharacterizing these professions’ cultures.28–32

This is not the case in some non-health care pro-

fessions, wherein both the culture, and its influ-ence on the interaction between members, hasbeen undertaken. For example, the professionalculture of probation officers was found to impact

the supervisory outcomes of parolees.33 Humanresource specialists’ professional culture, whichwas described as being more employee focused

rather than oriented toward the company,impacted advice to, and treatment of employees.34

While the professional cultures of management

accountant groups were found to foster miscom-munications, due to differing usages of accountingterminologies.35

Finally, an examination of the social psychol-ogy literature suggests that behavior is not merelya function of culture, but must also be consideredwithin the context of individual personality.36 As

such, the approach advocated by some social

psychologists is to treat culture and personalityas separate, but interacting variables.36 Workingfrom Rogers’ assertion that innovators and earlyadopters are different from other adopter groups,

an examination of the cultural characteristics andpersonality traits of Alberta pharmacists whoadopted the innovation of pharmacist prescribing,

known as obtaining APA, was undertaken.

Objectives

The primary objective of this study was to gaindescriptive insight into the culture and personality

traits of a group of innovator and early adopterAlberta pharmacists with APA using the Organi-zational Culture Profile (OCP) and Big Five

Inventory (BFI). The secondary objective of thisstudy was to see how these factors and traits maybe related to the self-described adoption and

usage of APA in practice.

Methods

Design

A cross-sectional survey design was used toaddress the study objectives. Ethics approval was

obtained from the Health Research Ethics Boardat the University of Alberta.

Population

The population consisted of all pharmacistswith APA, who provided consent to the AlbertaCollege of Pharmacists to be contacted for phar-

macy practice research activities. This included167 pharmacists at the time the survey wasadministered in 2012. As indicated in the back-

ground, the number of pharmacists who haveobtained APA since this time has increased. SinceRogers’ theory suggests that the first 16% of the

population to adopt an innovation comprise the“innovators” and “early adopters”19 and roughly10% of Alberta pharmacists had APA at thetime of this survey, it is assumed that all pharma-

cists surveyed could be classified into one of thesetwo groups.

Survey instrument

The survey instrument contained three sec-tions. The first section started with demographic

questions including number of years in practice,location of practice, age, gender, highest level ofeducation, and additional continuing education

Table 1

OCP constructs and their relationship to question

themes14

Construct Defining characteristics/themes

Competitiveness � Achievement orientation

� An emphasis on quality

� Being distinctive/different from

other groups

� Being competitive

Social

responsibility

� Being reflective

� Having a good reputation

� Being socially responsible

� Having a clear guiding

philosophy

Supportiveness � Being team orientated

� Sharing information freely

� Being people oriented

� Collaboration

Innovation � Being innovative

� Quick to take advantage of

opportunities

� Risk-taking

� Taking individual responsibility

Reward

orientation

� Fairness

� Opportunities for professional

growth

� High pay for good performance

� Praise for good performance

Performance

orientation

� Having high expectations for

performance

� Enthusiasm for the job

� Being result oriented

� Being highly organized

Stability � Stability

� Being calm

� Security of employment

� Low conflict

4 Rosenthal et al. / Research in Social and Administrative Pharmacy j (2014) 1–11

courses taken. These questions were based uponthose asked in previous studies conducted bymembers of the research team.31,37 Information

was then collected on what had prompted respon-dents to apply for APA, and in which clinicalpractice area(s) they first intended to use their au-thority.d These questions were based upon those

reflected in the original APA application, andnot been something previously reported upon.

Next, respondents were asked to outline how

they applied APA within their practices, includingwhich prescribing activities they engaged in mostfrequently. Finally, respondents were asked to

evaluate their success in integrating APA intotheir practices, and to identify any outstandingbarriers they faced. Response categories for spe-cific barriers faced by respondents were based on a

review of the pharmacy practice literature.18

Given the possibly diverse set of responses forsome questions, including the operationalization

of APA in practice, open-ended formatting wasused as appropriate, resulting in the collection ofqualitative data. A total of 26 questions were

asked as part of section one.Sections two and three of the survey instru-

ment contained the OCP and BFI, respectively.

The OCP was used to gain insight into the sharedaspects of professional culture of pharmacists.While originally designed to measure organiza-tional culture,14 it has also been used to measure

the stated values of individual members of largerorganizations in an effort to compare these resultsto those of the leadership team within the organi-

zation.38 Furthermore, previous work using theOCP in a health care setting suggested that futurestudies should utilize the OCP to measure profes-

sional culture in an effort to distinguish its influ-ences from those of the organization or hospitalward.39

Unlike other culture measurement tools, reli-

ability analyses of the OCP, and previouslyidentified cultural factors, have been undertaken,making it a particularly appealing instrument.14

The average reliability scores for the instrumenthave ranged between 0.77 and 0.88, dependingupon the population under study.14 This instru-

ment is comprised of seven cultural factors:competitiveness, social responsibility, supportive-ness, innovation, emphasis on rewards, perfor-

mance orientation, and stability.14 The degree to

d At the time the survey was administered the application

areas for the use of the authority. This section has since bee

not disease specific (https://pharmacists.ab.ca/Content_Files/F

which a group perceives value in each of thesefactors is determined by scoring responses to

a particular sub-set of the 40 Likert scale-measured items linked specifically to that culturalfactor. Each Likert scale is measured from 1 (“not

at all”) to 5 (“very much”). The relationship be-tween each factor and its’ questionnaire items/themes is presented in Table 1.

The personality traits of pharmacists wereassessed using the BFI. This is a reliable

for APA requested applicants identify primary practice

n removed to better align with the notion that APA is

iles/APAApplicationForm2013.pdf).

5Rosenthal et al. / Research in Social and Administrative Pharmacy j (2014) 1–11

instrument that measures five personality traits:extraversion, agreeableness, conscientiousness,neuroticism, and openness (see Table 2 for defini-tions of traits).40–42 Reliability scores from a large

sample drawn from the North American popula-tion have ranged between 0.79 for agreeablenessand 0.87 for neuroticism.40 Unlike other personal-

ity traits measures, the BFI is said to specificallymeasure traits, rather than personality states orpreferences.40 The BFI is considered to be a short

instrument, suitable for self-administration, utiliz-ing 44 phrases measured on 5-point Likert scalesfrom strongly disagree to strongly agree.40 As

with the OCP, scoring the BFI involves combiningthe Likert responses to the 44 phrases into specificsub-sets related to each of the five personalitytraits.40

The BFI has been by research team members inother pharmacist populations,37 whereas the OCPhas not been used in pharmacist populations pre-

viously. Research team members reviewed allother questions for relevance, but no pilot testingof questions was undertaken.

Data collection

All instruments were completed online. Anemail invitation, along with a secure link to the

complete survey, was distributed to qualifyingpharmacists with the assistance of the AlbertaCollege of Pharmacists in September 2012. Two

reminder emails were sent two weeks apart to allparticipants to improve response rates. The web-based survey was available for pharmacists’ re-

sponses for a total of 5 weeks to allow adequatetime for pharmacists to complete it after the finalreminder was sent. No incentives were offered toparticipants to increase participation rates.

Table 2

BFI traits and descriptions40

Trait Participants who score more highly

behaviors:

Extraversion Being “energetic” and “enthusiasti

Agreeableness Being “altruistic”, “cooperative”,

warmth and kindness”

Conscientiousness Having the ability to “control imp

norms and rules”, and “efficienc

Neuroticism Having behaviors associated with

may also display “self-conscious

Openness Being likely to have a “wide, deep

likely to be “knowledgeable”, “p

and are more “artistic” and “inv

Analysis

All statistical analyses were completed usingSPSS� version 19 (IBM SPSS, Armonk, NY,USA). Demographic and background survey

questions were evaluated using descriptive statis-tics and central tendency measures, as appro-priate. Frequency counts were made of how andwhen respondents applied for APA, and in which

clinical activities they were engaged.The open-ended questions, about motivation

for obtaining APA, conditions treated, and bar-

riers to the implementation of APA in practice,were analyzed manually using conventional qual-itative content analysis.43 Conventional qualita-

tive content analysis is descriptive in nature, andinvolves a close examination of the data, allowingfor categories to emerge from the data.43 All cod-ing was completed by hand and used an open-

coding structure. Two members of the researchteam analyzed these data (MR and SLH), with athird team member (RT) being brought in to

resolve any disputes. All coding differences wereresolved via discussion and consensus. These re-sults are presented thematically. The first listed

theme represents the one with the greatest numberof mentions.

Next, the mean scores of the OCP and BFI for

this sample were calculated. In particular, thescoring guidelines provided by the authors of therespective instruments were used.14,40 These re-sults were used for the purposes of inferential

analyses described in detail below. The interpreta-tion of responses to the OCP and BFI, by them-selves, will be undertaken with an examination

of the frequency counts for each OCP factor andBFI trait. This is a method, which has been usedby members of the research previously, to address

in this traits may be more likely to exhibit the following

c”, “social”, “assertive”, “confident”, and “ambitious”

“willing to conform to group norms”, and “displaying

ulses” to “facilitate goal-directed behavior”, to “follow

y in planning, organizing and prioritizing tasks”

“feelings of anxiety”, “nervousness”, and “depression”

ness”, be more “moody”, “impulsive”, and “stress-prone”

and complex level of experience in the world”, and also

erceptive” and “analytical”, “seek out new experiences”,

estigative”

6 Rosenthal et al. / Research in Social and Administrative Pharmacy j (2014) 1–11

debate around the interpretation of Likert scaledata.37 As part of these frequency counts theends of the Likert scale have been truncated

(i.e., “strongly agree” and “agree” are combinedto become “disagree”), to facilitate the interpreta-tion.37 The determination of whether or not a fac-tor, or trait, is meaningful to respondents is then

based upon whether or not a majority of respon-dents agreed with the factor, or trait.

It is important to note that neither the OCP

nor the BFI are demonstrative measures, meaningthat it is inappropriate, for instance, to suggestthat a professional culture is innovative or that a

group’s personality is extraverted. As such, theresults of the OCP are interpreted as suggestingthat respondents “perceived value” in particularfactors, while the BFI results describe respondents

as being “more likely to exhibit behaviors” in linewith a particular trait.

Comparisons between the mean scores of the

OCP and BFI and the variables from the first partof the survey were then made. Specifically, com-parisons to the variables of the numbers of

prescription adaptations and initial access pre-scriptions written by respondents were made.These comparisons were made using analysis of

Table 3

Survey respondent demographics

Total pharmacist

Number of respondents 65

Mean number of years in practice 16 years (9 years)

Mean age 40 years (10 years

Gender 79% female

Highest level of education 73% BSc Pharma

Obtained additional certifications

(e.g., Certified diabetes educator,

travel medicine, injections

certification)

46%

Primary practice areaa

Community 22%

Hospital 23%

Ambulatory clinic 25%

Primary care clinics 26%

Long-term care facility 3%

Primary practice (% of

respondents spending O 20

h/week providing direct

patient care)

56%

Primary position 75% self-identified

pharmacists

Mean time with APA 24 months (18 mo

a One response was missing from this question.

variance (ANOVA) and simple bivariate linearregression. Due to the exploratory nature of thisstudy, post-hoc tests for ANOVA analysis,

including the Tukey and Games–Howell tests,were used to determine where specific sub-groupdifferences between means were located.44

Results

A total of 65 survey instruments were returned,for a response rate of 38% (Response rate is based

on the 172 pharmacists whoprovided permission tobe contacted for participation in research). Onaverage, respondents were 40 (SD 10) years of

age, had been in practice for 16 (SD 9) years and themajority of respondents were female (79%)(Table 3). No significant differences were noted

between those pharmacists who responded to thesurvey before the reminders, versus those who re-sponded after the reminders. When compared tothe overall population of Alberta pharmacists

with APA, according to records maintained bythe Alberta College of Pharmacists, survey respon-dents averaged twomore years in practice. Respon-

dents were alsomore likely to be female (þ7%) andworking in a primary care clinic, wherein the

respondents Total pharmacist population

with APA

197

14

) 40

72% female

cy Not available

Not available

26%

31%

28%

14%

Not available

Not available

as staff Not available

nths) 24 months

7Rosenthal et al. / Research in Social and Administrative Pharmacy j (2014) 1–11

pharmacist works within a family physician’s officeto see referred patients (þ12%).When compared tothe overall population of pharmacists with APA,respondents working in the hospital setting were

underrepresented (�8%).The conventional qualitative content analysis

of the open-ended questions revealed that the top

three reasons respondents cited for applying forAPA included the desire to improve patient care,expanding professional roles, and employer re-

quirements. The primary clinical practice areaslisted most frequently by respondents were dia-betes, dyslipidemia and hypertension, followed by

smoking cessation, surgery, travel medicine andgeriatrics. The therapeutic drug classes mostfrequently prescribed included antihypertensivemedicines, anticoagulants, oral antihyperglycemic

medicines, and statins. However, respondents alsoreported often prescribing acute therapies such asanalgesics, immunizations and antibiotics.

Upon receiving APA, nearly 90% of respon-dents wrote their first prescription within the firstmonth, with 58% of those using their APA within

the first week of obtaining it. When asked aboutthe number of prescription adaptations writtenper week, 72% of respondents wrote at least one

prescription adaptation per week (median of 3).Sixty-four percent of respondents wrote at leastone initial access prescription per week (medianof 5).

Over three-quarters (77%) of respondents feltthat they had successfully integrated APA intotheir practice, but identified a number of remain-

ing barriers. One barrier was a lack of supportfrom health care professionals (including otherpharmacists), patients and managers/employers.

Other barriers included a lack of time to completedocumentation, to develop relationships withother health care professionals, and to keep upwith the latest clinical data.

A total of 54 survey instruments containedcompleted OCP and BFI sections, meaning that83% of respondents completed the entire instru-

ment. This makes for a total response rate of29%. The following results are based on these 54respondents’ survey responses. The demographic

characteristics of this subsample of respondentsdid not differ significantly from the larger pool of65 respondents.

Applying the OCP scoring guidelines, themean scores of the seven cultural factors were asfollows: 3.70 (SD 0.81) for competitiveness, 3.69(SD 0.81) for social responsibility, 3.89 (SD 0.76)

for supportiveness, 2.99 (SD 0.82) for innovation,

3.37 (SD 0.76) for emphasis on rewards, 3.87 (SD0.80) for performance orientation, and 3.67 (SD0.64) for stability. Reliability analysis scores forthe OCP factors ranged between 0.90 for innova-

tion and reward orientation, and 0.96 for sup-portiveness. An examination of the frequencycounts from the visual scale for OCP results

reveals that greater than 50% of respondentsperceived value in the factors competitiveness,social responsibility, supportiveness, performance

orientation, and stability (Fig. 1).Using the scoring guidelines from the BFI, the

mean scores of the traits were as follows: 3.72 (SD

0.78) for extraversion, 4.18 (SD 0.56) for agree-ableness, 4.39 (SD 0.47) for conscientiousness,2.27 (SD 0.67) for neuroticism, and 3.59 (SD 0.51)for openness. Reliability analysis scores for the

BFI traits ranged between 0.70 for openness, and0.88 for extraversion. An examination of thefrequency count from the visual scale for the

BFI results reveals that greater than 50%of respondents may be more likely to exhibitbehaviors in line with the traits extraversion,

agreeableness, conscientiousness, and openness(Fig. 2).

Inferential statistical analysis revealed a signif-

icant linear relationship between the OCP factorsof social responsibility (t(49) ¼ 2.30, p ¼ 0.03,b ¼ 0.85) and competitiveness (t(49) ¼ �2.21,p ¼ 0.03, b ¼ �0.082) and the number of prescrip-

tion adaptations written by the respondents. Noother significant relationships were observed.

Discussion

To begin to understand the cultural factorsand personality traits of pharmacists, a group of“innovator” and “early adopter” pharmacists

from Alberta, Canada who obtained their APAwere surveyed. The top reason identified byrespondents for obtaining their APA was to

improve patient care, and they were primarilycaring for patients with chronic conditions. Uponobtaining APA, most respondents began using itimmediately, and continued using it on a weekly

basis. These findings compare favorably toanother recently published study examining theearly uptake of prescribing by Alberta pharma-

cists, and demonstrate a greater application ofprescribing by pharmacists from this sample.11

Most respondents also felt that they had success-

fully integrated APA into practice; however,they also identified a number of important bar-riers that had yet to be fully addressed.

Fig. 1. Proportional representation of frequency counts for OCP factors.

8 Rosenthal et al. / Research in Social and Administrative Pharmacy j (2014) 1–11

One interpretation of findings from the OCPsuggests that the majority of innovator and earlyadopter pharmacist respondents perceived value in

being achievement oriented and emphasizing qual-ity (i.e., competitiveness), being reflective and hav-ing a good reputation (i.e., social responsibility),

being team-oriented and sharing informationfreely (i.e., supportiveness), having high expecta-tions for performance and enthusiasm for their job(i.e., performance oriented) and being stable and

calm (i.e., stability). An interpretation of the BFI

Fig. 2. Proportional representation of

findings suggests that the majority of innovatorand early adopter pharmacist respondents may bemore likely to exhibit behavior in line with being

energetic and enthusiastic (i.e., extraversion), beingaltruistic and cooperative (i.e., agreeable), being incontrol of impulses and facilitating goal-directed

behavior (i.e., conscientiousness), and being likelyto have wide, deep, and complex levels of experi-ence with the world (i.e., openness).

Inferential analyses suggested a possible rela-

tionship between how pharmacists use APA and

frequency counts for BFI traits.

9Rosenthal et al. / Research in Social and Administrative Pharmacy j (2014) 1–11

their responses to the OCP. This relationship couldbe interpreted as suggesting that respondents whoperceived greater value in being socially responsiblewere more likely to write prescription adaptations,

while those who perceived greater value in compet-itiveness were less likely to write prescriptionadaptations. These findings also suggest the possi-

bility of sub-group differences within the inno-vator/early adopter group studied as part of thiswork, which may have implications for the wider

adoption of APA by pharmacists in Alberta.26

However, given the small sample, no definitive con-clusions about this relationship can bedrawn at this

time and further research is warranted.While preliminary, the results of this work

suggest that in addition to facilitating legislativechange, policy makers and pharmacy associa-

tions should concurrently consider the influenceof pharmacy’s professional culture and the per-sonality traits of pharmacists on the adoption of

new practice opportunities such as APA. Return-ing to Rogers’ five adopter groups, these resultscould be used to inform the development of

programs designed to gain buy-in from otherearly adopter pharmacists who have yet to obtainAPA.19 For example, a technology-enabled

knowledge translation study, which capitalizeson the perception of value in competitiveness,may involve the development of an onlineresource whereon pharmacists with APA could

post patient care success stories.45 If all Albertapharmacists, including those without APA,were allowed access to this resource, its influence

on the rate of adoption of APA by pharmacistsmay be examined.

There are several important limitations that

must be considered with respect to these findings.First, the questionnaires used to explore theprofessional culture of pharmacy provide prede-termined cultural factors that were not developed

specifically for the pharmacy profession. As such,there may be other values of more importance topharmacists that are not represented. Second, as

outlined in the methods section, the populationfrom which this sample of pharmacists was drawnwas relatively small, and the response rate was

also low. This may mean that these results are notrepresentative of all pharmacists with APA inAlberta. Third, this survey was not pilot-tested,

and some of the survey sections have not beenused in pharmacist populations in the past. How-ever, this work does open an alternative approachto the study of uptake of new practice opportu-

nities by pharmacists.

Future research into the culture and person-ality of pharmacy should determine if the factorsand traits identified herein resonate with otherpharmacists with APA. Future work should also

be conducted to verify if innovators and earlyadopters differ from their early and late majorityor laggard colleagues. Replication of this survey

among pharmacists who do not have APA, orwho have obtained APA since the survey wasconducted will help establish whether significant

differences indeed exist. With a firmer grasp ofthe cultural factors and personality characteris-tics of the profession of pharmacy, the wider

context in which pharmacists complete theirwork will be better understood. This will allowfor the development of better-informed knowl-edge translation intervention studies, designed to

test a particular knowledge implementation plan.In so doing, a systematic and theory-drivenapproach to assisting pharmacy practice change

can be achieved.

Conclusion

Pharmacy practice change is an ongoing pro-

cess, and an improved understanding of the pro-fessional culture, and personality traits, ofinnovator and early adopter pharmacists offers

insight into the types of pharmacists who embracethis change in the form of prescribing. The cultureand personality characteristics identified herein

can be used to develop tailored interventions suchas technology-enabled knowledge translation pro-grams, with the goal of improving the uptake ofpharmacists’ expanded authority and, ultimately,

the care of patients.

Acknowledgments

We would like to thank the Alberta College ofPharmacists for their financial support of this

project. We would also like to acknowledge theassistance of Leslie Ainslie from the AlbertaCollege of Pharmacists for her assistance indistributing the survey to Alberta pharmacists.

Appendix A

Supplementary data

Supplementary data related to this articlecan be found at http://dx.doi.org/10.1016/j.sapharm.2014.09.004.

10 Rosenthal et al. / Research in Social and Administrative Pharmacy j (2014) 1–11

References

1. Rycroft-Malone J, Seers K, Titchen A, Harvey G,

Kitson A, McCormack B. What counts as evidence

in evidence-based practice? Nurs Health Care Manag

Policy 2004;47:81–90.

2. Upshur REG. Seven characteristics of medical evi-

dence. J Eval Clin Pract 2000;6:93–97.

3. Houle SKD, McAlister FA, Jackevicius CA,

Chuck AW, Tsuyuki RT. Does performance-based

remuneration for individual health care practitioners

affect patient care?Ann InternMed 2012;157:889–899.

4. Summary of Pharmacists’ Expanded Scope of Practice

Activities Across Canada [Webpage], 2014. [cited

2014 February 27]. Available from: http://blueprint

forpharmacy.ca/docs/resource-items/pharmacists’-

expanded-scope-of-practice_summary-chart–cpha–

january-2014-from-graphicsDF4DC970F6835A01BE

1C1989.pdf.

5. Victory – SB 493 Signed into Law California, 2013.

[cited 2014 February 26]. Available from: http://

www.cshp.org/post/victory-sb-493-signed-law.

6. Baqir W, Miller D, Richardson G. A brief history of

pharmacist prescribing in the UK. Eur J Hosp Pharm

2012;19:487–488.

7. Tonna AP, Stewart D, McCaig D. An international

overview of some pharmacist prescribing models. J

Malta Coll Pharm Pract 2008;(Summer):20–26.

8. Yuksel N, Eberhart G, Bungard T. Prescribing by

pharmacists in Alberta. Am J Health Syst Pharm

2008;65:2126–2132.

9. Pharmacist Prescribing FAQs, 2012. [cited 2014

January 5]. Available from: https://pharmacists.ab.ca/

nPharmacistResources/PharmacistPrescribing.aspx.

10. Standards of Practice, 2012. [cited 2014 March 5].

Available from: https://pharmacists.ab.ca/npharma-

cistResources/StandardsofPractice.aspx.

11. Guirguis L, Makowsky M, Hughes C, Sadowski C,

Schindel T, Yuksel N. How have pharmacists in

different practice settings integrated prescribing priv-

ileges into practice in Alberta? A qualitative explora-

tion. J Clin Pharm Ther 2014;39:390–398.

12. The Link 2013 [cited 2014 March 5]. Available from:

http://www.mailoutinteractive.com/Industry/Landing-

Page.aspx?id¼1426616&p¼1.

13. Pharmacists in Canada. 2011 – National and Jurisdic-

tional Highlights. Ottawa, ON: Canadian Institute

for Health Information; 2012.

14. Sarros J, Gray J, Densten I, Cooper B. The organiza-

tional culture profile revisited and revised: an Austra-

lian perspective. Aust J Manag 2005;30:159–182.

15. Wubben DP, Vivian EM. Effects of pharmacist

outpatient interventions on adults with diabetes mel-

litus: a systematic review. Pharmacotherapy 2008;28:

421–436.

16. Dole EJ, Murawski MM, Adolphe AB, Aragon FD,

Hochstadt B. Provision of pain management by a

pharmacist with prescribing authority. Am J Health

Syst Pharm 2007;64:85–89.

17. Latter S, BlenkinsoppA, Smith A, et al.Evaluation of

Nurse and Pharmacist Independent Prescribing.

Department of Health Policy Research Programme;

2010. Contract No.: 0160108.

18. Lounsbery J, Green C, Bennett M, Pedersen C. Eval-

uation of pharmacists’ barriers to the implementation

of medication therapy management services. J Am

Pharm Assoc 2009;49:51–58.

19. Rogers E.Diffusion of Innovations. 5th ed.NewYork:

Free Press; 2003.

20. Ford EW,MenachemiN, PhillipsMT. Predicting the

adoption of electronic health records by physicians:

when will health care be paperless? J AmMed Inform

2006;13:106–112.

21. Harris JM, Novalis-Marine C, Harris RB. Women

physicians are early adopters of on-line continuing

medical education. J Contin Educ Health Prof

2003;23.

22. Teufel RJ, Kazley AS, BascoWTJ. Early adopters of

computerized physician order entry in hospitals that

care for children: a picture of US health care shortly

after the institute of medicine reports on quality.Clin

Pediatr 2009;48:389–396.

23. Castle NG. Innovation in nursing homes which facil-

itates are the early adopters. Gerontologist 2001;41:

161–172.

24. Fitzgerald L, Ferlie E, Wood M, Hawkins C. Inter-

locking interactions, the diffusion of innovations in

health care. Hum Relat 2002;55:1429–1449.

25. Livigni R. Occupational subcultures in the work-

place. Clin Sociol 1994;12:290–291.

26. Martin J. Organizational Culture: Mapping the

Terrain. Thousand Oaks: Sage Publications; 2002.

27. Schein EH. Organizational Culture and Leadership.

3rd ed. San Francisco, CA: Jossey-Bass; 2004.

28. Boutin-Foster C, Foster J, Konopasek L. Physician,

know thyself: the professional culture of medicine as

a framework for teaching cultural competence. Acad

Med 2008;83:106–111.

29. Hopkins A, Solomon J, Abelson J. Shifting bound-

aries in professional care. J R Soc Med 1996;89:

364–371.

30. Carroll J, QuijadaM. Redirecting traditional profes-

sional values to support safety: changing organiza-

tional culture in healthcare. Qual Saf Health Care

2004;13:ii16–ii21.

31. Al Hamarneh Y, Rosenthal M, McElnay J,

Tsuyuki R. Pharmacists’ perceptions of their profes-

sional role: insights into hospital pharmacy culture.

Can J Hosp Pharm 2011;64:31–35.

32. Rosenthal M, Breault R, Austin Z, Tsuyuki R. Phar-

macists’ self perception of their professional role: in-

sights into community pharmacy culture. J Am

Pharm Assoc 2011;51:363–367.

33. Burke L, Davies K. Introducing the special edition

on occupational culture and skills in probation prac-

tice. Eur J Probat 2011;3:1–14.

34. Hansen CD, KahnweilerWM,Wilensky AS. Human

resource development as an occupational culture

11Rosenthal et al. / Research in Social and Administrative Pharmacy j (2014) 1–11

through organizational stories. Hum Resour Dev Q

1994;5:253–268.

35. Johnson SD, Koh HC, Killough LN. Organizational

and occupational culture and the perception of

managerial accounting terms: an exploratory study

using perceptual mapping techniques. Contemp

Manag Res 2009;5:317–342.

36. McCrae RR, Terracciano A. Personality profiles of

cultures: aggregate personality traits. J Pers Soc Psy-

chol 2005;89:407–425.

37. Hall J, Rosenthal M, Family H, Sutton J, Hall K,

Tsuyuki R. Personality traits of hospital pharma-

cists: toward a better understanding of factors influ-

encing pharmacy practice change. Can J Hosp

Pharm 2013;66:289–295.

38. Cable DM, Judge TA. Interviewers’ perceptions of

person – organization fit and organizational selection

decisions. J Appl Psychol 1997;82:546–561.

39. Vandenberghe C. Organizational culture, person-

culture fit, and turnover: a replication in the health-

care industry. J Organ Behav 1999;20:175–184.

40. JohnO,NaumannL,SotoC.ParadigmShift to the Inte-

grative Big Five Taxonomy: History, Measurement and

Conceptual Issues. New York: Guilford Press; 2008.

41. BarrickM,MountM, Gupta R.Meta-analysis of the

relationship between the Five Factor Model of per-

sonality and Holland’s occupational types. Pers Psy-

chol 2003;56:45–74.

42. Chong WW, Aslani P, Chen TF. Pharmacist-patient

communication on use of antidepressants: a simu-

lated patient study in community pharmacy. Res

Soc Adm Pharm 2012;10:419–437.

43. Hsieh H-F, Shannon SE. Three approaches to quali-

tative content analysis. Qual Health Res 2005;15:

1277–1288.

44. Field A.Discovering Statistics Using SPSS Statistics.

3rd ed. Thousand Oaks, California: Sage; 2009.

45. Scott R, MarsM, Hebert M. How global is ‘e-health’

and ‘knowledge translation’? In: Ho K, Jarvis-

Selinger S, Luauscher HN, Cordeiro J, Scott R,

eds. Technology Enabled Knowledge Translation for

ehealth. New York: Springer; 2012. p. 339–357.