Barriers and facilitators to pharmaceutical care in rural community practice

The overall goal of this study was to determine the influence of various perceived facilitators and barriers on the provision of pharmaceutical care in rural communities. Data collected from 162 pharmacy owner-managers in the 43 rural counties of West Virginia were used in the study. For study purposes, pharmaceutical care was measured as a function of four constructs: drug related problem identification and solving, patient communication, drug therapy monitoring, and obtaining and maintaining patient information. Based on past research, perceived barriers were measured by the following: lack of reimbursement, lack of time, lack of employer encouragement, and physician attitude; while perceived facilitators were measured by the following: pharmacists' attitude, pharmacists' confidence, consumer attitude, and lack of legal liability. Confirmatory factor analysis was performed using LISREL VIII to assess the influence of various study barriers and facilitators on the self-reported extent of provision of pharmaceutical care services. The barriers and facilitators together explain 61.2% of the variance in the provision of pharmaceutical care services. Goodness of fit statistics indicated a chi-square value of 52.51(P=0.30, df = 48) and an adjusted goodness of fit index of 0.95. Facilitators such as perceived patient attitude, pharmacists' positive attitude towards patient care, and pharmacists' confidence significantly influenced the provision of pharmaceutical care services. Barriers like lack of reimbursement, lack of time, and physician attitude towards the provision of pharmaceutical care did not significantly affect the provision of pharmaceutical care services.