Jeroen van de Pol

160 Chapter 6 Within the general discussion, we first address the different methodological approaches used in this thesis. Next, we present the results and review these findings in a broader perspective. Results found within this thesis The provision of CPS by community pharmacist can have a positive impact on the outcomes of drug treatment, both on the individual patient level and on a societal level [4-12]. Furthermore, CPSmay support general practitioners (GPs) who are increasingly expected to provide care that was previously delivered within the secondary care system. However, when community pharmacists are expected to devotemore time to the provision of CPS, they also need to gain time by de-implementing other activities. This balance requires changes within and outside the profession. Kotters’ 8-step change model [13] was introduced in the general introduction of this thesis. The first steps of Kotters’ model, (1) creating a sense of urgency, (2) building a guiding coalition, (3) forming a strategic vision and initiatives, (4) enlisting a volunteer army and, to some degree, (5) enabling action by removing barriers, have been made within the community pharmacy profession. The community pharmacy profession is currently on the fifth step of Kotters’ model. Barriers are being identified and facilitators are in the transitional process of focusing more on CPS provision. Understanding these barriers and facilitators is the first step to overcome the barriers and enhance the facilitating factors. This thesis collected insight into time-utilization and task-prioritization by community pharmacists, preferences of the general public and patients regarding potential services of community pharmacists and added value on a societal level based of the pharmacist-led clinical medication review (CMR). Chapter 2.1 and 2.2 describe community pharmacists’ time-utilization by means of self-reported work sampling, using a smartphone application to register daily activities in the pharmacy. Chapter 2.1 reports that community pharmacists spend 52%of their timeonprofessional activities, suchas thefinal checkingof prescriptions, clinical risk management, and CPS, with the remainder mostly spent on semi- professional activities that could be delegated to other pharmacy staff members, such as logistics and the dispensing process. They spent a limited amount of time on CPS, such as clinical medication reviews and patient counseling after hospital discharge. Chapter 2.2 presents associations between background characteristics of community pharmacists and time-utilization. We demonstrate that community pharmacists who are able to spend more time on CPS predominantly spend less time on managerial activities and tend to be more active as locum pharmacists.