Jeroen van de Pol

165 6 General discussion lack of opportunity can independently and through decreased motivation affect the provision of CPS. This finding implies that community pharmacists are motivated to focus on CPS when they are both capable enough (based on knowledge and skills) and are provided enough opportunity (adequate resources and societal expectations) to enhance motivation. Motivation, however, also includes habits and intrinsic factors. Growing accustomed to certain habits may hamper behavioral change, and intrinsic motivation [18] is important as it can determine an individual’s will to obtain new capabilities and create opportunities through behavior [14]. Mitigating potential barriers and simultaneously enhance facilitating factors is key. The COM-B model can, therefore, be seen as a suitable tool to work on step 5 of Kotters’ 8-step change model (enable action by removing barriers). Capability Community pharmacists’ capabilities affect the success of the transition to focusing on the provision CPS [17, 19]. However, in addition to the community pharmacist’s skills and knowledge (such as clinical reasoning and consulting techniques) [15-17], those of pharmacy technicians are important, especially in the Netherlands where pharmacy technicians fulfill an important role within community pharmacy practice. Organization of the community pharmacy and the dispensing process The dispensing of medicines is still considered a core function of community pharmacies by both patients and those pharmacists [16, 20-24]. For the majority of patients, filling a prescription is the primary reason to visit a community pharmacy [25, 26]. Therefore, community pharmacy teams (technicians and pharmacists) should professionally and efficiently organize the dispensing process, accompanied with appropriate counselling. This step is a starting point for future CPS [26]. Inefficient dispensing can even be regarded as a missed opportunity to convince patients of the added value of CPS. An efficient organization and dispensing process consists of several patient- centered aspects, such as adequate hours of operation, easy accessibility to the community pharmacy, short wait times, and availability of medicines [27-29]. The importance of these aspects was also discussed in chapter 5.1 as convenience (e.g., short wait times) was highly preferred by the general public. An efficiently organized community pharmacymost likely provides a basis to build on the pharmacist-patient relationship and, therefore, facilitates the community pharmacist’s provision of CPS [23, 26, 30-32].