Jeroen van de Pol

169 6 General discussion Managerial organization Task differentiation in pharmacies can also benefit from local joint ownership of several community pharmacies. Joint ownership enables community pharmacists to share managerial tasks and to reshuffle tasks to allow the individual community pharmacist to focus on specific tasks (e.g., management, logistics, patient care). Community pharmacy chains support community pharmacists in a similar way, potentially enabling pharmacists employed by them to spend more time on CPS (e.g. by supporting the community pharmacist with managerial tasks regarding finances and logistics). However, larger pharmacy chains have a caveat because the introduction of multiple layers of management may reduce flexibility and the ability to innovate [53]. The added value to the quality of the pharmacotherapy of some tasks performed by community pharmacists is subject to discussion. The final prescription check, which is mandatorily performed by community pharmacists, originates from a time when prescriptions were handwritten and compounding - including complex calculations written on the prescription - was common. However, currently, most prescriptions are electronic and the dispensing process contains several in- process controls, such as barcode scanning, which effectively identify potential erroneous dispensing. In addition, pharmacy information systems increasingly contain sophisticated clinical risk management tools. These safeguards lead to community pharmacists rarely identifying erroneous dispensing with the final check [54], suggesting this time consuming activity may be superfluous. Therefore, this activity seems a candidate for de-implementation or at least adaptations to render it more efficient, such as risk prioritization of prescriptions (with only the medium-to-high-risk prescriptions requiring a final check). By limiting this activity to the medium-to-high-risk prescriptions, the low risk prescription (which account for the vast majority) no longer have to undergo final checking. This adjustment would better balance the amount of time being invested into this activity and the actual benefit it provides to the dispensing process as a whole. Reimbursement Lack of reimbursement is frequently mentioned as a major barrier for the implementation of CPS [15, 19, 45, 55-62]. Reimbursement is an opportunity to change behavior according to the COM-B model [14, 63, 64]. Therefore, altering the community pharmacy reimbursementmodel canbe expected tomotivate community pharmacists to focus more on the provision of CPS and less on the dispensing of medicines if reimbursement is more attractive for CPS than for dispensing.