Jeroen van de Pol

36 Chapter 2.1 This study shows that work sampling can be done in an efficient and user-friendly way by using smartphone technology. This technology makes it possible to include large groups of participants so as to generate more data and to repeat studies. Moreover, using self-reporting limits the “Hawthorne” effect compared to direct observation [32]. Another advantage is that pharmacists have a better insight into their activities than trained observer [33]. However, there are drawbacks to self-reported data. Participants may provide socially desirable answers and they may classify activities differently. The participants were provided with feedback on their time registration and included a benchmark, so as to discourage socially desirable responses. In the pilot stage of this study, it was found that the impact of misclassification was limited, perhaps because the smartphone application provided a brief explanation of what each activity entailed. This helped participants to choose the category that fitted best to their activity. The use of a smartphone application meant that participants had to keep their smartphone with them at all times, which might not always be possible or desirable in daily clinical practice. Therefore, some activities were registered with a delay after the original alert, which could introduce recall bias and more socially desirable answers. Sensitivity analysis, however, showed no major differences between responses given within an hour after the alert versus responses given more than an hour after the alert. However, there was a significant difference between participants responding on average within an hour to alerts and those who responded later. This is probably because some activities (e.g. counselling patients) are not easily interrupted and so they are registered later. A potential study limitation is recruitment bias. Community pharmacists with efficient coordinated work streams might have been over-represented, because they had more time to participate in research. However, the invitation letter encouraged pharmacists to participate in the study as it would give insight into own activities and would provide a benchmark. This might have stimulated pharmacists who are struggling with inefficient work streams to participate. Some participants actually reported that the study helped them gain insight into their own time utilization. Conclusion Community pharmacists spend half of their time on professional activities, mainly CPS, dispensing tasks, and the final prescription check. This study suggests that various aspects of the current situation are barriers to the optimal utilization of the community pharmacy workforce.