Jeroen van de Pol

75 How community pharmacists prioritize cognitive pharmaceutical services 3 Regarding pharmacy management, participating pharmacists state that some of these activities can be easily delegated to supporting staff members. This is consistent with an earlier study in which pharmacists prefer to spend less time on management than the actual time they are spending on this type of activity [11]. Due to the perceived unimportance of PM and logistics by community pharmacists, it is important to investigate ways to delegate these activities. One example could be to delegate some managerial activities to a pharmacy technician or a store manager. This would save time for the community pharmacist which could be spent on CPS that is ranked important [13]. The three groups differ in their prioritization of quality assurance (QA). Differences between group 1 and 3 regarding QA mostly come from the final checking of prescriptions (activity 47) and checking the clinical risk management alerts (activity 48). Some pharmacists in group 1 stated that they experience these activities as time consuming without having a clear added benefit and lacks visibility to both patients and other healthcare professionals. A possible welcome development for group 1 would be to delegate these activities (to a certain degree) to pharmacy technicians [29]. On the other hand, pharmacists belonging to group 3 state that they consider that these activities need to be performed by pharmacists to ensure the safe use of drugs. The characteristics of pharmacists belonging to one of the three different groups (see also supplementary material table 1) are slightly different. Group 2 has a higher proportion of male participants in comparison to group 1 and 3 and also consists of more pharmacy owners. Pharmacists in group 2 are also slightly older than participants in group 1 and 3. This suggests that older, male pharmacists that own a community pharmacy regard logistics and QA as relatively more important. Surprisingly even these pharmacists, who more frequently own a pharmacy do not give high priority to pharmacy management. Strengths and limitations The first strength of this study is the use of Q-methodology, which forced participants to prioritize activities. Therefore Q-methodology may generate more valuable information compared to the Likert-scale questionnaires that are generally used for this type of study. Second, community pharmacists were able to participate online anonymously. This lowers the threshold to participate and therefore enhances the response rate [30]. Third, a comparison with previously reported characteristics of community pharmacists in The Netherlands suggests that the group of participating pharmacists in this study resemble the Dutch population of community pharmacists [26]. Still, we cannot exclude that a certain