Martine Kruijtbosch

134 Chap t e r 3. 3 between a PE-MRP and the likelihood of the nine intended actions, only the intended action ‘I would likely import the medicine of which there is a shortage’ was positively associated with a dominant PE-MRP and only within the Parkinson’s disease scenario. This study clearly shows that the potential impact of a drug shortage on patient outcomes has the strongest association with a PE-MRP. Pharmacists confronted with the Contraceptive drug shortage, with a perceived medium impact on patient outcomes, were significantly less likely to have dominant PE-MRPs compared to pharmacists confronted with the Parkinson’s drug shortage, with a perceived high impact on patient outcomes. Being a managing pharmacist was negatively associated with a PE-MRP in situations of drug shortages. Managing pharmacists may have reasons to give higher priority to both rules and regulations and business orientation considerations. Dutch managing pharmacists may experience more conflicts of professional ethics with adherence to rules and regulations and the financial impact of solutions to drug shortages on the continuity of the pharmacy. Concerns regarding the financial aspects of pharmacy practice in relation to patient safety have been discussed in various studies. 4,13 Managing pharmacists may make some concessions regarding their PE-MRPs in the Contraceptive scenario. They might decide to offer an alternative contraceptive dependent on the ability of patients to pay for it rather than import it, whereby the pharmacy may have a financial loss. In the case of the Parkinson’s drug shortage, with a potential high impact on patient outcomes, financial concerns seem to become less important in the moral reasoning of managing pharmacists as well as locum pharmacists, as both would import the Parkinson’s disease medicine with no (financial) strings attached for the patient. The large number of contraceptive users in an average pharmacy in the Netherlands, compared to the much lower number of users of a Parkinson’s disease medicine, may play an important role in this difference (see Appendix B). In addition, pharmacists may take into account the frailty of patients with Parkinson’s disease. Concurrently, managing pharmacists probably have less patient contacts compared to locum pharmacists. 14 This may also explain managing pharmacists’ lower likelihood of a predominant PE-MRP, as patient orientation is not a major day-to-day aspect of the pharmacy work of a managing pharmacist. In this study, gender, age and working in a chain pharmacy were not significantly associated with a dominant PE-MRP. Although gender has sometimes been associated with moral development, there is no clear consensus that gender plays an important role. 15,16 This is confirmed by our study. Age differences may also reflect duration of practice. Viewed in that way, the result of the present study contrasts Latif’s study, which showed that greater years of pharmacists’ tenure was negatively associated with higher levels of moral reasoning. 17 Perhaps the reason for this is not the age difference but the fact that older pharmacists are