Martine Kruijtbosch

135 De t e rmi nan t s t ha t i n f l uence mo ra l r eason i ng pe r spec t i ves more often also managing pharmacists. In our study, increasing age showed a trend of a negative association with a dominant PE-MRP in a univariate model. In the multivariate model, this trend reversed, suggesting a confounding effect of job profile. We did not find an association between pharmacists working in a chain pharmacy and a PE- MRP (shown in both the crude as well as the adjusted odds ratios). The effects of working in a chain pharmacy may be complex. On the one hand, the pharmacist may not perceive any personal financial impact of solutions for drug shortages. On the other hand, pharmacy chain management may make different ethical decisions compared to the pharmacists they employ. More research is recommended here in order to gain in-depth insights into the motivation and MRPs of pharmacists employed by pharmacy chains. Strengths and limitations A strength of this study is that we used three scenarios that were very likely to be familiar to all respondents. 10 Moreover, because these scenarios were selected for their impact on patient outcomes, this study allowed for comparisons between their possible associations with dominant MRPs. However, more research is warranted with other drug shortage scenarios and practice scenarios other than drug shortages to be able to say something in general about the association between determinants and a dominant PE-MRP. Because the majority of the participating pharmacists had dominant PE-MRPs, the determinant analysis was only performed for pharmacists with that level of moral reasoning against the pharmacists not having dominant PE-MRPs in each drug shortage scenario. Therefore, we cannot say anything about the MRPs of the pharmacists which we classified as not having dominant PE-MRPs. CONCLUSION This study showed that a dominant PE-MRP is especially influenced by the potential impact of a drug shortage scenario on patient outcomes rather than by pharmacists’ characteristics. ACKNOWLEDGEMENTS We express our gratitude to all the pharmacists who participated in this study.