Martine Kruijtbosch

208 Append i ces In Chapter 3.1 the Dutch-translated version of the PEP test, the PEP-NL test, was completed by 376 early career pharmacists working in a community pharmacy. The results showed the same three MRPs for Dutch pharmacists’ moral reasoning as for Australian pharmacists. However, Dutch pharmacists’ professional ethics MRP was expressed in different statements than the Australian pharmacists’ professional ethics MRP. We perceived these differences to be possibly rooted in the country-specific professional ethical guidance. We concluded that the Australian PEP test can be used for pharmacists in the Netherlands when the test is appropriately adjusted to the Dutch pharmacy practice context and professional language. Moreover, the statements that represent the professional ethics MRP should be adjusted to reflect the professional ethics that guide community pharmacists in the Netherlands. In Chapter 3.2 we adjusted the PEP-NL test (Chapter 3.1) to the context of three drug shortage dilemma scenarios. We explored from which MRPs Dutch pharmacists reason in their decision-making process in these drug shortage scenarios. The scenarios concerned an osteoporosis medicine shortage, a contraceptive shortage and a Parkinson’s medicine shortage. These three scenarios were deliberately chosen for their various perceived levels of impact on patient outcomes (i.e. a low, medium and high impact respectively). The adjusted PEP- NL test was completed by 267 community pharmacists. The three MRPs were significantly present in the community pharmacists’ moral reasoning. We found that the pharmacists handled the three shortages in similar ways. However, pharmacists would be more likely to import the medicine in the case of a contraceptive and Parkinson’s medicine shortage than for an osteoporosis medicine shortage. Further, pharmacists’ intended handling of the three drug shortages was predominantly influenced by professional ethics MRP statements. When the drug shortage was perceived to have a lower impact on patient outcomes (i.e. in the contraceptive and osteoporosis medicine shortages) and alternative drugs or therapy were expensive (i.e. in the osteoporosis medicine shortage) community pharmacists were more influenced by business orientation MRP statements. We concluded that in such drug shortage situations pharmacists' professional ethics MRP can be compromised. In Chapter 3.3 we made use of the same dataset of 267 community pharmacists as in Chapter 3.2. We aimed to find groups of pharmacists with a dominant MRP and detect determinants (i.e. characteristics of pharmacists or the different drug shortage scenarios) that may be associated with such dominant MRPs. The determinants analysed were gender, age, type of pharmacy, job profile, and the type of drug shortage scenario (three different levels of impact on patient outcomes). We found that pharmacists who have the job profile of a ‘managing pharmacist’ or who are confronted with a shortage with a lower impact on patient outcomes (i.e. the contraceptive drug shortage) have a significantly lower likelihood to reason with a dominant professional ethics MRP. This likelihood was in the latter case the lowest.