Policy solutions to address community pharmacy working conditions.

Objective: Increasing attention has been drawn to poor working conditions in community pharmacy, the impact on patient safety, and the role of pharmacy benefit managers (PBMs) in the United States. This study assessed community pharmacists' perceptions of potential solutions to improve working conditions.

Methods: This mixed-methods, survey-based study explored pharmacists' proposed solutions for improving working conditions. The participants' perceptions of solutions at the company and state or national levels were assessed using a 7-point Likert-type response format (from 1 = strongly disagree to 7 = strongly agree). Multiple regression assessed the relationships between participant perceptions and pharmacy type (e.g., national chain, grocery, or independent), pharmacy degree, age, average number of prescriptions processed daily (prescription volume), and years of experience. The participants' perceptions of how to improve working conditions were explored to provide more depth and nuance to the understanding of these issues.

Results: The sample size was 1222 participants. Respondents working for national chains were statistically significant more in favor of limiting the number of prescriptions verified per pharmacist and less in favor of addressing reimbursement issues than those working for grocery or big-box stores (P = 0.001 and P = 0.006, respectively) and independent pharmacies (P < 0.001 and P < 0.001, respectively), when controlling for years of experience, degree, and prescription volume. Although addressing staffing issues and changing corporate priorities were immediate concerns, the participants felt that regulating PBM reimbursement practices should be the first priority.

Conclusion: Identifying solutions from employee stakeholders may be an effective way to inform actions that both employers and extraorganizational entities can take to improve pharmacist working conditions and patient care. Restricting PBMs was the most preferred solution, followed by direct and indirect reimbursement for nondispensing services. However, working conditions in community pharmacy are influenced by multiple factors that often are dependent on one another. Thus, a multifaceted approach will likely be required to improve working conditions.