Table 2 Selected quotes by thematic categories

Legitimization of Previous Practices:

Before we had prescribing, we did continuity as well. We just provided the medication and got the ok from the doctor the next day – kind of thing. It just changed the procedure; it hasn’t really changed what we do‘ (P14, male, rural independent community pharmacist).

Relative Advantage:

‘I’m traditionally a hospital pharmacist and I couldn’t be doing community if all of these changes hadn’t happened to access prescribing, additional, expanded scope of practice’ (R 31, female, owner community pharmacy, PCN pharmacist).

Nature of Knowledge Required:

‘I will give you a classic example. Friday night a young lady comes in looking for birth control; she was out of refills and has an appointment next month…. There are very few adverse effects or harm. There is potential for harm to come if you don’t give the medication. So you do the adaptation’ (R19, male, rural Community Pharmacist).

Liability:

‘There was far more risk under the old system because you were not legally allowed to do what you were doing most of the time’ (P19 male, rural community chain manager, No APA).

‘initial access prescribing, … That’s a road we’ve got to be really careful going down because it’s full of goblins. It’s full of risks, it’s full of potholes’ (P26, male, urban hospital pharmacist).

Workload and Trialability:

‘Well, it is an onerous process. It is not easy to do I am finding…. all of the steps and then my colleague sent in his application and got rejected so I am starting to think oh man, I have got to work hard at that’ (R14, male, owner rural community pharmacy).

Knowledge, Skills and Confidence:

‘I’m sure that a lot of the younger people should be doing this, if they’re not. And us old guys will kind of fade out anyway’ (P29, male, urban PCN pharmacist).

Beliefs and Emotions about Prescribing:

‘…feels, let’s see, I think it’s a little scarier. For me because patients expect more of you and they know your role is this and such and such, and I didn’t go to school learning that and I’ve been out for a while’ (P33, female, urban community chain pharmacist).

Motivation:

‘I’m not as gung ho as I probably should be and I guess it’s basically kinda almost fear’ (P11, female, urban community chain pharmacist).

‘I’m certainly not a pharmacist who will sit on a stool and work till midnight somewhere for extremely good money (laughter). I’d rather put all my money on the line and make a difference’ (P13, APA, male, rural independent pharmacy owner).

Beliefs about Patient Responsibility:

‘But I guess we have to teach people what the importance is of, the doctor prescribed them a year’s worth, it now says zero, I think they want to see you again’ (P30, male, rural community independent pharmacist).

Innovation-system fit:

‘It is too – it’s a grocery store. It needs to be in a clinical setting….’ (P10, female, urban community chain pharmacist).

‘I just think of how just our practice environment currently is set up. Just time

challenges, also just shortages of pharmacists as well, and also more training up of technicians as well, to take on more responsibility. Also, just acceptance by other health care professionals. Patients – educating them as well. So I think there will be challenges but it will be a really great opportunity too’ (P 37, female, urban community chain pharmacist).

‘And then of course now, they are saying “why are you not prescribing?” and I say when you are truly in a collaborative practice like I am, we discuss prescriptions, there is a conversation back and forth between the nurse practitioner/doctor/doctors and it becomes irrelevant who puts it into the electronic health record generates it and signs it’ (P20, female, urban primary care consultant).

‘For a primary care network pharmacist it just makes sense and it fits into our practice. I can see some of the concerns from both sides from the community pharmacists and their sort of … feeling like they are on an island and they don’t have enough information to make this decisions to prescribe’ (P12, female, urban PCN manager).

‘You can spend more time with the patient and make the best decision for them [in the PCN]. Whereas the community is a very face paced setting. Most patients don’t have an extra 10 minutes to sit down with you because they’re on their way home from grocery shopping and have to rush to pick up their kid from soccer, that type of thing. Whereas, in the primary care network, you’re sitting in an office and they’ve committed that time to you. It’s important. The patient sees it as important. And I don’t know, it could still work in the community, but I think it would be more difficult’ (P27, male, urban PCN, chain community pharmacist).

Support:

‘And they actually made me a prescription pad, that’s kind of cool (laughter)’ Pharmacist 34 (APA, female, urban PCN practice).

Relationship with Physicians:

‘Contact the doctor first and see if we can get [a refill]’ (P37, female, urban community chain pharmacist); and prescribe ‘as a last resort if the physician was not available’ (P24, male, urban PCN, community pharmacy).

‘I feel the independence and the freedom is second to none and I am not at the mercy of a physician that I can rarely get in touch with and have to chase down and stuff. It’s – if I know what they need and I am confident and sure and they are willing to let me help them, that I can do it and I don’t need to rely on someone else to do it’ (R4, Community, urban LTC care pharmacist, APA).

‘I have had one doctor – not a local doctor– who told his patient that if she ever had a pharmacist extend her prescription again that she would not be his patient anymore, but I haven’t…other than that, I haven’t had any real negative reactions’ (P14, male, rural independent community pharmacist).

Formal dissemination:

‘I would think just the constant reminders from the college about “hey, don’t forget, you guys can do this and just make sure you are embracing that”’ (P24, male, urban PCN pharmacist).

Informal diffusion: n/a

‘…without the funding it’s not something we’ve done a whole lot with’ (R9, APA, female, rural Community/PCN pharmacist).