Relationship between assertiveness in community pharmacists and pharmacist-initiated prescription changes

Res Social Adm Pharm. 2023 Oct;19(10):1380-1385. doi: 10.1016/j.sapharm.2023.06.006. Epub 2023 Jun 30.


Background: Despite the usefulness of assertiveness by healthcare professionals in improving patient safety, few studies have evaluated the assertiveness of community pharmacists. Community pharmacists' assertiveness might be associated with pharmacist-initiated prescribing changes to improve medication safety.

Objectives: Our objective was to examine which types of assertiveness-related self-expression are associated with community pharmacist-initiated prescribing changes while adjusting for possible confounding factors.

Methods: We conducted a cross-sectional survey in Japan between May and October 2022 in 10 prefectures. Community pharmacists belonging to a large pharmacy chain were recruited. The outcome variable was the frequency of community pharmacist-initiated prescription changes over 1 month. Community pharmacists' assertiveness was assessed using the Interprofessional Assertiveness Scale (IAS) and 3 sub-domains (nonassertive, assertive, and aggressive self-expression). Participants were classified into 1 of 2 categories based on medians. Demographic and clinical characteristics were compared by group with univariate analysis. A generalized linear model (GLM) was used to investigate the association between pharmacist-initiated prescription changes as an ordinal variable and pharmacists' assertiveness.

Results: Of 3346 community pharmacists invited, 963 were included in the analysis. Participants with high assertive self-expression scores had a significantly higher frequency of pharmacist-initiated prescription changes. There was no association between nonassertive or aggressive self-expression and pharmacist-initiated prescription changes. After adjustments, high assertive self-expression remained associated with a high frequency of community pharmacist-initiated prescription changes (odds ratio, 1.34; 95% confidence interval, 1.02-1.74; p = 0.032).

Conclusions: Higher assertive self-expression among community pharmacists is associated with higher frequency of pharmacist-initiated prescription changes.

Keywords: Assertiveness; Collaboration; Community pharmacist; Interprofessional; Medication safety; Prescription change.

MeSH terms

  • Assertiveness
  • Community Pharmacy Services*
  • Cross-Sectional Studies
  • Humans
  • Japan
  • Pharmacists*
  • Prescriptions