Changes in Pharmacists’ Perceptions of their Roles During Pharmacy Policy Reforms: A Comparative Repeated-Cross-Sectional Study of Patients and Pharmacists

Technical Summary: Changes in Pharmacists' Perceptions of their Roles During Pharmacy Policy Reforms

Problem Statement
Despite the expansion of pharmacists' professional roles globally and specifically within Japan's rapidly aging society, empirical research regarding how these role changes are perceived by both pharmacists and patients remains limited. Role theory suggests that discrepancies between expected and actual roles, or divergent perceptions among stakeholders, can lead to service inefficiencies. While Japan has implemented significant pharmacy policy reforms—driven by amendments to the Pharmacists Act and revisions to the reimbursement system—to promote patient-centered, community-based care, it is unclear whether these institutional changes have successfully aligned the role perceptions of pharmacists and patients over time. Previous studies have noted persistent gaps in role perception, but few have examined the evolution of these gaps against the backdrop of specific policy reforms in a super-aging society.

Methodology
This study employed a repeated cross-sectional design to analyze changes in role perceptions across three distinct time points: 2014 (prior to a major 2014 legal amendment), 2017 (three years post-amendment), and 2023 (three years post-2019 regulatory changes). Data were pooled from nationwide online surveys involving community pharmacy patients (N ≈ 1,000 per wave) and pharmacists (N ≈ 800–900 per wave). The final analyzed dataset comprised 2,639 valid responses (583 patients and 366 pharmacists in 2023; historical data from 2014 and 2017 were integrated).

The study utilized a 12-item questionnaire based on role theory, rated on a 5-point Likert scale. Confirmatory Factor Analysis (CFA) validated a three-factor structure across all groups and years:

• F1 (Communication): Approachability, clarity of explanation, and responsiveness.
• F2 (Assessment of Patient's Condition): Monitoring medication effects and health status changes.
• F3 (Identity): Perceptions of pharmacists as medication experts relative to physicians.

Statistical analysis involved a two-way Analysis of Covariance (ANCOVA) with survey year and group (patient vs. pharmacist) as independent variables, and age and sex as covariates. Post-hoc pairwise comparisons with Bonferroni correction were conducted to examine temporal changes within groups.

Key Results

1. Baseline Discrepancy: Pharmacists consistently reported significantly higher role perception scores than patients across all three factors (F1, F2, and F3) and all time points.
2. Temporal Trends:
   • Pharmacists: Scores remained consistently high and stable across all three factors from 2014 to 2023, indicating a pre-existing strong professional self-identity that was not significantly altered by the reforms.
   • Patients: Scores showed a significant upward trend, particularly between 2014 and 2023.
3. Factor-Specific Convergence:
   • F1 (Communication) and F2 (Assessment): Significant Year × Group interactions were observed. Patient scores for F1 and F2 increased significantly (e.g., F2 rose from 2.95 in 2014 to 3.31 in 2023), while pharmacist scores remained stable. This resulted in a statistically significant narrowing of the perception gap between the two groups, especially for F2.
   • F3 (Identity): While a significant interaction was detected in the ANCOVA, post-hoc pairwise comparisons revealed no statistically significant differences between specific years for either group. Patient scores showed a slight upward trend, but the gap regarding professional identity (relative to physicians) did not close significantly.
4. Covariates: Age and sex did not have significant effects on the factor scores.

Key Contributions

• Empirical Evidence of Policy Impact: The study provides longitudinal evidence that pharmacy policy reforms in Japan have successfully influenced patient perceptions of specific behavioral roles (communication and condition assessment), aligning them more closely with the pharmacists' own professional self-perception.
• Differentiation of Role Dimensions: The research distinguishes between behavior-based role perceptions (F1 and F2), which are sensitive to regulatory and service delivery changes, and abstract identity-based perceptions (F3), which appear resistant to short-to-medium term policy shifts.
• Methodological Rigor: By utilizing a repeated cross-sectional design with large, representative samples and validating a consistent factor structure across time, the study offers a robust framework for tracking role perception evolution in healthcare systems.

Significance and Claims
The authors claim that their findings offer critical insights for future institutional design and professional education. The convergence of perceptions in behavioral areas suggests that policy-driven changes in service delivery (such as mandatory counseling and adherence monitoring) are becoming visible and recognized by patients. This alignment is crucial for ensuring that patients' healthcare needs match the services provided, potentially enhancing the effectiveness of care delivery.

However, the paper modestly notes that the lack of significant change in F3 (Identity) indicates that policy reforms alone are insufficient to transform patients' broader cognitive structures regarding the professional status of pharmacists relative to physicians. The authors conclude that achieving full alignment between healthcare needs and professional services will require long-term initiatives, including patient education and broader social perception shaping, in addition to institutional interventions. The study explicitly avoids claiming causal relationships due to its cross-sectional nature, framing the results as population-level trends reflecting the impact of successive policy reforms.