Home' Australian Pharmacist : Australian Pharmacist July 2016 Contents Australian Pharmacist July 2016 I © Pharmaceutical Society of Australia Ltd.
Rural pharmacy brings, out of necessity, innovative changes to the way
pharmacy is practiced in Australia.
With the well‐established shortage
of healthcare practitioners in rural
and regional Australia, pharmacy
is increasingly being looked at by
governments and consumers to provide
increasingly complex and useful services
to help this vulnerable population.
The successful implementation of any
new or existing service relies on the trust
that develops between pharmacists, other
healthcare providers and importantly
the consumer. Roy Morgan polls since
1994 have consistently rated nursing as
the most ethical and honest profession,
followed closely by pharmacists and then
However, the true meaning of
these surveys is more complex. The nature
of these surveys, and the questions used,
equate it more with a satisfaction survey,
as these don’t explore the elements of
trust in detail.
While there are many theories and
models of trust, one that resonates well
with pharmacy is described by Ward.2
He suggests that trust is layered with
alternating levels of trust in the individual
and trust in the healthcare system
(Figure 1). It is likely that pharmacists
have a high level of individual trust
with consumers due to the low
confrontational nature of pharmacy and
ease of access to a pharmacist.
This is likely to be what is identified in the
general trust polls.
However, this surface level of trust
must be penetrated and the deeper
levels of trust in the newly defined
scopes of practice for pharmacy will be,
by necessity, explored by consumers.
The consumer will have a desire to
test their perceptions of trust in the
healthcare system and in particular,
where new forms of healthcare delivery
are not yet fully accepted by the
community. A sound understanding of
their trust perceptions could be useful in
overcoming their barriers to acceptance.
While trust has been explored in the
literature in other professions there is
surprisingly little specifically referring to
pharmacists. However, there are some
key characteristics that are common to all
professions (Table 1).
It has been observed over several
years that consumer trust of health
care providers is decreasing in society,
both in terms of the individual and
This shifting consumer
sentiment potentially has a significant
impact on the degree in which patients
accept risk in adopting new services.
Trust involves the consumer accepting
a degree of risk in the relationship
and requires them to make decisions
based on this relationship.
this risk and increasing trust is essential
in maintaining the good standing of
healthcare in situations where consumers
are uncertain and lack confidence in the
individual or system.
There is a distinction between two
commonly used terms; mistrust and
distrust. Understanding these may help
overcome some barriers to implementing
services. Distrust is a healthy concept
Trust in pharmacy
BY MARK KIRSCHBAUM MPS
and reflects a modern skepticism of the
system in which we operate.
are likely to experience distrust on their
first exposure to pharmacy innovations and
it provides an opportunity for pharmacy
to support a patient’s decision making
through establishing a rapport with the
individual and an understanding of the
Mistrust, on the other hand, is an unhealthy
cynicism of their healthcare system
and may require considerable effort to
re‐engage with this group.
express mistrust of a system have often
had a specific event or trigger that leads
them to this position. It is important to
note that when trust is violated, there is
often a disproportionate response by the
patient as they see this as a betrayal and a
moral and personal attack on themselves.
Pharmacy, and in particular rural pharmacy,
has developed dramatically over the years
with the introduction of vaccinations and
greater involvement in primary healthcare
as examples. The implementation of these
new innovative practices can be greatly
supported by understanding consumers’
acceptance of these services and building a
strong, trusting relationship.
1. Morgan gallup poll. Image of Professions Survey 2015;
[Accessed 29 May 16] At: www.roymorgan.com/findings/6188-
2. Ward P, Coates A. We shed tears, but there is no one there to
wipe them up for us: Narratives of (mis)trust in a materially
deprived community. Health. 2006;10(3):283–301.
3. McKnight DH, Chervany NL. What is trust? A conceptual
analysis and an interdisciplinary model. AMCIS 2000
4. Gidman W, Ward P, McGregor L. Understanding public trust in
services provided by community pharmacists relative to those
provided by general practitioners: a qualitative study. BMJ
Mark Kirschbaum BPharm GradDipClinPharm
MPharmSc MPS is Chair of the Rural Pharmacy
Support Network and a Lecturer in Pharmacy at the
University of Tasmania and University of New England.
» RURAL PHARMACY
Table 1. Characteristics of trust.3
Trust related characteristics
Competent, expert, dynamic
Good moral, good will,
benevolent, caring, responsive
Honest, creditable, reliable,
Open, careful, safe, shared
Figure 1. Layers of trust
Trust in the
Deep level trust
Surface level trust
Trust in individual
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