While this is an important work, it does not fully explain the slow and incomplete transition towards patient-centred care. We wonder if pharmacists’ own mental barriers are a missing piece. In our comparison of two legislatively progressive jurisdictions, community pharmacists in Northern Ireland provided more patient-centred responses Ipilimumab in vitro than community pharmacists in Alberta (P = 0.013), although both described product-focused roles in 39–45% of their responses. The product focus of pharmacists was also borne out in the word-cloud analyses, with very little use of patient-care terminology to describe what a pharmacist does. To our knowledge this is the first study to use short telephone

interviews which elicit a ‘top of mind’ or automatic response to compare how community pharmacists from Alberta and Northern Ireland describe what a pharmacist does. This approach engages certain

unconscious mental processes which affect and influence the judgements, feelings and behaviours of the person.[35] In the literature it has been reported that individuals’ automatic response does not usually match their self-reported attitudes.[36] The slight deception and restriction of response were intended to remove some of the effects of social desirability bias.[37] We think that our findings are generalisable to pharmacy practice in Alberta and Northern Ireland because the key demographic features of our samples are similar to regional averages (Table 3). A potential limitation of the present study relates to the fact that pharmacists’ responses were restricted VE-822 manufacturer by the study question and our request for a brief response. If they had more time to think about their responses there is a chance that they would have been different. Nevertheless, the intention of using this methodology was to prevent pharmacists from thinking too much about their answer, thereby eliciting a ‘top of mind’ or automatic response and to avoid some of the effects of social desirability bias. Another potential limitation is the use of word clouding which represents a visualisation of Cell Penetrating Peptide the frequency

of the reported words. This method may not take into account the context in which the words were used. Also the use of open questions has the potential to introduce recall bias as this approach assumes that if a term was not reported then that term is not relevant. The higher degree of patient-centred responses provided by Northern Ireland pharmacists might be explained by the differences in contracts and payment schemes between Northern Ireland and Alberta. In Northern Ireland community pharmacists are paid for offering certain patient-centred services such as smoking cessation and minor ailments management,[33] while in Alberta (and Canada in general) the current model of reimbursement provides pharmacists with dispensing fees only (as in the traditional system of practice).