Effectiveness of a videoconference training course on implementing pharmacy services

A therapist-focused knowledge translation intervention for improving patient adherence in musculoskeletal physiotherapy practice

Background

Nonadherence to treatment remains high among patients with musculoskeletal conditions with negative impact on the treatment outcomes, use of personal and cost of care. An active knowledge translation (KT) strategy may be an effective strategy to support practice change. The purpose of this study was to deliver a brief, interactive, multifaceted and targeted KT program to improve physiotherapist knowledge and confidence in performing adherence enhancing activities related to risk, barriers, assessment and interventions.

Methods

We utilised a 2-phase approach in this KT project. Phase 1 involved the development of an adherence tool kit following a synthesis of the literature and an iterative process involving 47 end-users. Clinicians treating patients with musculoskeletal conditions were recruited from two Physiotherapy and Occupational therapy national conferences in Canada. The intervention, based on the acronym SIMPLE TIPS was tested on 51 physiotherapists in phase 2. A pre- and post-repeated measures design was used in Phase 2. Graham’s knowledge-to-action cycle was used as the conceptual framework. Participants completed a pre—intervention assessment, took part in a 1-h educational session and completed a post—intervention assessment. A questionnaire was used to measure knowledge of evidence—based treatment adherence barriers, interventions and measures and confidence to perform evidence—based adherence practice activities. Data was analysed using descriptive statistics (frequency and percentage), Fisher’s exact test and Wilcoxon Sign-Ranked tests.

Results

Barriers and facilitators of adherence were identified under three domains (therapist, patient, health system) in phase 1. Seventy percent of the participants completed the questionnaire. Results indicated that 46.8% of respondents explored barriers including the use of behaviour change strategies and 45.7% reported that they measured adherence but none reported the use of validated outcomes. A significant improvement in post-self-efficacy scores for the four adherence enhancing activities was observed immediately after the workshop.

Conclusion

The use of a multi-modal KT intervention is feasible in an educational setting. A brief interactive educational session was successfully implemented using a toolkit and caused a significant increase in physiotherapists’ knowledge and confidence at performing adherence enhancing activities in the very short-term. Further testing of SIMPLE TIPS on long-term adherence practices could help advance best practices specific to treatment adherence in MSK practice.

Electronic supplementary material

The online version of this article (doi:10.1186/s40945-016-0029-x) contains supplementary material, which is available to authorized users.

Exploring long term implementation of cognitive services in community pharmacies - a qualitative study

Implementing cognitive services in community pharmacies faces certain obstacles. One approach aimed at improving long-term implementation is to consider the implementation process as consisting of different stages, all of which require tailored initiatives. Taking this approach into account, there is a marked need for increased knowledge regarding the initiatives necessary to support especially the later phases of the implementation process.

Objective

The aim of this project was to develop insight into factors pertaining to the later phases of implementing cognitive services in community pharmacies.

Methods

A qualitative study was conducted, consisting of semi-structured interviews with 12 Danish pharmacy staff members, who were all in charge of improving the implementation of the Inhaler Technique Assessment Service (ITAS) in the 5 years following its introduction. The interviews were used to explore which implementation barriers had been identified by the staff and how they had sought to overcome them. The interviews were analyzed by combining content and critical common sense analysis with theoretical interpretations based on Rogers "Diffusion of innovation" theory.

Results

The most predominant long-term barrier was the staff members' adoption of the ITAS at very different rates. The problem of laggards was not lack of competencies, but a lack of self-efficacy in believing that their actual competencies were sufficient to provide the service. Lack of time and attention to the service and obtaining support from the more senior members of the pharmacy were also problematic. Both individual and group activities were launched to overcome the identified challenges belonging to different phases of the implementation process.

Conclusions

Those in charge of ensuring long term implementation of cognitive services in community pharmacies should consider the necessity to handle several simultaneous actions of both an individual and collective kind at the same time. Hence, the implementation process should be perceived as a series of interrelated stages rather than a linear process where one stage succeeds the other.

Practice change in community pharmacy: using change-management principles when implementing a pharmacy asthma management service in NSW, Australia

OBJECTIVE

This study aimed to investigate the application of a research-based change-management tool, the Pharmacy Change Readiness Wheel (PCRW), in practice, and the impact it had on the implementation of an asthma service (Pharmacy Asthma Management Service or PAMS).

METHODS

All pharmacists implementing the PAMS in the state of New South Wales, Australia, were provided training using a custom-designed module explaining change readiness as it applied to the PAMS. This training and a self-administered PCRW checklist were completed before PAMS implementation. Following PAMS service delivery, semi-structured phone interviews were conducted with the pharmacists and any additional staff involved regarding their experiences of change management. Interviews were transcribed verbatim and content analysed.

KEY FINDINGS

Thirty seven of the forty five pharmacies who delivered PAMS returned the PCRW checklist (82% response rate) and participants from 29 pharmacies were interviewed (29 pharmacists and six additional staff). Perception of readiness for change before service delivery was remarkably high. From the interviews conducted after service delivery it was evident that systematic management of the practice change using theoretical concepts had not really been undertaken and that many challenges were faced in the implementation of practice change (PAMS). The results of the content analysis from the interviews revealed that factors external or internal to the pharmacy or those related to the individual pharmacist could affect implementation of practice change.

CONCLUSION

Change is not as straightforward as it may appear and is a multi-step process over time. Pharmacists were unaware of this. A change-management framework should be applied to specific services with enough flexibility so that pharmacists can individualise them for their pharmacies.

Systematic review of knowledge translation strategies in the allied health professions

BACKGROUND

Knowledge translation (KT) aims to close the research-practice gap in order to realize and maximize the benefits of research within the practice setting. Previous studies have investigated KT strategies in nursing and medicine; however, the present study is the first systematic review of the effectiveness of a variety of KT interventions in five allied health disciplines: dietetics, occupational therapy, pharmacy, physiotherapy, and speech-language pathology.

METHODS

A health research librarian developed and implemented search strategies in eight electronic databases (MEDLINE, CINAHL, ERIC, PASCAL, EMBASE, IPA, Scopus, CENTRAL) using language (English) and date restrictions (1985 to March 2010). Other relevant sources were manually searched. Two reviewers independently screened the titles and abstracts, reviewed full-text articles, performed data extraction, and performed quality assessment. Within each profession, evidence tables were created, grouping and analyzing data by research design, KT strategy, targeted behaviour, and primary outcome. The published descriptions of the KT interventions were compared to the Workgroup for Intervention Development and Evaluation Research (WIDER) Recommendations to Improve the Reporting of the Content of Behaviour Change Interventions.

RESULTS

A total of 2,638 articles were located and the titles and abstracts were screened. Of those, 1,172 full-text articles were reviewed and subsequently 32 studies were included in the systematic review. A variety of single (n = 15) and multiple (n = 17) KT interventions were identified, with educational meetings being the predominant KT strategy (n = 11). The majority of primary outcomes were identified as professional/process outcomes (n = 25); however, patient outcomes (n = 4), economic outcomes (n = 2), and multiple primary outcomes (n = 1) were also represented. Generally, the studies were of low methodological quality. Outcome reporting bias was common and precluded clear determination of intervention effectiveness. In the majority of studies, the interventions demonstrated mixed effects on primary outcomes, and only four studies demonstrated statistically significant, positive effects on primary outcomes. None of the studies satisfied the four WIDER Recommendations.

CONCLUSIONS

Across five allied health professions, equivocal results, low methodological quality, and outcome reporting bias limited our ability to recommend one KT strategy over another. Further research employing the WIDER Recommendations is needed to inform the development and implementation of effective KT interventions in allied health.