1
|
Ulutas Deniz E, Ceylan C, Eren R, Memiş OB. Advancing empathy and emotional intelligence among pharmacy students: A comparative mixed-methods study with peer role-play simulation intervention. CURRENTS IN PHARMACY TEACHING & LEARNING 2024; 16:102112. [PMID: 38795610 DOI: 10.1016/j.cptl.2024.102112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 05/28/2024]
Abstract
INTRODUCTION Due to the significance of interpersonal empathy and emotional intelligence in pharmaceutical practices, it has become essential to emphasize its importance in pharmacy education. The aim of this study is to provide pharmacy students, who require proper communication skills throughout their professional careers, with a simulation-based intervention focusing on empathy and emotional intelligence, and to evaluate the influence of this educational intervention on emotional intelligence and empathy levels. METHODS The methodological approach adopted in this study aims to integrate both qualitative and quantitative data for a comprehensive analysis, that is, the mixed method, and to provide in-depth answers to the research questions. RESULTS There was a difference observed in the change in empathy and emotional intelligence scores between the control and intervention groups. When the pre-test and mid-test results with the intervention group were analyzed, there was a difference in the values for emotional intelligence when only education was offered. Conversely, no difference was found in empathy scores under the same conditions. In the intervention group, after the implementation of both training and simulation practice resulted in a difference in the scores for emotional intelligence and empathy when comparing the results before and after the test. Gender and the interaction between gender and group had small effect sizes on both empathy and emotional intelligence. The comprehensive data collected from these interviews enabled a rigorous thematic analysis, culminating in the identification of three primary themes accompanied by respective categories: the contribution of theoretical education to simulation, perceptions of simulation practice, the significance of debriefing sessions. Students highlighted the development of various communication skills, such as improving patient-provider relationships, conveying empathy to patients, being aware of and managing their emotions, and building self-confidence through simulated encounters and debriefing sessions. CONCLUSION Based on these findings, it is recommended that simulation methods be made mandatory in pharmacy school curricula and be disseminated nationwide.
Collapse
Affiliation(s)
- Elif Ulutas Deniz
- Department of Pharmacy Management, Faculty of Pharmacy, Atatürk University, 25240 Yakutiye-Erzurum, Türkiye.
| | - Ceren Ceylan
- Faculty of Pharmacy, Atatürk University, Türkiye
| | - Rumeysa Eren
- Department of Pharmacy Management, Faculty of Pharmacy, Atatürk University, Türkiye
| | - Olcay Besnili Memiş
- Department of Labor Economics and Industrial Relations, Faculty of Economics and Administrative Sciences, Atatürk University, Türkiye.
| |
Collapse
|
2
|
Michel DE, Tonna AP, Dartsch DC, Weidmann AE. Implementation of medication reviews in community pharmacy: reaching consensus on stakeholders' recommendations for mechanisms of change using the nominal group technique. Int J Clin Pharm 2024; 46:714-726. [PMID: 38489050 PMCID: PMC11133082 DOI: 10.1007/s11096-024-01708-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/24/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Since 2022, patients with five or more medicines are eligible for a medication review (MR) in a community pharmacy remunerated by the German health system. However, implementation has been slow, with few pharmacies providing MRs. Stakeholders' input is necessary to detail how implementation strategies can be executed effectively on a national level. Prior research identified "external facilitation" and "altering incentives" as crucial strategies to achieve implementation outcomes. AIM To gather stakeholders' recommendations for, and obtain consensus on, mechanisms of change that allow implementation strategies to work in practice. METHOD The consensus method used was the nominal group technique (NGT) with NGT-discussions held separately with pharmacy owners and pharmacy chambers employees. Votes were summed and the relative importance (rI) calculated, defined as (score achieved for a mechanism)/(maximum possible score) × 100. Content analysis provided context for the highest ranked mechanisms and allowed linking to implementation outcomes. RESULTS Four NGT-discussions were held in 2023 (n = 2 owners; n = 2 chamber employees) with a total of 17 participants. The overall highest ranked mechanisms were fit-for-purpose software (rI = 154.7) detailed process support (rI = 104.9) and an expert support line (rI = 77.7). These together with financial viability (rI = 40.0) were prioritised by both participant groups. Three mechanisms were favoured for both implementation strategies, namely software, process support and materials (rI = 34.3). CONCLUSION This study identified stakeholders' priorities for mechanisms of change to implement MRs in community pharmacies. Focusing efforts on the prioritised mechanisms is likely to significantly advance a national implementation plan for countries which are at an early implementation stage.
Collapse
Affiliation(s)
- Dorothee E Michel
- School of Pharmacy and Life Sciences, Robert Gordon University, Garthdee Road, Aberdeen, AB10 7GJ, Scotland
| | - Antonella P Tonna
- School of Pharmacy and Life Sciences, Robert Gordon University, Garthdee Road, Aberdeen, AB10 7GJ, Scotland
| | | | - Anita E Weidmann
- Department of Clinical Pharmacy, Innsbruck University, Innrain 80, 6020, Innsbruck, Austria.
| |
Collapse
|
3
|
Solh Dost L, Gastaldi G, Schneider MP. Patient medication management, understanding and adherence during the transition from hospital to outpatient care - a qualitative longitudinal study in polymorbid patients with type 2 diabetes. BMC Health Serv Res 2024; 24:620. [PMID: 38741070 DOI: 10.1186/s12913-024-10784-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 02/26/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Continuity of care is under great pressure during the transition from hospital to outpatient care. Medication changes during hospitalization may be poorly communicated and understood, compromising patient safety during the transition from hospital to home. The main aims of this study were to investigate the perspectives of patients with type 2 diabetes and multimorbidities on their medications from hospital discharge to outpatient care, and their healthcare journey through the outpatient healthcare system. In this article, we present the results focusing on patients' perspectives of their medications from hospital to two months after discharge. METHODS Patients with type 2 diabetes, with at least two comorbidities and who returned home after discharge, were recruited during their hospitalization. A descriptive qualitative longitudinal research approach was adopted, with four in-depth semi-structured interviews per participant over a period of two months after discharge. Interviews were based on semi-structured guides, transcribed verbatim, and a thematic analysis was conducted. RESULTS Twenty-one participants were included from October 2020 to July 2021. Seventy-five interviews were conducted. Three main themes were identified: (A) Medication management, (B) Medication understanding, and (C) Medication adherence, during three periods: (1) Hospitalization, (2) Care transition, and (3) Outpatient care. Participants had varying levels of need for medication information and involvement in medication management during hospitalization and in outpatient care. The transition from hospital to autonomous medication management was difficult for most participants, who quickly returned to their routines with some participants experiencing difficulties in medication adherence. CONCLUSIONS The transition from hospital to outpatient care is a challenging process during which discharged patients are vulnerable and are willing to take steps to better manage, understand, and adhere to their medications. The resulting tension between patients' difficulties with their medications and lack of standardized healthcare support calls for interprofessional guidelines to better address patients' needs, increase their safety, and standardize physicians', pharmacists', and nurses' roles and responsibilities.
Collapse
Affiliation(s)
- Léa Solh Dost
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland.
| | - Giacomo Gastaldi
- Division of Endocrinology, Diabetes, Hypertension and Nutrition, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Marie P Schneider
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland.
| |
Collapse
|
4
|
Senćanski D, Marinković V, Tadić I. A cross-sectional study comparing emotional intelligence and perceived stress amongst community pharmacists delivering and not delivering a new service. Int J Clin Pharm 2023; 45:1136-1143. [PMID: 36773208 PMCID: PMC9918812 DOI: 10.1007/s11096-023-01542-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/11/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Community pharmacists contribute substantially to public health and person-centred care. Emotional intelligence (EI) may help health professionals better engage with patients, handle stress in challenging situations and, presumably, better introduce and implement new services. AIM The study's aims were to compare the EI and perceived stress (PS) levels of community pharmacists who provided a new service to patients with diabetes with their controls who provided standard pharmaceutical services and to test the correlations between the two constructs. METHOD This study used a survey methodology. Well-validated instruments were distributed electronically to all participating pharmacists. To compare the continuous EI and PS data between the two study groups, the paired-samples t test was used. Pearson and Spearman's correlations were used to test the associations between EI and PS and their respective subdomains. RESULTS A total of 86 pharmacists participated in the study (n = 43 in each group). The study groups did not differ by any characteristic except gender. Their mean EI and PS levels were 120.95 ± 11.53 and 17.45 ± 4.55, respectively, with no difference between the groups. In both study groups, inverse correlations were found between PS and EI levels, with statistical significance in the control group and in the overall study population (r = - 0.611 and r = - 0.370, respectively). CONCLUSION Our results suggest that the introduction of the EI agenda into certification programmes for new community pharmacy services should be considered. The results also suggest that higher EI may have protective effects against PS. Additional research would clarify the need to invest more in such programmes.
Collapse
Affiliation(s)
- Dejan Senćanski
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450, 11000, Belgrade, Serbia.
| | - Valentina Marinković
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450, 11000, Belgrade, Serbia
| | - Ivana Tadić
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450, 11000, Belgrade, Serbia
| |
Collapse
|
5
|
Sanders KA, Wolverton D, Stamopoulos M, Zunich R, Niznik J, Ferreri SP. An EHR-based method to structure, standardize, and automate clinical documentation tasks for pharmacists to generate extractable outcomes. JAMIA Open 2023; 6:ooad034. [PMID: 37181730 PMCID: PMC10174697 DOI: 10.1093/jamiaopen/ooad034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/27/2023] [Accepted: 05/05/2023] [Indexed: 05/16/2023] Open
Abstract
As the recognition of team-based care grows and pharmacists increase in patient care interventions, it is important that tools to track clinical services are easily accessible and well-integrated into workflow for all providers. We describe and discuss feasibility and implementation of data tools in an electronic health record to evaluate a pragmatic clinical pharmacy intervention focused on deprescribing in aged adults delivered at multiple clinical sites in a large academic health system. Of the data tools utilized, we were able to demonstrate clear documentation frequency of certain phrases during the intervention period for 574 patients receiving opioids and 537 patients receiving benzodiazepines. Although clinical decision support and documentation tools exist, they are underutilized or cumbersome to integrate into primary health care and strategies, such as employed, are a solution. This communication incorporates the importance of clinical pharmacy information systems in research design.
Collapse
Affiliation(s)
- Kimberly A Sanders
- Corresponding Author: Kimberly A. Sanders, PharmD, Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, 301 Pharmacy Lane, Campus Box 7574, Chapel Hill, NC 27599-7574, USA;
| | - Daniel Wolverton
- Department of Pharmacy, UNC Health, Chapel Hill, North Carolina, USA
| | | | - Rada Zunich
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
| | - Joshua Niznik
- Division of Geriatrics and Center for Aging and Health, Division of Pharmaceutical Outcomes and Policy, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - Stefanie P Ferreri
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
| |
Collapse
|
6
|
Michel DE, Tonna AP, Dartsch DC, Weidmann AE. Just a 'romantic idea'? A theory-based interview study on medication review implementation with pharmacy owners. Int J Clin Pharm 2023; 45:451-460. [PMID: 36639520 PMCID: PMC10147800 DOI: 10.1007/s11096-022-01524-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/18/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Recent legal changes in Germany entitle patients on multiple medications to receive a medication review (MR). However, the provision of MRs is not mandatory and pharmacy owners decide whether to implement this service in their pharmacies. AIM To determine pharmacy owners' attitudes towards MRs, explore their experiences with MR implementation and examine their perceptions of barriers and facilitators towards implementation of MRs in community pharmacies. METHOD Pharmacy owners were invited to participate in semi-structured interviews. Purposive sampling was used with selection criteria being MR-implementation stage, and geographical location of the pharmacy. The topic guide was based on a systematic review and the Framework for Implementation of Services in Pharmacy (FISpH). Interviews were recorded, transcribed verbatim and coded directly against the FISpH. RESULTS Twenty-one pharmacy owners were interviewed. Despite participants' consistent positive attitude towards MRs, most believed that providing MRs on an economically viable basis would be challenging. Several practical suggestions emerged which would enable community pharmacies a smoother implementation of MRs. Suggestions included employing 'change facilitators', who visit and support implementing pharmacies; national awareness campaigns targeting patients and health professionals; reducing bureaucracy; continuing professional development; involving technicians in some MR-tasks; and offering an additional incentive to lower the initial implementation threshold. CONCLUSION This research identified numerous factors that are likely to increase owners' and managers' support to the idea of MRs. This may be of interest to any country planning implementation of MRs.
Collapse
Affiliation(s)
- Dorothee E Michel
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, AB10 7GJ, Scotland
| | - Antonella P Tonna
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, AB10 7GJ, Scotland
| | | | | |
Collapse
|
7
|
Perspectives of pharmacists on medication reviews- Exploring implementation research in service establishment in community settings. Res Social Adm Pharm 2023; 19:673-680. [PMID: 36529621 DOI: 10.1016/j.sapharm.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pharmacists' roles have been evolving to include more patient-centered care services such as medication reviews that help patients receive the most benefits from their medication. In Malaysia, medication review is yet to be widely implemented in the community pharmacy setting for several reasons, including the non-dispensing separation healthcare system. To establish and implement a feasible medication review service model in Malaysia, it is important to gather community pharmacists' perspectives on such services. AIM To explore community pharmacists' perceptions of barriers, facilitators, and strategies for the implementation of a medication review service in Malaysia. METHODS A focus group discussion followed by semi-structured interviews were conducted among purposively sampled community pharmacists with an interest in medication review service. A framework analysis approach using the consolidated framework for implementation research (CFIR) was utilized to generate and analyze the data. After data mapping, the CFIR-ERIC (expert recommendations for implementing change) matching tool was used to generate the strategies according to the barriers identified. RESULTS Twenty community pharmacists participated in this study. Several barriers and facilitators to service implementation were identified based on the respondent's input. The CFIR-ERIC strategies matching tool analysis reported potential plans that can mitigate the barriers such as: identify and prepare champions, conduct local consensus discussions, conduct educational meetings, alter incentive/allowance structures, and develop a formal implementation blueprint. CONCLUSION Multifaceted strategies are required to ensure the successful implementation of medication review services in Malaysia. The findings of this study will assist in the development of a sustainable medication review service blueprint for the Malaysian community pharmacy setting.
Collapse
|
8
|
Cerqueira-Santos S, Rocha KSS, Araújo DCSA, Santos Júnior GA, Menezes PWS, Sanchez JM, Mesquita AR, Lyra Júnior DP. Which factors may influence the implementation of drug dispensing in community pharmacies? A qualitative study. J Eval Clin Pract 2023; 29:83-93. [PMID: 35789071 DOI: 10.1111/jep.13731] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 01/21/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVES Implementation of clinical pharmacy services, such as drug dispensing, is a complex process. It is necessary to understand the challenges associated with this practice from the perspective of the actors involved to help ensure optimal service provision. Thus, this study aimed to understand the factors that may influence the implementation of drug dispensing in community pharmacies, according to the perceptions of pharmacists. METHOD This qualitative study was based on semistructured, face-to-face interviews. The participants were pharmacists who worked in a chain of community pharmacies in Brazil, selected based on their direct participation in the implementation process. The interview recordings were transcribed full verbatim and were independently analyzed using thematic analysis, followed by consensus meetings between researchers. The factors identified by the participants were classified according to the Apoteca framework. This study was approved by the Committee of Ethics in Research and all participants signed an informed consent form. RESULTS We conducted 18 interviews, with 47 factors that may influence the implementation of drug dispensing in community pharmacies being identified. These factors were allocated to seven categories: support from community pharmacy chain (4), pharmacy infrastructure (11), characteristics of the pharmacy, medicines and other health products (4), pharmacist (16), dispensing work process (2), pharmacy team (2) and patient (8). The classification of factors according to the Apoteca framework allocated most of them to administrative (14) and technical (15) domains, followed by attitudinal (13) and political (5) domains. CONCLUSION(S) This study identified several factors that can influence the implementation of drug dispensing and classified them according to the domains of the Apoteca framework, highlighting the multifactorial nature of the implementation process. The results of this study can guide the planning of strategies aimed at providing efficient drug dispensing in community pharmacies.
Collapse
Affiliation(s)
- Sabrina Cerqueira-Santos
- Graduate Program in Pharmaceutical Sciences, Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Kérilin S S Rocha
- Health Sciences Graduate Program, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Dyego C S A Araújo
- Health Sciences Graduate Program, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Genival A Santos Júnior
- Research Group on Implementation and Integration of Pharmaceutical Care, Federal University of Espírito Santo, Alegre, Espírito Santo, Brazil
| | - Pedro W S Menezes
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Júlia M Sanchez
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Alessandra R Mesquita
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Divaldo P Lyra Júnior
- Graduate Program in Pharmaceutical Sciences, Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.,Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| |
Collapse
|
9
|
Nabergoj Makovec U, Tomsic T, Kos M, Stegne Ignjatovic T, Poplas Susic A. Pharmacist-led clinical medication review service in primary care: the perspective of general practitioners. BMC PRIMARY CARE 2023; 24:6. [PMID: 36627568 PMCID: PMC9832745 DOI: 10.1186/s12875-022-01963-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 12/29/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND An advanced level medication review service (CMR) is systematically reimbursed and available nationwide in Slovenian primary care since 2016. CMR is performed by clinical pharmacists (CP). Close collaboration with general practitioner (GP) is required as they perform patient selection and make clinical decisions regarding patient's medication. METHODS A prospective observational study was conducted in 2018 aiming to evaluate the perspective of GPs on the implementation of pharmacist-led medication review service in Community Health Care Centre Ljubljana, Slovenia. GPs of the patients, who provided written informed consent were invited for the interviews. The semi-structured interview consisted of 5 open ended questions addressing reasons for referral of the patients, implementation of CP recommendations and the GPs' perspective of the service in general. Interviews were audio recorded with GPs written consent, transcribed verbatim and inductive content analysis was performed in NVivo11 Pro. RESULTS In total 38 interviews with 24 GPs were performed. The emerged themes were nested under 3 main domains representing Donabedian model of quality healthcare - structure, process, outcomes. The service structure is built on broad pharmacotherapy knowledge as the main CP competency, good accessibility, and complementarity of healthcare professions. Patients are mainly referred to the CMR due to polypharmacotherapy, however in majority there is a more in-depth reason behind (e.g., adverse events, etc.). Lack of time to recognize eligible patients and additional workload to study and implement the recommendations present the major challenges in the service process and therefore low number of referrals. CPs recommendations are mostly accepted, although the implementation time varies. When recommendation addresses medicines prescribed by a clinical specialist, the CMR report is forwarded to them for decision regarding implementation. The empowerment of the patients in medicines use was emphasized as the major benefit of the CMR, which consequently supports and enhances the quality of GP's patient care. Transferability of recommendations to similar cases and high satisfaction with the service of GPs and patients, were mentioned. CONCLUSION GPs experiences with CMR are encouraging and supportive and present a base for further growth of the service.
Collapse
Affiliation(s)
- Urska Nabergoj Makovec
- grid.8954.00000 0001 0721 6013University of Ljubljana, Faculty of Pharmacy, Department of Social Pharmacy, Askerceva cesta 7, 1000 Ljubljana, Slovenia
| | - Tanja Tomsic
- grid.457211.40000 0004 0597 4875Community Health Centre Ljubljana, Ljubljana, Slovenia
| | - Mitja Kos
- grid.8954.00000 0001 0721 6013University of Ljubljana, Faculty of Pharmacy, Department of Social Pharmacy, Askerceva cesta 7, 1000 Ljubljana, Slovenia
| | - Tea Stegne Ignjatovic
- grid.457211.40000 0004 0597 4875Community Health Centre Ljubljana, Ljubljana, Slovenia
| | - Antonija Poplas Susic
- grid.457211.40000 0004 0597 4875Community Health Centre Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
10
|
Community pharmacist intervention to close statin gaps in diabetes care: The GuIDE-S study. J Am Pharm Assoc (2003) 2023; 63:108-117. [PMID: 36163125 DOI: 10.1016/j.japh.2022.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Statin therapy is recommended for people with type 2 diabetes (T2D) to lower cardiovascular risk; however, evidence suggests that significant gaps in statin therapy exist. OBJECTIVE To evaluate (1) the impact of a community pharmacist-led model for initiating statin therapy in people with type 2 diabetes (T2D) on statin initiation and (2) pharmacists' self-reported perceptions of the intervention feasibility and fidelity to the intervention. METHODS This was a type 1 hybrid effectiveness-implementation study of 9 intervention and 18 control pharmacies within a community pharmacy chain. Pharmacy staff proactively identified patients with T2D not taking a statin and prescribed a statin via a collaborative practice agreement or facilitated acquisition of a prescription from the patient's preferred prescriber. The eligible population included patients aged 18-84 years with T2D, who had filled ≥60 days' supply of one, noninsulin, diabetes medication in a rolling 6-month period, and who had not filled a statin during the same period. A Cox proportional hazards model was used to compare time to statin initiation. Pharmacists at intervention pharmacies completed a survey at 6 and 12 months after implementation (March and August 2019, respectively) to assess intervention feasibility and fidelity. RESULTS For the statin initiation analysis, 1670 intervention patients were matched to 3358 control patients. Overall, 26.3% (n=442) of intervention patients and 25.4% (n=854) of control patients initiated a statin within 12 months of their index date. There was no difference in statin initiation likelihood between intervention and control patients (hazard ratio: 1.00; 95% CI: 0.83, 1.21). Fifteen pharmacists completed the 6-month survey (33% response rate), and 12 completed the 12-month survey (26%). The intervention's feasibility score was 4.0 at 6 months and 4.2 at 12 months, indicating an increase in perceived feasibility. Fidelity decreased from 6 to 12 months. CONCLUSION The community pharmacist-led intervention resulted in more patients initiating statin therapy as compared to usual care; however, the differences were not statistically significant. Pharmacists perceived the intervention to be feasible; however, fidelity decreased over time.
Collapse
|
11
|
Owen EC, Abrams R, Cai Z, Duddy C, Fudge N, Hamer-Hunt J, Husson F, Mahtani KR, Ogden M, Swinglehurst D, Turner M, Whittlesea C, Wong G, Park S. Community pharmacy and general practice collaborative and integrated working: a realist review protocol. BMJ Open 2022; 12:e067034. [PMID: 36581431 PMCID: PMC9806063 DOI: 10.1136/bmjopen-2022-067034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Increasing collaborative and integrated working between General practice (GP) and Community pharmacy (CP) is a key priority of the UK National Health Service and has been proposed as a solution to reducing health system fragmentation, improving synergies and coordination of care. However, there is limited understanding regarding how and under which circumstances collaborative and integrated working between GP and CP can be achieved in practice and how regulatory, organisational and systemic barriers can be overcome. METHODS AND ANALYSIS The aim of our review is to understand how, when and why working arrangements between GP and CP can provide the conditions necessary for optimal communication, decision-making, and collaborative and integrated working. A realist review approach will be used to synthesise the evidence to make sense of the complexities inherent in the working relationships between GP and CP. Our review will follow Pawson's five iterative stages: (1) finding existing theories; (2) searching for evidence (our main searches were conducted in April 2022); (3) article selection; (4) data extraction and (5) synthesising evidence and drawing conclusions. We will synthesise evidence from grey literature, qualitative, quantitative and mixed-methods research. The research team will work closely with key stakeholders and include patient and public involvement and engagement throughout the review process to refine the focus of the review and the programme theory. Collectively, our refined programme theory will explain how collaborative and integrated working between GP and CP works (or not), for whom, how and under which circumstances. ETHICS AND DISSEMINATION Formal ethical approval is not required for this review as it draws on secondary data from published articles and grey literature. Findings will be widely disseminated through: publication in peer-reviewed journals, seminars, international conference presentations, patients' association channels, social media, symposia and user-friendly summaries. PROSPERO REGISTRATION NUMBER CRD42022314280.
Collapse
Affiliation(s)
- Emily Claire Owen
- Department of Primary Care & Population Health, University College London, London, UK
| | - Ruth Abrams
- School of Health Sciences, University of Surrey, Surrey, UK
| | - Ziyue Cai
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Claire Duddy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nina Fudge
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK, London, UK
| | - Julia Hamer-Hunt
- Department of Primary Care & Population Health, University College London, London, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Fran Husson
- Department of Primary Care & Population Health, University College London, London, UK
- Faculty of Medicine, Imperial College London, London, UK
| | - Kamal Ram Mahtani
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Margaret Ogden
- Department of Primary Care & Population Health, University College London, London, UK
| | - Deborah Swinglehurst
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK, London, UK
| | - Malcolm Turner
- Department of Primary Care & Population Health, University College London, London, UK
| | - Cate Whittlesea
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sophie Park
- Department of Primary Care & Population Health, University College London, London, UK
| |
Collapse
|
12
|
Moecker R, Weissenborn M, Klingenberg A, Wirbka L, Fuchs A, Eickhoff C, Mueller U, Schulz M, Kaufmann-Kolle P, Haefeli WE, Seidling HM. Task sharing in an interprofessional medication management program - a survey of general practitioners and community pharmacists. BMC Health Serv Res 2022; 22:1005. [PMID: 35933349 PMCID: PMC9356506 DOI: 10.1186/s12913-022-08378-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/25/2022] [Indexed: 11/25/2022] Open
Abstract
Background Pharmacist-led medication review and medication management programs (MMP) are well-known strategies to improve medication safety and effectiveness. If performed interprofessionally, outcomes might even improve. However, little is known about task sharing in interprofessional MMP, in which general practitioners (GPs) and community pharmacists (CPs) collaboratively perform medication reviews and continuously follow-up on patients with designated medical and pharmaceutical tasks, respectively. In 2016, ARMIN (Arzneimittelinitiative Sachsen-Thüringen) an interprofessional MMP was launched in two German federal states, Saxony and Thuringia. The aim of this study was to understand how GPs and CPs share tasks in MMP when reviewing the patients’ medication. Methods This was a cross-sectional postal survey among GPs and CPs who participated in the MMP. Participants were asked who completed which MMP tasks, e.g., checking drug-drug interactions, dosing, and side effects. In total, 15 MMP tasks were surveyed using a 5-point Likert scale ranging from “I complete this task alone” to “GP/CP completes this task alone”. The study was conducted between 11/2020 and 04/2021. Data was analyzed using descriptive statistics. Results In total, 114/165 (69.1%) GPs and 166/243 (68.3%) CPs returned a questionnaire. The majority of GPs and CPs reported (i) checking clinical parameters and medication overuse and underuse to be completed by GPs, (ii) checking storage conditions of drugs and initial compilation of the patient’s medication including brown bag review being mostly performed by CPs, and (iii) checking side-effects, non-adherence, and continuous updating of the medication list were carried out jointly. The responses differed most for problems with self-medication and adding and removing over-the-counter medicines from the medication list. In addition, the responses revealed that some MMP tasks were not sufficiently performed by either GPs or CPs. Conclusions Both GPs’ and CPs’ expertise are needed to perform MMP as comprehensively as possible. Future studies should explore how GPs and CPs can complement each other in MMP most efficiently. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08378-4.
Collapse
Affiliation(s)
- Robert Moecker
- Cooperation Unit Clinical Pharmacy, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Marina Weissenborn
- Cooperation Unit Clinical Pharmacy, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Anja Klingenberg
- aQua Institute for Applied Quality Improvement and Research in Health Care, Maschmühlenweg 8-10, 37073, Göttingen, Germany
| | - Lucas Wirbka
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Andreas Fuchs
- AOK PLUS - Die Gesundheitskasse, Sternplatz 7, 01067, Dresden, Germany
| | - Christiane Eickhoff
- Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Heidestraße 7, 10557, Berlin, Germany
| | - Uta Mueller
- Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Heidestraße 7, 10557, Berlin, Germany
| | - Martin Schulz
- Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Heidestraße 7, 10557, Berlin, Germany.,Institute of Pharmacy, Freie Universität Berlin, Kelchstraße 31, 12169, Berlin, Germany
| | - Petra Kaufmann-Kolle
- aQua Institute for Applied Quality Improvement and Research in Health Care, Maschmühlenweg 8-10, 37073, Göttingen, Germany
| | | | - Walter E Haefeli
- Cooperation Unit Clinical Pharmacy, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Hanna M Seidling
- Cooperation Unit Clinical Pharmacy, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. .,Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| |
Collapse
|
13
|
Edwards J, Coward M, Carey N. Barriers and facilitators to implementation of non-medical independent prescribing in primary care in the UK: a qualitative systematic review. BMJ Open 2022; 12:e052227. [PMID: 35676011 PMCID: PMC9185484 DOI: 10.1136/bmjopen-2021-052227] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/27/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To support workforce deficits and rising demand for medicines, independent prescribing (IP) by nurses, pharmacists and allied health professionals is a key component of workforce transformation in UK healthcare. This systematic review of qualitative research studies used a thematic synthesis approach to explore stakeholders' views on IP in primary care and identify barriers and facilitators influencing implementation. SETTING UK primary/community care. PARTICIPANTS Inclusion criteria were UK qualitative studies of any design, published in the English language. Six electronic databases were searched between January 2010 and September 2021, supplemented by reference list searching. Papers were screened, selected and quality-appraised using the Quality Assessment Tool for Studies with Diverse Designs. Study data were extracted to a bespoke table and two reviewers used NVivo software to code study findings. An inductive thematic synthesis was undertaken to identify descriptive themes and interpret these into higher order analytical themes. The Diffusion of Innovations and Consolidated Framework for Implementation Research were guiding theoretical anchors. PRIMARY AND SECONDARY OUTCOME MEASURES N/A. RESULTS Twenty-three articles addressing nurse, pharmacist and physiotherapist IP were included. Synthesis identified barriers and facilitators in four key stages of implementation: (1) 'Preparation', (2) 'Training', (3) 'Transition' and 4) 'Sustainment'. Enhancement, substitution and role-specific implementation models reflected three main ways that the IP role was used in primary care. CONCLUSIONS In order to address global deficits, there is increasing need to optimise use of IP capability. Although the number of independent prescribers continues to grow, numerous barriers to implementation persist. A more coordinated and targeted approach is key to overcoming barriers identified in the four stages of implementation and would help ensure that IP is recognised as an effective approach to help alleviate workforce shortfalls in the UK, and around the world. PROSPERO REGISTRATION NUMBER CRD42019124400.
Collapse
Affiliation(s)
- Judith Edwards
- School of Health Sciences, University of Surrey Faculty of Health and Medical Sciences, Guildford, UK
| | - Melaine Coward
- School of Health Sciences, University of Surrey Faculty of Health and Medical Sciences, Guildford, UK
| | - Nicola Carey
- Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness, UK
| |
Collapse
|
14
|
Chalmers L, Czarniak P, Hughes J, Iacob R, Lee YP, Parsons K, Parsons R, Sunderland B, Sim TF. Implementation factor mapping of a pilot study of point-of-care C-reactive protein testing for respiratory tract infections in community pharmacy. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 6:100147. [PMID: 35733607 PMCID: PMC9207564 DOI: 10.1016/j.rcsop.2022.100147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 04/29/2022] [Accepted: 05/26/2022] [Indexed: 11/06/2022] Open
Abstract
Background Explicit consideration of implementation factors in community pharmacy service development may facilitate widespread implementation and sustainability. Objectives This study involved mapping the methodology for the pilot study of point-of-care C-reactive protein (CRP) testing to support pharmacists' management of respiratory tract infections in Western Australian pharmacies against an implementation factor framework, focussing on the resources and training program provided to participating pharmacy staff. Methods Phase 1 involved post hoc mapping of the pilot study methodology against the framework previously described by Garcia-Cardenas et al.; phase 2 was an a priori evaluation of the resources and training program, involving pre-training, post-training, and post-pilot questionnaires administered to pharmacists and pharmacy assistants/interns. A mixed model analysis compared pharmacists' responses at the three time points. Results Employment of comprehensive strategies to optimise service feasibility and sustainability was demonstrated across the five domains of ‘professional service’, ‘pharmacy staff’, ‘pharmacy’, ‘local environment’ and ‘system’; further consideration of ‘consumer’ or ‘patient’ factors is needed to address issues such as patient refusal. Study pharmacists (n = 10) and pharmacy assistants/interns (n = 5) reported high levels of satisfaction with the training (100% ‘good’/‘excellent’). Pharmacists reported significantly improved attitudes towards, confidence in, and knowledge about CRP testing and service provision from pre- to post-training (p < 0.05). Positive perceptions were maintained at the post-pilot time point. Conclusions Post hoc mapping of implementation factors highlighted potential strengths and deficiencies of the current service model. Systematic, prospective mapping, coupled with strategies to explicitly emphasise the patient perspective, may have value in optimising service implementation or modifying future service delivery models.
Collapse
|
15
|
Husted GR, Hansen RN, El-Souri M, Lorenzen JK, Iversen PB, Rossing CV. What do persons with diabetes want from community pharmacies? A qualitative study. Pharm Pract (Granada) 2022; 20:2677. [PMID: 35919802 PMCID: PMC9296095 DOI: 10.18549/pharmpract.2022.2.2677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/15/2022] [Indexed: 11/14/2022] Open
Abstract
Background Diabetes is a demanding disease with a complex treatment regimen. Many persons with diabetes have difficulty managing their disease and taking medication as prescribed, possibly because they lack knowledge and sometimes misinterpret medical benefits. Community pharmacies continuously provide professional counselling to persons with diabetes. Objective This study aimed to explore 1) which services adults with type 1 and type 2 diabetes want from community pharmacies and 2) how pharmacies can meet these wishes. Methods A qualitative, explorative study design using focus group interviews was chosen. Informants were recruited from Region Zealand in Denmark. Data were digitally recorded, transcribed verbatim and analyzed by means of thematic analysis. Results Thirteen adults (11 female) with the mean age of 66.2 years (range 49-81 years) participated in one physical (n=6) or one online (n=7) focus group interview. Ten had type 2 diabetes, three had type 1 diabetes. The average duration of participants' diabetes was 13.4 years (range 2.3-33.0 years). The analysis revealed three overall themes of the functions which the informants would like community pharmacies to fulfil: 1) raise awareness of pharmacies' counselling service and competences; 2) act as a dialogue partner; 3) be a source of information and guidance about local activities and support. Conclusion The informants did not regard community pharmacies as a natural part of the healthcare system or as a place where they would expect counselling. They would like the community pharmacy to make their medical competences and services obvious and the community pharmacy staff to act as a dialogue partner and provide competent counselling. The informants would like to have a contact person with diabetes competences with whom they can book an appointment to complement over-the-counter counselling. They experience a gap in their care between routine visits in the healthcare system and suggest that community pharmacies counselling services become a natural supplement and that healthcare professionals in the primary and secondary sectors inform patients about the services - especially for patients newly diagnosed with diabetes. Finally, they would like a formal collaboration between diabetes associations and community pharmacies to make their competences, services and information visible.
Collapse
Affiliation(s)
- Gitte Reventlov Husted
- PhD, MScN, Consultant, Department of Research and Development, Danish College of Pharmacy Practice, Pharmakon, Denmark.
| | - Rikke Nørgaard Hansen
- MSc Pharmacy, Head of Research and Development, Danish College of Pharmacy Practice, Pharmakon, Denmark.
| | - Mira El-Souri
- MSc Pharmacy, Consultant, Department of Research and Development, Danish College of Pharmacy Practice, Pharmakon, Denmark.
| | | | | | - Charlotte Verner Rossing
- PhD, MSc. Pharmacy, Director of Research and Development, Danish College of Pharmacy Practice, Pharmakon, Denmark.
| |
Collapse
|
16
|
Yong FR, Hor SY, Bajorek BV. Considerations of Australian community pharmacists in the provision and implementation of cognitive pharmacy services: a qualitative study. BMC Health Serv Res 2021; 21:906. [PMID: 34479542 PMCID: PMC8413700 DOI: 10.1186/s12913-021-06838-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 07/30/2021] [Indexed: 11/24/2022] Open
Abstract
Background Australian federally-funded cognitive pharmacy services (CPS) (e.g. medication management and reconciliation services) have not been translated into practice consistently. These health services are purportedly accessible across all Australian community pharmacies, yet are not delivered as often as pharmacists would like. There are international indicators that pharmacists lack the complete behavioural control required to prioritise CPS, despite their desire to deliver them. This requires local investigation. Objective To explore Australian pharmacists’ perspectives [1] as CPS providers on the micro level, and [2] on associated meso and macro level CPS implementation issues. Methods Registered Australian community pharmacists were recruited via professional organisations and snowball sampling. Data were collected via an online demographic survey and semi-structured interviews until data saturation was reached. Interview transcripts were de-identified then verified by participants. Content analysis was performed to identify provider perspectives on the micro level. Framework analysis using RE-AIM was used to explore meso and macro implementation issues. Results Twenty-three participants across Australia gave perspectives on CPS provision. At the micro level, pharmacists did not agree on a single definition of CPS. However, they reported complexity in interactional work and patient considerations, and individual pharmacist factors that affected them when deciding whether to provide CPS. There was an overall deficiency in pharmacy workplace resources reported to be available for implementation and innovation. Use of an implementation evaluation framework suggested CPS implementation is lacking sufficient structural support, whilst reach into target population, service consistency and maintenance for CPS were not specifically considered by pharmacists. Conclusions This analysis of pharmacist CPS perspectives suggests slow uptake may be due to a lack of evidence-based, focused, multi-level implementation strategies that take ongoing pharmacist role transition into account. Sustained change may require external change management and implementation support, engagement of frontline clinicians in research, and the development of appropriate pharmacist practice models to support community pharmacists in their CPS roles. Trial registration This study was not a clinical intervention trial. It was approved by the University of Technology Sydney Human Research Ethics Committee (UTS HREC 19–3417) on the 26th of April 2019.
Collapse
Affiliation(s)
- Faith R Yong
- Discipline of Pharmacy, Graduate School of Health, Faculty of Health, University of Technology Sydney, 100 Broadway, Chippendale, Sydney, NSW, 2008, Australia.
| | - Su-Yin Hor
- Centre for Health Services Management, Faculty of Health, University of Technology Sydney, Building 10, 15 Broadway, Ultimo, Sydney, NSW, 2007, Australia
| | - Beata V Bajorek
- Discipline of Pharmacy, Graduate School of Health, Faculty of Health, University of Technology Sydney, 100 Broadway, Chippendale, Sydney, NSW, 2008, Australia
| |
Collapse
|
17
|
Experiences of key stakeholders with the implementation of medication reviews in community pharmacies: A systematic review using the Consolidated Framework for Implementation Research (CFIR). Res Social Adm Pharm 2021; 18:2944-2961. [PMID: 34420864 DOI: 10.1016/j.sapharm.2021.07.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 07/12/2021] [Accepted: 07/16/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Though medication reviews have shown positive patient outcomes, they are still not widely implemented in community pharmacies. Published reviews on their implementation often include several other pharmacy services, making them non-specific. Using the Consolidated Framework for Implementation Research (CFIR) to focus solely on the experiences of different stakeholders with the implementation of medication reviews will help to better understand relevant facilitators and barriers. OBJECTIVES To critically appraise, synthesise and present the available evidence on experiences of key stakeholders with the implementation of medication reviews and to identify barriers and facilitators to its implementation in community pharmacies. METHODS A systematic literature search was conducted in four databases for studies published in English, Spanish or German. Key search terms included: implementation, pharmac*, medication review, facilitator, barrier. Study selection, quality assessment and data extraction were performed by two independent reviewers. Findings were mapped directly against the constructs of the CFIR. RESULTS Out of 924 retrieved records 24 articles from 9 countries met the inclusion criteria. Key facilitators identified included pharmacists' openness to practice change and a high degree of patient satisfaction post medication review. Attracting patients to the service was stated as challenging due to an unawareness of the scope and potential benefit of a medication review. The dominant barrier was inadequate remuneration, as it impacted all additional resourcing and ultimately the viability of the service. Further barriers included difficult professional relationships with doctors and little mandate from health authorities. Most reports were from the employed pharmacists' perspective and concerned the inner setting, other perspectives were under-reported. CONCLUSIONS Results of this systematic review illustrate different stakeholders' experiences and add to the understanding of challenges in the implementation process. Nevertheless, findings also highlight how scarce reporting of external stakeholders' views is and that filling this gap can unveil hidden barriers and facilitators. REGISTRATION PROSPERO register (CRD 42019122836).
Collapse
|
18
|
Olufemi-Yusuf DT, Kung JY, Guirguis LM. Medication reviews in community pharmacy: a scoping review of policy, practice and research in Canada. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [DOI: 10.1093/jphsr/rmab040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objectives
This scoping review aims to systematically map the empirical evidence on publicly funded medication reviews provided by community pharmacists in Canada and identify gaps that could inform future research directions.
Methods
We used a scoping review framework and PRISMA guidelines for Scoping Reviews to conduct the study. Three electronic databases were searched for papers published between January 2000 until August 2020. Data was charted on study characteristics, and a thematic synthesis was performed.
Key findings
Of 41 original studies included, most were conducted in Ontario (n = 21). Majority of the studies employed quantitative designs (70%). Five major themes identified were program uptake, patient health outcomes, stakeholder beliefs and attitudes, processes and collaboration and pharmacy workplace culture, which varied considerably. At the individual, organizational and policy levels, many factors were interrelated and influenced the implementation of reimbursed medication reviews by community pharmacists. Gaps in eligibility policy highlighted some patients who may have complex needs are excluded. Variation in clinical outcomes may relate to different types of medication review and pharmacist practice across Canada. Few researchers evaluated eligibility criteria, the impact of policy changes, strategies to engage patients and healthcare professionals, patient–pharmacist communication or compared practice models of medication reviews. About 12% of the research applied a theoretical framework.
Summary
Publicly funded medication reviews in Canadian community pharmacies reduce medication-related problems and potentially improve patient health outcomes. Future research and policies could consider addressing barriers and exploring models for sustainable delivery of high-quality medication reviews internationally.
Collapse
Affiliation(s)
- Damilola T Olufemi-Yusuf
- University of Alberta, Faculty of Pharmacy and Pharmaceutical Sciences, Edmonton, Alberta, Canada
| | - Janice Y Kung
- Public Services Librarian, John W. Scott Health Sciences Library, University of Alberta, Edmonton, Canada
| | - Lisa M Guirguis
- University of Alberta, Faculty of Pharmacy and Pharmaceutical Sciences, Edmonton, Alberta, Canada
| |
Collapse
|
19
|
Implementation of a Real-Time Medication Intake Monitoring Technology Intervention in Community Pharmacy Settings: A Mixed-Method Pilot Study. PHARMACY 2021; 9:pharmacy9020105. [PMID: 34070544 PMCID: PMC8162977 DOI: 10.3390/pharmacy9020105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/10/2021] [Accepted: 05/19/2021] [Indexed: 11/16/2022] Open
Abstract
Innovative dispensing products offering real-time medication intake monitoring are being developed to address medication non-adherence. However, implementation of these interventions within the workflow of a community pharmacy is unknown. The purpose of this study was to explore factors affecting implementation of a real-time adherence-monitoring, multidose-dispensing system in community pharmacies. A mixed-method study was conducted with pharmacy staff, who packaged and dispensed medications in smart multidose packages and monitored real-time medication intake via web-portal. Pharmacy staff participated in semi-structured interviews. The Technology Acceptance Model, Theory of Planned Behaviour and Capability, Opportunity, Motivation, Behaviour Model informed the interview guide. Interview transcripts were analyzed thematically and findings were mapped back to the frameworks. The usability was assessed by the System Usability Scale (SUS). Three pharmacists and one pharmacy assistant with a mean of 19 years of practice were interviewed. Three themes and 12 subthemes were generated. Themes included: pharmacy workflow factors, integration factors, and pharmacist-perceived patient factors. The mean SUS was found to be 80.63. Products with real-time adherence monitoring capabilities are valued by pharmacists. A careful assessment of infrastructure—including pharmacy workload, manpower and financial resources—is imperative for successful implementation of such interventions in a community pharmacy setting.
Collapse
|
20
|
Campeau Calfat A, Duval C, Laberge M, Savard AM, Sirois C. Clinical services in community pharmacies: a scoping review of policy and social implications. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:116-125. [PMID: 33729524 DOI: 10.1093/ijpp/riaa007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/08/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Clinical services have allowed pharmacists to shift from product-oriented to patient-oriented services. However, the policy and social implications of clinical services in community pharmacies are not well described. The purpose of this scoping review was to identify these implications. KEY FINDINGS We searched Pubmed and Embase, from inception to March 2019, as well as grey literature for publications that discussed policy (e.g. pharmacy model and pharmacist status) or social (e.g. role of pharmacists and interprofessional collaboration) implications of clinical services. Publications had to address clinical services provided by pharmacists in community settings that target the global long-term care of patients. We extracted data related to the implications and classified them into themes thereafter. The search process identified 73 relevant publications, of which 13 were included in regard to policy implications and 60 relative to social implications. Two themes emerged from policy implications: implementation and characteristics of policies, and professional status. Pharmacists' independence from distribution, financial coverage of clinical services and innovative models of practice were addressed. Social implications involved three themes: roles and interprofessional collaboration, changes in practice and barriers and model of practices and services. Perceptions of pharmacists' skills, organisational barriers, time constraints, lack of self-confidence and cultural shifts required to implement clinical services were included in these themes. SUMMARY Our review demonstrates the changing role of community pharmacists in provision of clinical services within the healthcare system. The range of clinical services varies widely from one setting to another. The context of community pharmacy is not well suited to these changes in practice.
Collapse
Affiliation(s)
- Alexandre Campeau Calfat
- Department of Social and Preventive Medicine, Université Laval, Québec, Canada.,Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Québec, Canada.,Centre of Excellence on Aging of Quebec, CIUSSS-CN, Québec, Canada
| | - Cécile Duval
- Department of Social and Preventive Medicine, Université Laval, Québec, Canada
| | - Maude Laberge
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Québec, Canada.,Centre de recherche du Centre hospitalier universitaire de Québec - Université Laval, Québec, Canada.,Department of Operations and Decision Systems, Faculty of Business Administration, Université Laval, Québec, Canada
| | | | - Caroline Sirois
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Québec, Canada.,Centre of Excellence on Aging of Quebec, CIUSSS-CN, Québec, Canada.,Centre de recherche du Centre hospitalier universitaire de Québec - Université Laval, Québec, Canada.,Faculté de pharmacie, Université Laval, Québec, Canada
| |
Collapse
|
21
|
Moecker R, Terstegen T, Haefeli WE, Seidling HM. The influence of intervention complexity on barriers and facilitators in the implementation of professional pharmacy services - A systematic review. Res Social Adm Pharm 2021; 17:1651-1662. [PMID: 33579611 DOI: 10.1016/j.sapharm.2021.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 01/06/2021] [Accepted: 01/24/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Community pharmacies increasingly offer professional pharmacy services, whose implementation is often influenced by facilitating or obstructive implementation factors. The occurrence and composition of implementation factors vary among different services with discrete characteristics and complexity of the intervention, making it difficult to foresee potential barriers in implementation. OBJECTIVE(S) This paper investigates potential associations between intervention complexity and occurring implementation factors. METHODS A systematic literature search on the implementation factors and intervention complexity of professional pharmacy services in the community setting was carried out in electronic databases (PubMed, CINAHL, and PsycINFO) throughout December 2018. Implementation factors were extracted from semi-structured interviews, focus groups, and surveys with community pharmacists and categorized using the Consolidated Framework for Implementation Research (CFIR). The complexity of each service was assessed using the following complexity parameters: (I) number of involved healthcare professions, (II) number of service components such as recruiting of patients, screening intervention, and follow-up, (III) frequency of the service, (IV) expenditure of time per patient (encounter), and (V) workflow distortion, i.e. booking appointments for intervention with the patient. Finally, the association between implementation factors and intervention complexity was analyzed by quantifying implementation factors and by relating them to specific intervention characteristics using Fisher's exact test. RESULTS 15 studies covering a broad spectrum of professional pharmacy services were included. There was a trend that in services with higher complexity more implementation factors occurred (p = 0.094). Single key complexity parameters can trigger specific implementation factors. For instance, general practitioner and pharmacy technician involvement were significantly associated with interprofessional communication and leadership engagement, respectively. CONCLUSION Key implementation factors and associated complexity parameters seem to be of similar or more importance than the total number of implementation factors with regard to successful implementation. By assessing various complexity parameters of an intervention, potential key barriers could be identified and subsequently addressed prior to implementation.
Collapse
Affiliation(s)
- Robert Moecker
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany; Cooperation Unit Clinical Pharmacy, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - Theresa Terstegen
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany; Cooperation Unit Clinical Pharmacy, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany; Cooperation Unit Clinical Pharmacy, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - Hanna M Seidling
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany; Cooperation Unit Clinical Pharmacy, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| |
Collapse
|
22
|
Measuring implementation of medication optimization services: Development and validation of an implementation outcomes questionnaire. Res Social Adm Pharm 2021; 17:1623-1630. [PMID: 33526353 DOI: 10.1016/j.sapharm.2021.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/23/2020] [Accepted: 01/03/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Implementation outcomes serve as progress and success indicators of the implementation process. They are also key antecedents to achieving the more traditional clinical outcomes typically associated with a service. Despite their importance, there are few implementation outcomes measures with appropriate psychometric properties, none of which have yet been adapted for medication optimization services. OBJECTIVES This study aims to develop and validate the Implementation Outcomes Questionnaire (IOQ) to assess implementation of medication optimization services, starting with Comprehensive Medication Management (CMM). The resulting IOQ is a 40-item self-report instrument for six implementation outcomes, including adoption, acceptability, feasibility, appropriateness, penetration, and sustainability. METHODS A three-phase approach was used to develop and validate the IOQ. Development of the instrument, Phase I, was informed by a targeted search of existing implementation outcomes measures in other fields, a review of suitableoptions options by an expert panel, and item adaptation. To assess content validity, Phase II, an internal vetting process was conducted using an adapted version of Rubio and colleagues' methodology. Evidence of reliability and construct validity, Phase III, was obtained through a pilot test with 167 pharmacists within 78 different care settings. RESULTS Overall, the results supported the reliability and validity (both content and construct) of the IOQ, with further psychometric testing needed for adoption. The items' relevance, clarity, and alignment with each implementation concept were high, except for Penetration. As a result, the Penetration items were refined for further use. Best-fit models were identified for each outcome based on the MCFA analyses, thereby providing insights into the factor structures and interpretation for each measure. Cronbach' alphas indicated good internal consistency. CONCLUSIONS This questionnaire is the first of its kind tailored to medication optimization services, starting with CMM. Access to this survey should facilitate measurement of implementation outcomes, thereby increasing the likelihood of achieving the desired clinical outcomes.
Collapse
|
23
|
Patient-initiated consultations in community pharmacies. Res Social Adm Pharm 2021; 17:428-440. [DOI: 10.1016/j.sapharm.2020.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 02/13/2020] [Accepted: 03/02/2020] [Indexed: 11/21/2022]
|
24
|
Dineen-Griffin S, Benrimoj SI, Williams KA, Garcia-Cardenas V. Co-design and feasibility of a pharmacist-led minor ailment service. BMC Health Serv Res 2021; 21:80. [PMID: 33482801 PMCID: PMC7821549 DOI: 10.1186/s12913-021-06076-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 01/12/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Community pharmacies provide an appropriate setting to deliver minor ailment services (MASs). Many community pharmacy services have been developed previously without stakeholder involvement. As a result, implementation of services may fail to produce the expected impact. The aim of this research was to co-design and test the feasibility of an Australian MAS for minor ailment presentations. METHODS This study used co-design methodology which included two phases: (1) a focus group with stakeholders to allow the conceptualization of the service and agreement on service elements; (2) a literature review of clinical guidelines and three working meetings with a team of editors and general practitioners for the development of treatment pathways. Following this, a study evaluating the feasibility of the co-designed service was undertaken. The qualitative part of the methodology associated with the feasibility study comprised semi-structured interviews with MAS pharmacists, observation and completion of a tool by change facilitators identifying barriers and facilitators to service delivery. Qualitative data obtained for all phases were analysed using thematic analysis. RESULTS The developed service included the following components: (i) an in-pharmacy consultation between the patient and pharmacist, (ii) treatment pathways accessible to pharmacists on the internet to guide consultations, (iii) existing digital communication systems used by general practice to exchange patient information, (iv) training, and (v) change facilitation. As a result of feasibility testing, twenty-six implementation factors were identified for practice change, with the main change being the simplification of the pharmacist-patient consultation and data collection processes. CONCLUSIONS An Australian MAS was generated as a result of co-design, while testing revealed that the co-designed service was feasible. As a result of integrating the views of multiple stakeholders, the designed MAS has been adapted to suit healthcare practices, which may increase the acceptance and impact of MAS when implemented into practice.
Collapse
|
25
|
Hashmi F, Hassali MA, Saleem F, Saeed H, Islam M, Malik UR, Atif N, Babar ZUD. Perspectives of community pharmacists in Pakistan about practice change and implementation of extended pharmacy services: a mixed method study. Int J Clin Pharm 2021; 43:1090-1100. [PMID: 33411180 DOI: 10.1007/s11096-020-01221-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
Background Community pharmacists' role in the primary health care, patient-centered services, beyond traditional dispensing services is well established in the developed world. However, this role is not fully established in low-middle-income countries including Pakistan. Objective To explore community pharmacists' perspectives and preparedness about practice change and associated facilitators and barriers to extended services. Setting A study was conducted involving community pharmacists of Lahore, Pakistan. Method Two phased studies were conducted using mixed-method sequential design. The first phase involved qualitative semi-structured face-to-face interviews with the community pharmacists, while the second phase constituted a questionnaire-based cross-sectional study. Main outcome measure Pharmacists' perspectives about extended pharmacy services, facilitators, barriers and preparedness for the practice change. Results For the first phase, pharmacists were purposively sampled and the saturation yielded a final sample size of fifteen pharmacists (N = 15). The thematic content analysis yielded four distinct themes; (1) current practices and familiarity with extended pharmacy services (2) practice gap between Pakistan and the developed countries (3) facilitators and the preparedness, and (4) barriers towards its implementation and provision. The second part was a questionnaire-based cross-sectional phase, where a total of 348 community pharmacists were approached, while only 242 responded, yielding a response rate of 69.5%. The triangulation of qualitative and quantitative data identified several barriers such as; shortage of pharmacists, lack of knowledge and skills, poor collaboration with general practitioners, failure of customers to pay for extended services. Facilitators and preparedness for the provision of extended pharmacy services were; access to patient notes, follow-up, separate counselling areas, accreditation of specific services and sufficient resources. Conclusion This study's findings call for the implementation and enforcement of Punjab Drug Sale Rules 2007 to facilitate the practice change and provision of comprehensive pharmacy services in Punjab, Pakistan. There is a need for additional laws to define community pharmacists' roles, uniform job description, training, new funding model, separate area, and accreditation of extended pharmacy services in Pakistan.
Collapse
Affiliation(s)
- Furqan Hashmi
- University College of Pharmacy, University of the Punjab Allama Iqbal Campus, Lahore, Pakistan.
| | - Mohamed Azmi Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Pulau Penang, Malaysia
| | - Fahad Saleem
- Faculty of Pharmacy, University of Balochistan, Sariab Road, Quetta, Pakistan
| | - Hamid Saeed
- University College of Pharmacy, University of the Punjab Allama Iqbal Campus, Lahore, Pakistan
| | - Muhammad Islam
- University College of Pharmacy, University of the Punjab Allama Iqbal Campus, Lahore, Pakistan
| | | | - Naveel Atif
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, China
| | - Zaheer-Ud-Din Babar
- Department of Pharmacy, University of Huddersfield, Huddersfield, HD1 3DH, UK
| |
Collapse
|
26
|
Parajuli J, Horey D. Barriers to and facilitators of health services utilisation by refugees in resettlement countries: an overview of systematic reviews. AUST HEALTH REV 2020; 44:132-142. [PMID: 30654856 DOI: 10.1071/ah18108] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 10/11/2018] [Indexed: 12/11/2022]
Abstract
Objective The aim of this study was to provide an overview of the previously reviewed research literature to identify barriers and facilitators to health service utilisation by refugees in resettlement countries. Methods An overview of systematic reviews was conducted. Seven electronic databases (Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, ProQuest Central, Scopus, EBSCO and Google Scholar) were searched for systematic reviews of barriers and facilitators to health-seeking behaviour and utilisation of health services by refugees following resettlement. The two authors independently undertook data selection, data extraction and quality assessment using a validated tool. Results Nine systematic reviews covered a range of study areas and refugee populations. Barriers to health service utilisation fell into three broad areas: (1) issues related to refugees, including refugee characteristics, sociocultural factors and the effects of previous experiences; (2) issues related to health services, including practice issues and the knowledge and skills of health professionals; and (3) issues related to the resettlement context, including policies and practical issues. Few facilitators were identified or evaluated, but these included approaches to care, health service responses and behaviours of health professionals. Conclusions Barriers to accessing health care include refugee characteristics, practice issues in health services, including the knowledge and skills of health professionals, and the resettlement context. Health services need to identify barriers to culturally sensitive care. Improvements in service delivery are needed that meet the needs of refugees. More research is needed to evaluate facilitators to improving health care accessibility for these vulnerable groups. What is known about the topic? Refugee health after resettlement is poor, yet health service use is low. What does this paper add? Barriers to accessing health services in resettlement countries are related not only to refugees, but also to issues regarding health service practices and health professionals' knowledge and skill, as well as the context of resettlement. Few facilitators to improving refugee access to health services have been identified. What are the implications for practitioners? The barriers associated with health professionals and health services have been linked to trust building, and these need to be addressed to improve accessibility of care for refugees.
Collapse
Affiliation(s)
- Jamuna Parajuli
- Department of Public Health, La Trobe University, Bundoora, Vic. 3086, Australia; and Corresponding author.
| | - Dell Horey
- Department of Public Health, La Trobe University, Bundoora, Vic. 3086, Australia; and College of Science, Health and Engineering, La Trobe University, Bundoora, Vic. 3086, Australia.
| |
Collapse
|
27
|
Pérez-Escamilla B, Benrimoj SI, Martínez-Martínez F, Gastelurrutia MÁ, Varas-Doval R, Musial-Gabrys K, Garcia-Cardenas V. Using network analysis to explore factors moderating the implementation of a medication review service in community pharmacy. Res Social Adm Pharm 2020; 18:2432-2443. [PMID: 33461944 DOI: 10.1016/j.sapharm.2020.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/20/2020] [Accepted: 12/13/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Implementation factors are hypothesised to moderate the implementation of innovations. Although individual barriers and facilitators have been identified for the implementation of different evidence-based services in pharmacy, relationships between implementation factors are usually not considered. OBJECTIVES To examine how a network of implementation factors and the position of each factor within this network structure influences the implementation of a medication review service in community pharmacy. METHODS A mixed methods approach was used. Medication review with follow-up service was the innovation to be implemented over 12 months in community pharmacies. A network analysis to model relationships between implementation factors was undertaken. Two networks were created. RESULTS Implementation factors hindering the service implementation with the highest centrality measures were time, motivation, recruitment, individual identification with the organization and personal characteristics of the pharmacists. Three hundred and sixty-nine different interrelationships between implementation factors were identified. Important causal relationships between implementation factors included: workflow-time; characteristics of the pharmacy-time; personal characteristics of the pharmacists-motivation. Implementation factors facilitating the implementation of the service with highest centrality scores were motivation, individual identification with the organization, beliefs, adaptability, recruitment, external support and leadership. Four hundred and fifty-six different interrelationships were identified. The important causal relationships included: motivation-external support; structure-characteristics of the pharmacy; demographics-location of the pharmacy. CONCLUSION Network analysis has proven to be a useful technique to explore networks of factors moderating the implementation of a pharmacy service. Relationships were complex with most implementation factors being interrelated. Motivation and individual identification with the organisation seemed critical factors in both hindering and facilitating the service implementation. The results can inform the design of implementation programs and tailored strategies to promote faster implementation of innovations in pharmacy.
Collapse
Affiliation(s)
- Beatriz Pérez-Escamilla
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Grupo de Investigación en Atención Farmacéutica, Facultad de Farmacia, Sección de Farmacia Asistencial, Social y Legal, 5(a) planta, 18011, Granada, Spain.
| | - Shalom I Benrimoj
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Grupo de Investigación en Atención Farmacéutica, Facultad de Farmacia, Sección de Farmacia Asistencial, Social y Legal, 5(a) planta, 18011, Granada, Spain.
| | - Fernando Martínez-Martínez
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Grupo de Investigación en Atención Farmacéutica, Facultad de Farmacia, Sección de Farmacia Asistencial, Social y Legal, 5(a) planta, 18011, Granada, Spain.
| | - Miguel Ángel Gastelurrutia
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Grupo de Investigación en Atención Farmacéutica, Facultad de Farmacia, Sección de Farmacia Asistencial, Social y Legal, 5(a) planta, 18011, Granada, Spain.
| | - Raquel Varas-Doval
- General Pharmaceutical Council of Spain, Consejo General de Colegios Oficiales de Farmacéuticos, Calle Villanueva 11, 7(a) planta, 28001, Madrid, Spain.
| | - Katarzyna Musial-Gabrys
- University of Technology Sydney, School of Computer Science, Advanced Analytics Institute, School of Computer Science, Faculty of Engineering and IT, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia.
| | - Victoria Garcia-Cardenas
- University of Technology Sydney, Faculty of Health, Graduate School of Health, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia.
| |
Collapse
|
28
|
Viljoen B, Chambers SK, Dunn J, Ralph N, March S. Deciding to Enrol in a Cancer Trial: A Systematic Review of Qualitative Studies. J Multidiscip Healthc 2020; 13:1257-1281. [PMID: 33149597 PMCID: PMC7603415 DOI: 10.2147/jmdh.s266281] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/01/2020] [Indexed: 01/01/2023] Open
Abstract
Background Clinical trials are essential for the advancement of cancer treatments; however, participation by patients is suboptimal. Currently, there is a lack of synthesized qualitative review evidence on the patient experience of trial entry from which to further develop decision support. The aim of this review is to synthesise literature reporting experiences of participants when deciding to enrol in a cancer clinical trial in order to inform practice. Methods A systematic review and meta-synthesis of qualitative studies were conducted to describe the experiences of adult cancer patients who decided to enrol in a clinical trial of an anti-cancer treatment. Results Forty studies met eligibility criteria for inclusion. Three themes were identified representing the overarching domains of experience when deciding to enrol in a cancer trial: 1) need for trial information; (2) trepidation towards participation; and (3) justifying the decision. The process of deciding to enrol in a clinical trial is one marked by uncertainty, emotional distress and driven by the search for a cure. Conclusion Findings from this review show that decision support modelled by shared decision-making and the quality of a shared decision needs to be accompanied by tailored or personalised psychosocial and supportive care. Although the decision process bears similarities to theoretical processes outlined in decision-making frameworks, there are a lack of supportive interventions for cancer patients that are adapted to the clinical trial context. Theory-based interventions are urgently required to support the specific needs of patients deciding whether to participate in cancer trials.
Collapse
Affiliation(s)
- Bianca Viljoen
- Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Springfield, Brisbane, Australia.,Cancer Council Queensland, Brisbane, Australia.,School of Nursing & Midwifery, University of Southern Queensland, Toowoomba, Australia
| | - Suzanne K Chambers
- Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Springfield, Brisbane, Australia.,Cancer Council Queensland, Brisbane, Australia.,Faculty of Health, University of Technology Sydney, Sydney, Australia.,Australian and New Zealand Urogenital and Prostate Cancer (ANZUP) Trials Group, Sydney, NSW, Australia.,Prostate Cancer Foundation of Australia, Sydney, NSW, Australia.,Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia
| | - Jeff Dunn
- Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Springfield, Brisbane, Australia.,Cancer Council Queensland, Brisbane, Australia.,Faculty of Health, University of Technology Sydney, Sydney, Australia.,Australian and New Zealand Urogenital and Prostate Cancer (ANZUP) Trials Group, Sydney, NSW, Australia
| | - Nicholas Ralph
- Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Springfield, Brisbane, Australia.,School of Nursing & Midwifery, University of Southern Queensland, Toowoomba, Australia.,Faculty of Health, University of Technology Sydney, Sydney, Australia.,Australian and New Zealand Urogenital and Prostate Cancer (ANZUP) Trials Group, Sydney, NSW, Australia
| | - Sonja March
- Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Springfield, Brisbane, Australia.,School of Psychology and Counselling, University of Southern Queensland, Springfield, Brisbane, Australia
| |
Collapse
|
29
|
Bach-Mortensen AM, Verboom B. Barriers and facilitators systematic reviews in health: A methodological review and recommendations for reviewers. Res Synth Methods 2020; 11:743-759. [PMID: 32845574 DOI: 10.1002/jrsm.1447] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 07/26/2020] [Accepted: 08/21/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Systematic reviews cataloguing the barriers to and facilitators of various outcomes are increasingly popular, despite criticisms of this type of review on philosophical, methodological, and practical grounds. The aims of this review are to appraise, analyze, and discuss the reporting and synthesis practices used in recently published barriers and facilitators reviews in health services research. METHODS All English-language peer-reviewed systematic reviews that synthesized research on barriers and facilitators in a health services context were eligible for inclusion. We searched 11 databases over a 13-month period (1 November 2017-30 November 2018) using an exhaustive list of search terms for "barrier(s)," "facilitator(s)," and "systematic review." RESULTS One hundred reviews were included. We found a high degree of variation in the synthesis practices used in these reviews, with the majority employing aggregative (rather than interpretive) approaches. The findings echo common critiques of this review type, including concerns about the reduction of complex phenomena to simplified, discrete factors. Although several reviews highlighted the "complexity" of barriers and facilitators, this was usually not analyzed systematically. Analysis of the subsample of reviews that explicitly discussed the barriers and facilitators approach revealed some common issues. These tended to be either conceptual/definitional (eg, ideas about interrelationships and overlap between factors) and methodological/practical (eg, challenges related to aggregating heterogeneous research). CONCLUSION Barriers and facilitators reviews should (a) clearly operationally define "barrier" and "facilitator," (b) explicitly describe how factors are extracted and subsequently synthesized, and (c) provide critical reflection on the contextual variability and reliability of identified factors.
Collapse
Affiliation(s)
| | - Ben Verboom
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| |
Collapse
|
30
|
Al AdAwi RM, Stewart D, Ryan C, Tonna AP. A systematic review of pharmacist input to metabolic syndrome screening, management and prevention. Int J Clin Pharm 2020; 42:995-1015. [PMID: 32607719 PMCID: PMC7476979 DOI: 10.1007/s11096-020-01084-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 06/11/2020] [Indexed: 11/30/2022]
Abstract
Background Metabolic syndrome is a cluster of factors that increase the risk of cardiovascular disease and include: diabetes and prediabetes, abdominal obesity, elevated triglycerides, low high-density lipoprotein cholesterol and high blood-pressure. However, the role of the pharmacist in the metabolic syndrome has not yet been fully explored. Aim of the review This systematic review aimed to critically appraise, synthesise, and present the available evidence on pharmacists’ input to the screening, prevention and management of metabolic syndrome. Method The final protocol was based on the “Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P)”. Studies published in English from January 2008 to March 2020 reporting any pharmacist activities in the screening, prevention or management of metabolic syndrome were included. Databases searched were Medline, Cumulative Index to Nursing and Allied Health Literature, International Pharmaceutical Abstracts, Cochrane and Google Scholar. Studies were assessed for quality by two researchers, data extracted and findings synthesised using a narrative approach. Results Of the 39,430 titles reviewed, ten studies were included (four were randomised controlled trials). Most studies focused on pharmacist input to metabolic syndrome screening and management. Screening largely involved communicating metabolic parameters to physicians. Management of metabolic syndrome described pharmacists collaborating with members of the multidisciplinary team. A positive impact was reported in all studies, including achieving metabolic syndrome parameter goals, reverting to a non-metabolic syndrome status and, improved medication adherence. The populations studied were paediatrics with risk factors, adults with comorbidities and psychiatric patients. Integration of the pharmacist within the multidisciplinary team, an easy referral process and accessibility of service were potential facilitators. Inadequate funding was the key barrier. Conclusion The studies describing pharmacist input in metabolic syndrome provide limited evidence of positive outcomes from screening and management as part of collaborative practice. Further work is required to provide more robust evidence of effectiveness and cost-effectiveness while considering key barriers.
Collapse
Affiliation(s)
| | - Derek Stewart
- College of Pharmacy, QU Health, Qatar University, PO Box 2713, Doha, Qatar
| | - Cristin Ryan
- College of Pharmacy, Trinity College Dublin, Dublin, Ireland
| | - Antonella Pia Tonna
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, AB10 7AQ, Scotland, UK.
| |
Collapse
|
31
|
Medication review service implementation in community pharmacy settings: Scoping review with focus on implementation studies. Res Social Adm Pharm 2020; 16:875-885. [DOI: 10.1016/j.sapharm.2019.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/21/2019] [Accepted: 10/06/2019] [Indexed: 11/18/2022]
|
32
|
Deibl S, Mueller D, Kirchdorfer K, Stemer G, Hoppel M, Weidmann AE. Self-reported clinical pharmacy service provision in Austria: an analysis of both the community and hospital pharmacy sector-a national study. Int J Clin Pharm 2020; 42:1050-1060. [PMID: 32494989 DOI: 10.1007/s11096-020-01066-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 05/23/2020] [Indexed: 12/28/2022]
Abstract
Background With expansion of more advanced clinical roles for pharmacists we need to be mindful that the extent to which clinical pharmacy services are implemented varies from one country to another. To date no comprehensive assessment of number and types of services provided by either community or hospital pharmacies in Austria exists. Objective To analyse and describe the number and types of clinical pharmacy services provided in both community and hospital pharmacies, as well as the level of clinical pharmacy education of pharmacists across Austria. Setting Austrian community and hospital pharmacies. Method An electronic questionnaire to determine number and types of clinical pharmacy services provided was send to all chief pharmacists at all community (n = 1365) and hospital pharmacies (n = 40) across Austria. Besides current and future services provision, education and training provision were also assessed. Main outcome measure Extent of and attitude towards CPS in Austria. Results Response rates to the surveys were 19.1% (n = 261/1365) in community and 92.5% (n = 37/40) in hospital pharmacies. 59.0% and 89.2% of community and hospital pharmacies, respectively, indicated that the provision of clinical pharmacy services in Austria has increased substantially over the past 10 years. Fifty-one percent of community pharmacies reported to provide a medication review service, while 97.3% of hospitals provide a range of services. Only 18.0% of community pharmacies offer services other than medication review services at dispensing. Binary regressions show that provision of already established medication management is a predictor for the willingness of community pharmacists to extend the range of CPS (p < 0.01), while completed training in the area of clinical pharmacy is not (p > 0.05). More hospital than community pharmacists have postgraduate education in clinical pharmacy (17.4% vs 6.5%). A desire to complete postgraduate education was shown by 28.3% of community and 14.7% of hospital pharmacists. Lack of time, inadequate remuneration, lack of resources and poor relationship between pharmacists and physicians were highlighted as barriers. Conclusion Both community and hospital pharmacists show strong willingness to expand their service provision and will need continued support, such as improved legislative structures, more supportive resources and practice focused training opportunities, to further these services.
Collapse
Affiliation(s)
- S Deibl
- Österreichische Apothekerkammer, Spitalgasse 31, Postfach 87, 1091, Vienna, Austria.
| | - D Mueller
- Vienna Pharmacy Department, Hanusch-Hospital, Heinrich Collin-Straße 30, 1140, Vienna, Austria
| | - K Kirchdorfer
- Vienna Pharmacy Department, Hanusch-Hospital, Heinrich Collin-Straße 30, 1140, Vienna, Austria
| | - G Stemer
- Pharmacy Department, Vienna General Hospital - Medical University Campus, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - M Hoppel
- Österreichische Apothekerkammer, Spitalgasse 31, Postfach 87, 1091, Vienna, Austria
| | - A E Weidmann
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK
| |
Collapse
|
33
|
Factors influencing the implementation of clinical pharmacy services for hospitalized patients: A mixed-methods systematic review. Res Social Adm Pharm 2020; 16:437-449. [DOI: 10.1016/j.sapharm.2019.06.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 05/16/2019] [Accepted: 06/26/2019] [Indexed: 12/24/2022]
|
34
|
Fleury MJ, Grenier G, Farand L, Ferland F. Use of Emergency Rooms for Mental Health Reasons in Quebec: Barriers and Facilitators. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 46:18-33. [PMID: 30074113 DOI: 10.1007/s10488-018-0889-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study explored barriers and facilitators in mental health (MH) patient management in four Quebec (Canada) emergency rooms (ERs) that used different operational models. Forty-nine stakeholders (managers, physicians, ER and addiction liaison team members) completed semi-structured interviews. Barriers and facilitators affecting patient management emanated from health systems, patients, organizations, and from professionals themselves. Effective management of MH patients requires ER access to a rich network of outpatient, community-based MH services; integration of general and psychiatric ERs; on-site addiction liaison teams; round-the-clock ER staffing, including psychiatrists; ER staff training in MH; and adaptation to frequent and challenging ER users.
Collapse
Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada. .,Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada.
| | - Guy Grenier
- Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada
| | - Lambert Farand
- Department of Health Administration, Policy and Evaluation School of Public Health, University of Montreal, Montreal, QC, Canada
| | - Francine Ferland
- School of Social Work, Laval University, Quebec City, QC, Canada
| |
Collapse
|
35
|
Sato N, Fujita K, Kushida K, Chen TF. Exploring the factors influencing the quality of "Health Support Pharmacy" services in Japan: Perspectives of community pharmacists. Res Social Adm Pharm 2020; 16:1686-1693. [PMID: 32147461 DOI: 10.1016/j.sapharm.2020.02.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/05/2020] [Accepted: 02/19/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Internationally, community pharmacists play a key role in public health services. In Japan, a new system called Health Support Pharmacy (HSP) was introduced in 2016, to promote responsible self-medication with non-prescription medicines and increase awareness of public health activities provided through community pharmacies. The number of HSP services provided has been increasing; however, the service quality varies depending on pharmacies and/or pharmacists. Thus, it is important to identify factors that influence HSP service quality. OBJECTIVE To identify factors that can impact on the quality of HSP services provided by community pharmacists in Japan. METHODS In-depth semi-structured online interviews were conducted with twenty-four community pharmacists from across Japan. Interviews were audio-recorded, transcribed verbatim, and thematically analysed. All themes identified were deductively categorised into 3 domains using Donabedian's framework of structure, process and outcome. RESULTS Participants identified 8 key themes and 23 sub-themes pertaining to the quality of pharmacy public health services. For the structure domain these were: adequate resources, professional expertise, and policy and procedures. For the process domain these were: provision of individual services, provision of community health education and other events, and collaboration with other professionals. For the outcome domain these were: impact on individuals and the general public, and impact on other professionals. CONCLUSIONS This study identified factors which can impact HSP service quality by community pharmacists in Japan. Whilst the major themes identified align with those reported in other studies pertaining to expanded roles for community pharmacists, this study also identified findings which appear to be unique to the Japanese context. These findings, based on Donabedian's framework, may be used to better understand the scope and quality of HSP services delivered in Japan.
Collapse
Affiliation(s)
- Noriko Sato
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, Camperdown, New South Wales, 2006, Australia.
| | - Kenji Fujita
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, Camperdown, New South Wales, 2006, Australia.
| | - Kazuki Kushida
- Showa Pharmaceutical University, Faculty of Pharmacy, Tokyo, 194-8543, Japan.
| | - Timothy F Chen
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, Camperdown, New South Wales, 2006, Australia.
| |
Collapse
|
36
|
Groman AS, Chen XN, Lavigne JE. Applying the Model for Improvement to a Student-run Quality Improvement Project in a Refugee Center: A Pilot Study. Innov Pharm 2020; 11. [PMID: 34017641 PMCID: PMC8132537 DOI: 10.24926/iip.v11i1.2202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Due to insufficient communication strategies between healthcare providers and refugees in the United States, this quality improvement project aimed to improve disparity in refugee healthcare. We chose to focus on community pharmacist counseling sessions with refugees in the city of Rochester, New York. The two refugee populations we focused on were the Burmese and Nepali. Due to illiteracy in their native language, the refugees were not receptive to a pamphlet detailing the beneficial roles a pharmacy can have in improving their health and wellbeing. We created a pictorial survey of pharmacies near a refugee center to identify the pharmacies the refugees were utilizing in the area. Once we identified these pharmacies, we created a counseling aid booklet translating common pharmacy language/terms into English, Burmese, and Nepalese languages supported by pictorial diagrams. The counseling aid booklet was evaluated by pharmacists using a satisfaction scale. Overall, the counseling aid booklet was found to be helpful for the pharmacist’s daily interaction with refugee populations. Further plans for the counseling aid booklet include adding more pharmacy counseling terms for common disease states in refugee populations, making the book more inclusive of other languages, and implementation in more community pharmacies and other diverse healthcare settings.
Collapse
Affiliation(s)
- Aleah S Groman
- Wegmans School of Pharmacy, St John Fisher College, Rochester, New York
| | - Xiaodi N Chen
- Wegmans School of Pharmacy, St John Fisher College, Rochester, New York
| | - Jill E Lavigne
- Wegmans School of Pharmacy, St John Fisher College, Rochester, New York
| |
Collapse
|
37
|
A survey to assess the availability, implementation rate and remuneration of pharmacist-led cognitive services throughout Europe. Res Social Adm Pharm 2020; 16:41-47. [DOI: 10.1016/j.sapharm.2019.02.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 02/01/2019] [Accepted: 02/02/2019] [Indexed: 12/22/2022]
|
38
|
Wilson B, McMillan SS, Wheeler AJ. Implementing a clozapine supply service in Australian community pharmacies: barriers and facilitators. J Pharm Policy Pract 2019; 12:19. [PMID: 31406580 PMCID: PMC6685252 DOI: 10.1186/s40545-019-0180-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 05/15/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Clozapine is the most effective antipsychotic for treatment-resistant schizophrenia, although serious adverse effects such as agranulocytosis and cardiomyopathy limit its use. In July 2015, Australian regulations changed to allow community-based prescribing and supply of clozapine for maintenance therapy. However, there is currently no information on the rate of clozapine services available in Australian community pharmacies, or the factors that influence a pharmacist's decision to provide, or not provide, a clozapine service, particularly from the perspective of those pharmacists who do not offer this service. This study investigated Australian community pharmacies providing a clozapine supply service and the barriers to, and facilitators of, implementing this service. METHODS This mixed method exploratory study was conducted in two stages: (1) a brief online survey of community pharmacists Australia-wide; and (2) semi-structured telephone interviews. The survey was conducted between November 2017-January 2018; results were analysed via descriptive statistics. Survey respondents who did not provide a clozapine service were eligible to participate in a telephone interview exploring barriers and facilitators. Interviews were undertaken between December 2017-January 2018 and data analysed thematically. RESULTS A total of 265 pharmacists completed the survey; 51.3% (n = 136) provided a clozapine service. Consumer demand was a key facilitator (n = 18/247; 66.1%) and the main barrier to implementing a clozapine service was a perceived lack of need (n = 70/122; 57.4%). Twelve survey respondents were interviewed; while most participants acknowledged that supplying clozapine in community pharmacies would benefit consumers due to convenience, the lack of training and support led to difficulties in service implementation. CONCLUSIONS Although regulatory changes aimed to improve access to clozapine, it is unclear if they have been successful, or to what degree. Community pharmacists were positive about supplying clozapine in the community but identified a need for training and support to raise awareness of the service so that eligible clozapine consumers can be transitioned to community-based care. Further research is needed about the perceptions of clozapine consumers to determine whether the regulatory changes have resulted in positive outcomes for their independence and quality of life.
Collapse
Affiliation(s)
- Bethany Wilson
- School of Pharmacy and Pharmacology, Griffith University, Gold Coast, Australia
| | - Sara S. McMillan
- School of Pharmacy and Pharmacology, Quality Use of Medicines Network, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Amanda J. Wheeler
- School of Human Services and Social Work, Quality Use of Medicines Network, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| |
Collapse
|
39
|
Nazar ZJ, Nazar H, White S, Rutter P. A systematic review of the outcome data supporting the Healthy Living Pharmacy concept and lessons from its implementation. PLoS One 2019; 14:e0213607. [PMID: 30861046 PMCID: PMC6414028 DOI: 10.1371/journal.pone.0213607] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 02/25/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The Healthy Living Pharmacy (HLP) project, launched in England, UK in 2009 was a novel approach of introducing public health services within community pharmacy to tackle local health inequalities. A national roll-out followed a reported successful pilot; subsequent local evaluations ensued. OBJECTIVES To summarise reported outcomes and investigate contextual factors that indicate the presence, absence and maturity of implementation determinants, thus offering useful lessons to stakeholders in implementing future initiatives to achieve successful outcomes. METHODS A systematic review was conducted to identify all publications reporting on the HLP project. All HLP articles and conference abstracts were considered for inclusion and were assessed for methodological quality. The Consolidated Framework for Implementation Research (CFIR) was utilised to identify potential implementation determinants reported. Each article was then analysed to identify reported economic, humanistic or clinical outcomes. RESULTS The review included six peer-reviewed journal articles and 12 conference abstracts. Joanna Briggs Institute Qualitative Assessment and Review Instrument indicated deficiencies in methodological quality. Through adoption of the CFIR framework, the implementation determinants relevant to the implementation of HLP into community pharmacy were identified. A resonating issue emerged in that the absence of adopting an evidence-based implementation process limited the ability to capture meaningful outcome data. This resulted in a lack of evidence to support sustainability and the failure to address many of the well cited barriers, e.g. lack of awareness amongst patients, public and other healthcare professionals, and weak support for future investment in resource for training and dissemination. CONCLUSIONS Healthcare systems are increasingly called on to adopt evidence-based interventions that improve quality, control costs, and maximize value, thus offering opportunity to accelerate the implementation of clinical pharmacy services and programs aimed at improving patient care. Interventions, such as the HLP project require focused efforts on implementation and evaluation of those implementation efforts to produce effective and lasting changes in complex health care systems.
Collapse
Affiliation(s)
| | - Hamde Nazar
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Simon White
- School of Pharmacy, Keele University, Keele, United Kingdom
| | - Paul Rutter
- School of Pharmacy and Biomedical Science, University of Portsmouth, Portsmouth, United Kingdom
| |
Collapse
|
40
|
Hindi AMK, Schafheutle EI, Jacobs S. Community pharmacy integration within the primary care pathway for people with long-term conditions: a focus group study of patients', pharmacists' and GPs' experiences and expectations. BMC FAMILY PRACTICE 2019; 20:26. [PMID: 30736732 PMCID: PMC6368723 DOI: 10.1186/s12875-019-0912-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 01/24/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND This study aimed to use marketing theory to examine the views of patients, pharmacists and general practitioners (GPs) on how community pharmacies are currently used and to identify how community pharmacy services may be better integrated within the primary care pathway for people with long-term conditions (LTCs). METHODS A qualitative research design was used. Two focus groups were conducted with respiratory patients (n = 6, 5) and two with type 2 diabetes patients (both n = 5). Two focus groups were held with pharmacists (n = 7, 5) and two with GPs (both n = 5). The "7Ps marketing mix" ("product", "price", "place", "promotion", "people", "process", "physical evidence") was used to frame data collection and analysis. Data was analysed using thematic analysis. RESULTS Due to the access and convenience of community pharmacies ("place"), all stakeholder groups recommended using community pharmacies over GP practices for services such as management of minor ailments, medication reviews and routine check-ups for well managed LTCs ("product"). All stakeholder groups preferred pharmacy services with clear specifications which focused on specific interventions to reduce variability in service delivery and quality ("process"). However, all stressed the importance of having an appropriate system to share relevant information, allowing pharmacists and GPs two-way flow ("process"). Pharmacists and GPs mentioned difficulties in collaborating with each other due to inter-professional tensions arising from funding conflicts, which leads to duplication of services and inefficient workflow within the primary care pathway ("people"). Patients and GPs were sometimes doubtful of community pharmacies' potential to expand services due to limited space, size and poor quality consultation rooms ("physical evidence"). However, all stakeholder groups recommended promoting community pharmacy services locally and nationally ("promotion"). Patients felt the most effective form of promotion was first-hand experience of high quality pharmacy services and peer word-of-mouth. The added value of using pharmacy services was faster access and convenience for patients, and freeing up GPs' time to focus on more complex patients ("value"). CONCLUSIONS Using the 7Ps marketing mix highlighted factors which could influence utilisation and integration of community pharmacy services within the primary care pathway for patients with LTCs. Further research is needed to identify their relative importance.
Collapse
Affiliation(s)
- Ali M. K. Hindi
- Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry, The University of Manchester, Oxford Road, Manchester, M13 9PT UK
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PT UK
| | - Ellen I. Schafheutle
- Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry, The University of Manchester, Oxford Road, Manchester, M13 9PT UK
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PT UK
| | - Sally Jacobs
- Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry, The University of Manchester, Oxford Road, Manchester, M13 9PT UK
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PT UK
| |
Collapse
|
41
|
Frisk P, Holtendal C, Bastholm-Rahmner P, Sporrong SK. Competence, competition and collaboration: Perceived challenges among Swedish community pharmacists engaging in pharmaceutical services provision and research. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2019; 27:346-354. [DOI: 10.1111/ijpp.12518] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 01/07/2019] [Indexed: 11/30/2022]
Abstract
Abstract
Background
Creating evidence of effectiveness is an important part of service development. In an ongoing research project Swedish community pharmacists participate in services research by recruiting patients initiated on statins to an adherence-promoting cognitive pharmaceutical service, jointly run by nurses and pharmacists.
Aims
To explore the pharmacists’ experiences of providing part of the service and their views regarding future participation in practice research aiming at developing cognitive pharmaceutical services.
Methods
Focus group interviews were conducted with community pharmacists from pharmacies participating in the project. A semi-structured interview guide was developed, based on the aim and earlier research.
Results
The domains identified were the service itself, operative conditions, the pharmacists’ role/profession and stakeholders. The research project was thought to promote the local pharmacy to customers, increase job satisfaction and contribute to service development. However, a perceived lack of competence among pharmacists affected both patient communication and project involvement. Additional resources and strengthened collaboration with other local healthcare were requested. Competition among pharmacy chains was identified as a barrier to patient-centred service provision and research.
Conclusion
The current operative conditions in Swedish community pharmacies were perceived by pharmacists as hampering cognitive pharmaceutical services provision and research. Additional resources, improved communication skills and research competence, and increased collaboration with other healthcare and across pharmacy chains are necessary changes. A stronger patient-centred perspective among all stakeholders is required.
Collapse
Affiliation(s)
- Pia Frisk
- Public Healthcare Services Committee, Stockholm County Council, Stockholm, Sweden
| | | | - Pia Bastholm-Rahmner
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | | |
Collapse
|
42
|
Buss VH, Shield A, Kosari S, Naunton M. The impact of clinical services provided by community pharmacies on the Australian healthcare system: a review of the literature. J Pharm Policy Pract 2018. [DOI: 10.1186/s40545-018-0149-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
43
|
Hossain LN, Tudball J, Franco-Trigo L, Durks D, Benrimoj SI, Sabater-Hernández D. A multilevel stakeholder approach for identifying the determinants of implementation of government-funded community pharmacy services at the primary care level. Res Social Adm Pharm 2018; 14:765-775. [DOI: 10.1016/j.sapharm.2017.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/20/2017] [Accepted: 10/01/2017] [Indexed: 10/18/2022]
|
44
|
Dillon P, Smith SM, Gallagher P, Cousins G. Medication monitoring attitudes and perceived determinants to offering medication adherence advice to older hypertensive adults: a factorial survey of community pharmacy interns. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2018; 27:45-54. [PMID: 29897646 DOI: 10.1111/ijpp.12463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 04/26/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Community pharmacy is an ideal setting to monitor medication adherence, however, barriers to pharmacist-led interventions exist. Preparing future pharmacists for enhanced roles may overcome such barriers. Our objective was to identify medication monitoring attitudes and contextual factors that influence adherence monitoring by pharmacy interns to inform educational activities on medication adherence. METHODS An online factorial survey of all pharmacy interns (N = 123) in the Republic of Ireland, completing advanced community pharmacy experiential learning in May 2016 was undertaken to evaluate attitudes to medication monitoring and to identify respondent characteristics and contextual factors which influence adherence monitoring of older hypertensive adults during repeat dispensing. The medication monitoring attitude measure (MMAM) was used to evaluate interns' attitudes, and factorial vignette analysis was performed to identify factors influencing behavioural intention to offer adherence advice. RESULTS There were 121 completed online surveys. Half of interns reported they felt uncomfortable and confrontational discussing adherence with patients. In factorial vignette analysis, higher medication monitoring attitudes resulted in higher likelihood to offer adherence advice; experiential-learning characteristics such as pharmacy ownership-type (nonchain store) and contextual factors including patients being treated for longer and time-pressures had a significant negative influence on pharmacy interns' likelihood to offer adherence advice. DISCUSSION Medication monitoring attitudes and contextual factors influenced responses to offer adherence advice in hypothetical scenarios. Ensuring pharmacy students are educated on patterns of adherence and appropriate skills to address nonadherence, and engage in structured programmes to facilitate patient interactions during experiential learning, may improve medication monitoring attitudes and adherence monitoring.
Collapse
Affiliation(s)
- Paul Dillon
- School of Pharmacy, RCSI, St. Stephen's Green, Dublin 2, Ireland
| | - Susan M Smith
- Department of General Practice and HRB Centre for Primary Care Research, RCSI, St. Stephen's Green, Dublin 2, Ireland
| | - Paul Gallagher
- School of Pharmacy, RCSI, St. Stephen's Green, Dublin 2, Ireland
| | - Gráinne Cousins
- School of Pharmacy, RCSI, St. Stephen's Green, Dublin 2, Ireland
| |
Collapse
|
45
|
Silva SN, Lima MG, Ruas CM. Pharmaceutical interventions in mental health: A review of the literature to support evidence-informed policymaking. Res Social Adm Pharm 2017; 14:891-900. [PMID: 29195731 DOI: 10.1016/j.sapharm.2017.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 11/23/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pharmaceutical interventions may have an impact on different treatment aspects, such as therapy adherence, reducing the number of different medications in use and lowering treatment costs. OBJECTIVE Identify pharmaceutical interventions in the mental health field and their possible application in Brazilian public mental health services, considering the evidence-based model to establish implementation options. METHODS A structured search of the literature was performed in the Pubmed (Medline), Cochrane, PsycINFO and Lilacs databases to identify the main pharmaceutical intervention studies conducted in the mental health area. The articles selected were evaluated according to the quality of the evidence. The current laws and public database were researched to collect information on services and procedures provided by the Brazilian units, known as CAPS, and the number the pharmacists allocated to them. The proposal to synthesize the results of pharmaceutical interventions in Brazil was based on SUPPORT methodology items to prepare evidence-based policies. RESULTS A total of 1442 studies were identified, 18 of which were included. Several interventions are reported in the literature, educational interventions being frequently cited. However, there is a need for further studies with more methodological rigor. The number of pharmacists working in the CAPS is insufficient to cover all the services, since only 26.5% of CAPS employ pharmacists, who work an average of 29 (±11.1) hours a week. Three options were formulated to implement interventions in the Brazilian context that consider including pharmacists on the basic team of CAPS professionals and educational interventions through pharmacist training. CONCLUSIONS The present study could support the establishment of health policies, based on a synthesis of the evidence, contextualization of the current situation, given the absence of local evidence, and a discussion of the options available to implement pharmaceutical interventions in the Brazilian health system. Organizational changes in CAPS are needed to broaden pharmacist participation on the multidisciplinary team.
Collapse
Affiliation(s)
- Sarah Nascimento Silva
- Department of Social Pharmacy, School of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.
| | - Marina Guimarães Lima
- Department of Social Pharmacy, School of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Cristina Mariano Ruas
- Department of Social Pharmacy, School of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| |
Collapse
|