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Fitzmaurice Y, Beeke S, Isaksen J, Cunningham U, Jagoe C, Shé ÉN, McMenamin R. Communication partner training for student health and social care professionals engaging with people with stroke acquired communication difficulties: A protocol for a realist review. HRB Open Res 2024; 6:60. [PMID: 38384971 PMCID: PMC10879762 DOI: 10.12688/hrbopenres.13783.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 02/23/2024] Open
Abstract
Background Stroke acquired communication impairments impede effective communication. Consequently, in stroke care, communicative interactions can be challenging for both patients and staff and can predispose patients to increased risk of preventable adverse events. Communication partner training (CPT) can mitigate such negative outcomes by optimising communicative interactions. Providing CPT to student health and social care professionals (SH&SCPs) has the potential to enhance their clinical expertise and experiences and enhance the future clinical care of patients with stroke acquired communication impairments. This research aims to expand our understanding of how CPT is operationalised for SH&SCPs in higher education institutions and determine: what works; for whom; in what contexts; how and why? Methods This review is Phase 1 of a research project employing a realist approach with public and patient involvement (PPI). It incorporates five iterative steps: 1.) Clarifying the scope; 2.) Searching for evidence; 3.) Selecting and appraising evidence; 4.) Data extraction; 5.) Synthesising data and developing a middle range theory explaining how CPT is expected to work for SH&SCPs. An advisory panel, including PPI advisors, content advisors, student advisors, realist advisors and educationalist advisor has been set up to consult throughout the review and collaboratively agree the middle range theory. Discussion While there is an evolving evidence base for CPT, including stroke specific CPT for SH&SCPs, it is acknowledged that there are challenges to its implementation in complex real-world settings. In combining empirical evidence with theoretical understanding, realist review permits synthesis of data from diverse sources and goes beyond determining efficacy to explore generative causation and solutions for real world practice. A middle range realist programme theory that coherently explains how CPT is expected to work when teaching SH&SCPs to communicate with people with stroke acquired communication impairments will provide educators with new insights into CPT development and implementation in their higher education institutions.
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Affiliation(s)
- Yvonne Fitzmaurice
- School of Health Sciences, University of Galway, Galway, H91 TK33, Ireland
| | - Suzanne Beeke
- Division of Psychology and Language Sciences, University College London, London, England, WC1E 6BT, UK
| | - Jytte Isaksen
- Department of Language, Culture, History and Communication, University of Souhern Denmark, Odense, Denmark
| | - Una Cunningham
- Mater Misericordiae University Hospital, Dublin, D07 R2WY, Ireland
| | - Caroline Jagoe
- School of Linguistics, Speech and Communication Sciences, The University of Dublin Trinity College, Dublin, Leinster, D02 PN40, Ireland
- Speech Pathology and Audiology, School of Human and Communication Development, University of Witwatersrand, Johannesburg, South Africa
| | - Éidín Ní Shé
- Graduate School of Healthcare Management, RCSI University of Medicine and Health Sciences, Dublin, D02 YN77, Ireland
| | - Ruth McMenamin
- School of Health Sciences, University of Galway, Galway, H91 TK33, Ireland
- PPI Ignite Network @ University of Galway, University of Galway, Galway, H91 TK33, Ireland
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Morris C, McDonald J, Officer TN, Fa'asalele Tanuvasa A, Smiler K, Parore N, Dunn P, McKinlay E, Kennedy J, McBride-Henry K, Cumming J. A realist evaluation of the development of extended pharmacist roles and services in community pharmacies. Res Social Adm Pharm 2024; 20:321-334. [PMID: 38065764 DOI: 10.1016/j.sapharm.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 11/14/2023] [Accepted: 11/14/2023] [Indexed: 02/18/2024]
Abstract
BACKGROUND Internationally, community pharmacy models of care have been moving away from a focus on dispensing to extended, clinically-focused roles for pharmacists. OBJECTIVES To identify how community pharmacy strategies were being implemented in Aotearoa New Zealand; how changes were expected to influence health and health system outcomes; what extended services were being delivered; the responses of pharmacists, other health professionals and consumers to these developments; and the contexts and mechanisms supporting the successful implementation of new community pharmacy services. METHODS A realist evaluation methodology was employed, to explore a complex policy intervention. Realist evaluation explores the contexts (C) within which initiatives are introduced and identifies the mechanisms (M) triggered by different contexts to produce outcomes (O). Realist evaluation processes iteratively develop, test, and refine CMO configurations. In this study, initial programme theories were developed through key government and professional policy documents, then refined through key informant interviews, a survey and interviews with pharmacists and intern (pre-registration) pharmacists, and finally, 10 case studies of diverse community pharmacies. RESULTS Four intermediate health service outcomes were identified: development of extended community pharmacist services; consumers using extended community pharmacist services; more integrated, collaborative primary health care services; and a fit-for-purpose community pharmacy workforce. Enabling and constraining contexts are detailed for each outcome, along with the mechanisms that they trigger (or inhibit). CONCLUSIONS There are wide-ranging and disparate levers to support the further development of extended community pharmacy services. These include aligning funding with desired services, undergraduate educators and professional leaders setting expectations for the pharmacists' role in practice, and the availability of sufficient funding and time for both specific extended service accreditation and broader postgraduate training. However, no simple "fix" can be universally applied internationally, nor even in pharmacies within a single jurisdiction, to facilitate service development.
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Affiliation(s)
- Caroline Morris
- Department of Primary Health Care & General Practice, University of Otago, Wellington, PO Box 7343, Newtown, Wellington, 6242, New Zealand.
| | - Janet McDonald
- Te Hikuwai Rangahau Hauora, Health Services Research Centre, Te Herenga Waka-Victoria University of Wellington, PO Box 600, Wellington, 6140, New Zealand.
| | - Tara Nikki Officer
- Te Hikuwai Rangahau Hauora, Health Services Research Centre, Te Herenga Waka-Victoria University of Wellington, PO Box 600, Wellington, 6140, New Zealand.
| | - Ausaga Fa'asalele Tanuvasa
- Te Hikuwai Rangahau Hauora, Health Services Research Centre, Te Herenga Waka-Victoria University of Wellington, PO Box 600, Wellington, 6140, New Zealand.
| | - Kirsten Smiler
- Te Hikuwai Rangahau Hauora, Health Services Research Centre, Te Herenga Waka-Victoria University of Wellington, PO Box 600, Wellington, 6140, New Zealand.
| | - Nora Parore
- Te Hikuwai Rangahau Hauora, Health Services Research Centre, Te Herenga Waka-Victoria University of Wellington, PO Box 600, Wellington, 6140, New Zealand.
| | - Phoebe Dunn
- Te Hikuwai Rangahau Hauora, Health Services Research Centre, Te Herenga Waka-Victoria University of Wellington, PO Box 600, Wellington, 6140, New Zealand.
| | - Eileen McKinlay
- Department of Primary Health Care & General Practice, University of Otago, Wellington, PO Box 7343, Newtown, Wellington, 6242, New Zealand.
| | - Jonathan Kennedy
- Department of Primary Health Care & General Practice, University of Otago, Wellington, PO Box 7343, Newtown, Wellington, 6242, New Zealand.
| | - Karen McBride-Henry
- Te Hikuwai Rangahau Hauora, Health Services Research Centre, Te Herenga Waka-Victoria University of Wellington, PO Box 600, Wellington, 6140, New Zealand.
| | - Jacqueline Cumming
- Te Hikuwai Rangahau Hauora, Health Services Research Centre, Te Herenga Waka-Victoria University of Wellington, PO Box 600, Wellington, 6140, New Zealand.
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Leafe N, Pagnamenta E, Taggart L, Donnelly M, Hassiotis A, Titterington J. What works, how and in which contexts when supporting parents to implement intensive speech and language therapy at home for children with speech sound disorder? A protocol for a realist review. BMJ Open 2024; 14:e074272. [PMID: 38184311 PMCID: PMC10773357 DOI: 10.1136/bmjopen-2023-074272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 11/07/2023] [Indexed: 01/08/2024] Open
Abstract
INTRODUCTION Speech and language therapists (SLTs) worldwide report challenges with providing recommended, evidence-based intervention intensity for children with speech sound disorder (SSD). Challenges such as service constraints and/or family contexts impact on access to optimal therapy intensity. Existing research indicates that empowering and training parents to deliver intervention at home, alongside SLT support, offers one possible solution to increasing the intensity of intervention children with SSD receive. Digital health could increase accessibility to intensive home practice and help sustain engagement with therapy activities. Further exploration is needed around what makes parent-implemented interventions for children with SSD effective, for who and in which situations. This paper outlines the protocol for a realist review which aims to explore the active ingredients and contextual factors of effective digital parent-led interventions. METHODS AND ANALYSIS A realist review will explore the research question, following six stages. The scope of the review will be determined, and initial programme theories will be developed about what works in digital parent-implemented interventions for SSD, for whom, how, why and in what circumstances. Relevant secondary data, identified through a formal search strategy, will be selected, appraised, analysed and synthesised using realist principles to test and further refine the initial programme theories. This process will develop refined underpinning explanatory theories which capture the interaction between contexts, mechanisms and outcomes of the intervention. An expert steering group will provide insight to inform explanatory theories, searches, and dissemination. ETHICS AND DISSEMINATION Ethical approval is not required for this review. The refined programme theories from the review will inform the next stages of a wider study. A subsequent realist evaluation will test and further refine theories with key stakeholders. Following this, the underpinning programme theory will be used to coproduce a digital tool, to support parents to deliver home intervention alongside SLT support.
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Affiliation(s)
- Naomi Leafe
- Institute of Nursing and Health Research, Ulster University, Belfast, UK
| | - Emma Pagnamenta
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Laurence Taggart
- Institute of Nursing and Health Research, Ulster University, Belfast, UK
| | | | - Angela Hassiotis
- Psychiatry and Behavioural Sciences, Royal Free and University College Medical School, London, UK
| | - Jill Titterington
- Institute of Nursing and Health Research, Ulster University, Belfast, UK
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James R, Hodson K, Mantzourani E, Davies D. Exploring the implementation of Discharge Medicines Review referrals by hospital pharmacy professionals: A qualitative study using the consolidated framework for implementation research. Res Social Adm Pharm 2023; 19:1558-1569. [PMID: 37634995 DOI: 10.1016/j.sapharm.2023.08.006] [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: 06/15/2023] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND The Discharge Medicines Review (DMR) is a community pharmacy service in Wales that aims to reduce medicines-related harm after care transitions, including hospital discharge. To undertake a DMR, the Community Pharmacist must receive a patient's discharge medicines information, either electronically, by fax or presented by the patient. Although the DMR has evidenced benefits for improving patient safety, its evaluation showed inconsistent uptake, which Community Pharmacists partially attributed to hospitals not providing the necessary information. OBJECTIVE Aiming to develop recommendations to improve hospital engagement to DMR referrals, this study explores hospital pharmacy professionals' views of the service. METHODS Qualitative focus groups, using hermeneutic phenomenology, were conducted in 16 hospitals across Wales, using a quota sampling method to include 61 Pharmacists and 31 Pharmacy Technicians. To understand the suboptimal engagement to DMR referrals, framework analysis was undertaken using the Consolidated Framework for Implementation Research (CFIR). RESULTS The data were mapped onto all five CFIR domains, each containing barriers and facilitators to engagement with DMR referrals and suggestions for improvement. Only one hospital had successfully implemented DMR referrals, with many participants lacking any knowledge of the service or how to refer to it. Specific barriers included a clear absence of processes to implement referrals and engage hospital pharmacy professionals. A considerable barrier was many participants' perceptions that Community Pharmacist roles were less clinically orientated and patient-centred than their own, viewing them almost as a different profession. Participants believed that local champions for DMR referrals could promote engagement and integrate them into the workflow of hospital pharmacy professionals. Further recommendations to improve engagement was staff training for DMRs and regular feedback of its value. CONCLUSION Policymakers may use the findings and recommendations from this study to promote hospital pharmacy staff engagement to similar community pharmacy services like the Discharge Medicines Service in England.
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Affiliation(s)
- Robert James
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK.
| | - Karen Hodson
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
| | - Efi Mantzourani
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK; Digital Health and Care Wales, NHS Wales, Cardiff, Wales, UK
| | - Duncan Davies
- Pharmacy Department, Swansea Bay University Health Board, Swansea, Wales, UK
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Basger BJ, Moles RJ, Chen TF. Uptake of pharmacist recommendations by patients after discharge: Implementation study of a patient-centered medicines review service. BMC Geriatr 2023; 23:183. [PMID: 36991378 PMCID: PMC10061906 DOI: 10.1186/s12877-023-03921-2] [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: 07/17/2022] [Accepted: 03/22/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Polypharmacy and potentially inappropriate medicine use is common in older people, resulting in harm increased by lack of patient-centred care. Hospital clinical pharmacy services may reduce such harm, particularly prevalent at transitions of care. An implementation program to achieve such services can be a complex long-term process. OBJECTIVES To describe an implementation program and discuss its application in the development of a patient-centred discharge medicine review service; to assess service impact on older patients and their caregivers. METHOD An implementation program was begun in 2006. To assess program effectiveness, 100 patients were recruited for follow-up after discharge from a private hospital between July 2019 and March 2020. There were no exclusion criteria other than age less than 65 years. Medicine review and education were provided for each patient/caregiver by a clinical pharmacist, including recommendations for future management, written in lay language. Patients were asked to consult their general practitioner to discuss those recommendations important to them. Patients were followed-up after discharge. RESULTS Of 368 recommendations made, 351 (95%) were actioned by patients, resulting in 284 (77% of those actioned) being implemented, and 206 regularly taken medicines (19.7 % of all regular medicines) deprescribed. CONCLUSION Implementation of a patient-centred medicine review discharge service resulted in patient-reported reduction in potentially inappropriate medicine use and hospital funding of this service. This study was registered retrospectively on 12th July 2022 with the ISRCTN registry, ISRCTN21156862, https://www.isrctn.com/ISRCTN21156862 .
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Affiliation(s)
- Benjamin Joseph Basger
- Discipline of Pharmacy Practice, Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Room N517, A15 Science Road, Camperdown, Sydney, NSW, 2006, Australia.
- Wolper Jewish Hospital, 8 Trelawney Street, Woollahra, Sydney, NSW, 2025, Australia.
| | - Rebekah Jane Moles
- Discipline of Pharmacy Practice, Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Room N517, A15 Science Road, Camperdown, Sydney, NSW, 2006, Australia
| | - Timothy Frank Chen
- Discipline of Pharmacy Practice, Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Room N517, A15 Science Road, Camperdown, Sydney, NSW, 2006, Australia
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Duddy C, Wong G. Grand rounds in methodology: when are realist reviews useful, and what does a 'good' realist review look like? BMJ Qual Saf 2023; 32:173-180. [PMID: 36585019 DOI: 10.1136/bmjqs-2022-015236] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 12/07/2022] [Indexed: 01/01/2023]
Abstract
Research in the quality and safety field often necessitates an approach that supports the development of an in-depth understanding of how a complex phenomenon occurs, or how an intervention works. Realist review is an increasingly popular form of evidence synthesis that provides a theory-driven, interpretive approach to secondary research. Realist reviews offer quality and safety researchers the opportunity to draw on diverse types of evidence to develop explanatory theory about how, when and for whom interventions 'work' or outcomes occur. The approach is flexible, iterative and practical, typically drawing on the experience of policymakers, practitioners and patients throughout the review. With the increasing use of realist reviews, some common misconceptions about the approach have become evident in the literature. This paper introduces what is involved when planning and conducting a realist review, and where the approach can offer most value, as well as outlining common challenges that researchers may face when adopting the approach, and recommended solutions. Our aim is to support researchers who are considering conducting a realist review to understand the key principles and concepts involved, and how they can go about producing high-quality work.
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Affiliation(s)
- Claire Duddy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Tarrant C, Lewis R, Armstrong N. Polypharmacy and continuity of care: medicines optimisation in the era of multidisciplinary teams. BMJ Qual Saf 2023; 32:121-124. [PMID: 36216498 DOI: 10.1136/bmjqs-2022-015082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Carolyn Tarrant
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Rachel Lewis
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Natalie Armstrong
- Department of Health Sciences, University of Leicester, Leicester, UK
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Sørensen CA, Jeffery L, Falhof J, Harbig P, Roelsgaard K, Gram S, Olesen C. Developing and piloting a cross-sectoral hospital pharmacist intervention for patients in transition between hospital and general practice. Ther Adv Drug Saf 2023; 14:20420986231159221. [PMID: 36949765 PMCID: PMC10026123 DOI: 10.1177/20420986231159221] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/06/2023] [Indexed: 03/19/2023] Open
Abstract
Background Healthcare is challenged by a rapidly growing group of patients with multi-morbidity and polypharmacy. Increasing activity and specialization puts pressure on healthcare sectors. Medication errors in cross-sectoral transition of patients are often seen. The aim of the study was to explore drug-related problems (DRPs) in the transition of patients between sectors and to develop and pilot-test a cross-sectoral hospital pharmacist intervention to overcome some of these problems. Methods DRPs in cross-sectoral transitions were explored from four perspectives; the literature, the primary and secondary healthcare sector and the patients. An intervention was developed from the findings through co-creation between pharmacists, doctors and a nurse. The intervention was piloted and evaluated from data on the included patients and the activities performed. Results DRPs in transitions from general practice (GP) to hospital were caused by inadequate focus on updating the Shared Medication Record (SMR). For patients being discharged, DRPs were described with multiple facets; for example, missing information on medication changes, lacking patient involvement and problems with dose-dispensed medicine or electronic prescriptions. An intervention with a pharmacist in a shared employment between Hospital Pharmacy and GP was developed and piloted. The intervention included medication reconciliation and updating SMR for patients referred to hospital; and medication review, overview of medication changes and follow-up telephone calls for patients discharged from hospital. The intervention identified and solved several DRPs; in this way, medication errors were avoided. Access to health records in both sectors was important in the identification and resolution of DRPs. Conclusion DRPs in cross-sectoral transitions are multifaceted and the experiences depend on the point of view. The cross-sectoral hospital pharmacist intervention identified and solved several DRPs and medication errors were avoided. The intervention made sense to both healthcare sectors and patients. Shared employment and unique access to health records in both sectors showed to be of importance in the identification and resolution of DRPs. Plain language summary Development and pilot-test of a pharmacist intervention for patients in transition between hospital and general practice Background: Healthcare is challenged by a rapidly growing group of patients with multiple chronic diseases treated with several drugs at the same time. The aim of the study was to explore drug-related problems in the transition of patients between the hospital and patients' general practitioner and to develop and pilot-test a pharmacist intervention to overcome some of these problems.Methods: Drug-related problems in patient transitions were explored from the perspectives of the hospital, the general practitioner, the patients and the literature. An intervention was developed from the findings by pharmacists, doctors and a nurse. The intervention was pilot-tested and evaluated from the descriptions of the included patients and activities performed.Results: Drug-related problems in transitions from general practice to hospital were caused by inadequate focus on updating the Shared Medication Record.For patients being discharged, drug-related problems were related to for examplemissing information on medication changessparse involvement of the patient in their own treatmentproblems with medicine dispensed on a dose dispensing machine at the local pharmacy.An intervention with a pharmacist in a shared employment between Hospital Pharmacy and general practice was developed and piloted. The intervention includedtalking to the patient about their medication and updating the Shared Medication Record for patients referred to hospitalmedication review, overview of medication changes and follow-up telephone calls for patients discharged from hospital to general practice.The intervention identified and solved several drug-related problems. Access to health records in both the general practice and at the hospital was important in the identification of drug-related problems.Conclusions: Drug-related problems in cross-sectoral transitions are multifaceted. The pharmacist intervention identified and solved several drug-related problems. The intervention made sense to the general practitioner, hospital and patients. Shared employment and unique access to health records in both the general practice and at the hospital showed to be of importance in the identification of drug-related problems.
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Affiliation(s)
| | - Linda Jeffery
- Hospital Pharmacy Central Denmark Region,
Clinical Pharmacy, Silkeborg, Denmark
| | | | - Philipp Harbig
- Research Unit for General Practice, Aarhus
University, Aarhus, Denmark
| | | | - Solveig Gram
- Emergency Department, Randers Regional
Hospital, Randers, Denmark
| | - Charlotte Olesen
- Hospital Pharmacy Central Denmark Region,
Research & Development, Aarhus, Denmark
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Angley M, Criddle D, Rigby D, Elliott RA, Phillips K, Penm J, Sluggett JK, Gailer J, Thiele H, Page AT, Pauw C, Gillespie S, Shakib S, Yik J. Hospital‐initiated post‐discharge medication reviews in Australia: expert opinion on the barriers and enablers to implementation. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2022. [DOI: 10.1002/jppr.1832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Manya Angley
- Manya Angley Research and Consulting Adelaide Australia
| | - Deirdre Criddle
- Complex Needs Coordination Team and Sir Charles Gairdner Hospital Pharmacy Department Sir Charles Gairdner Hospital Nedlands Australia
| | | | - Rohan A. Elliott
- Pharmacy Department, Austin Health and Faculty of Pharmacy and Pharmaceutical Sciences, Monash University Melbourne Australia
| | | | - Jonathan Penm
- Faculty of Medicine and Health, School of Pharmacy The University of Sydney Sydney Australia
- Department of Pharmacy Prince of Wales Hospital Randwick Australia
| | - Janet K. Sluggett
- UniSA Allied Health and Human Performance University of South Australia Adelaide Australia
- Registry of Senior Australians South Australian Health and Medical Research Institute Adelaide Australia
- Centre for Medicine Use and Safety Monash University Parkville Australia
| | - Joy Gailer
- Drug and Therapeutics Information Service Southern Adelaide Local Health Network Adelaide Australia
| | - Horst Thiele
- Hospital in the Home Service (HITH) Northern Sydney Local Health District Sydney Australia
| | - Amy T. Page
- Centre for Optimisation of Medicines, School of Allied Health and WA Centre for Health and Ageing University of Western Australia Perth Australia
| | - Carly Pauw
- Hospital in the Home (HITH), Integrated Community Health Western Sydney Local Health District Sydney Australia
| | - Sarah Gillespie
- Australian Association of Consultant Pharmacy Canberra Australia
| | | | - Jerry Yik
- The Society of Hospital Pharmacists of Australia Melbourne Australia
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Mechanisms and contextual influences on the implementation of advance care planning for older people in long-term care facilities: A realist review. Int J Nurs Stud 2022; 133:104277. [PMID: 35717924 DOI: 10.1016/j.ijnurstu.2022.104277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 04/23/2022] [Accepted: 04/24/2022] [Indexed: 01/10/2023]
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Amalberti R, Staines A, Vincent C. Embracing Multiple Aims in Healthcare Improvement and Innovation. Int J Qual Health Care 2022; 34:6530228. [DOI: 10.1093/intqhc/mzac006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/08/2022] [Accepted: 02/16/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Healthcare and other industries have to manage and coordinate a number of different aims and longer-term ambitions. They must maintain quality, manage costs, support and retain the workforce, manage regulatory demands, and consider wider societal objectives. These aims are all legitimate, but they are not necessarily aligned, neither in their timeframe nor in their nature. Conflicts between aims have a profound influence on the implementation of safety and quality improvement and wider innovation system change. Healthcare leaders understand that these aims may conflict, but the extent and nature of such conflicts have been underestimated. This paper aims to support medical and nursing leadership and executives in the complex task of managing multiple aims in relation to improvement and innovation.
Methods
We drew on our experience and the wider industrial and healthcare literature to find examples of studies and improvement projects with multiple aims and examples of innovation and change in which conflicting aims were apparent. We sought to identify principles which would enable the management of parallel aims and practical strategies that might facilitate implementation.
Results
We argue that almost all improvement and innovation in healthcare should address parallel aims, actively seek to articulate these aims, and manage potential conflicts between them. We propose four underlying principles to support a more productive approach to the identification and management of parallel aims: embrace multiple aims, consider both short- and long-term aims and ambitions, consider the wider societal context, and appreciate that all change takes place within an evolving, dynamic context. In terms of practical actions, we identified five key strategies: (i) identify and monitor the parallel aims and accept that some will conflict; (ii) slow down to accommodate the natural flexibility of the system; (iii) think both short and long term; (iv) expect and endeavour to anticipate some unintended consequences; and (v) resist downgrading the project to partial implementation.
Conclusions
We have argued that most improvement and innovation, unlike controlled trials, should consider multiple aims. We set out some broad principles and practices to reduce conflict and suggest avenues to manage conflicts and support positive synergies. We suggest that if this is not done, conflicts are much more likely to arise, which will be detrimental to the change process. Articulating the multiple aims and actively seeking to manage them in parallel will promote a more flexible and productive approach to innovation and change.
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Affiliation(s)
- Rene Amalberti
- Public Foundation for Industrial Safety Culture, FONCSI, 6 Allée Emile Monso, Toulouse 31000, France
| | - Anthony Staines
- Patient Safety program director, Hospital Federation of Vaud, Bois de Cery, Prilly 1008, Switzerland
- IFROSS Institute, University of Lyon 3, 18 Rue Chevreul, Lyon 69007, France
| | - Charles Vincent
- Experimental Psychology, Anna Watts Building, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford, Oxfordshire OX2 6GG, UK
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Khayyat SM, Nazar Z, Nazar H. A study to investigate the implementation process and fidelity of a hospital to community pharmacy transfer of care intervention. PLoS One 2021; 16:e0260951. [PMID: 34962937 PMCID: PMC8714098 DOI: 10.1371/journal.pone.0260951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/19/2021] [Indexed: 11/23/2022] Open
Abstract
Background Hospital to community pharmacy transfer of care medicines-related interventions for inpatients discharged home aim to improve continuity of care and patient outcomes. One such intervention has been provided for seven years within a region in England. This study reports upon the implementation process and fidelity of this intervention. Methods The process evaluation guidance issued by the Medical Research Council has informed this study. A logic model to describe the intervention and causal assumptions was developed from preliminary semi-structured interviews with project team members. Further semi-structured interviews were undertaken with intervention providers from hospital and community pharmacy, and with patient and public representatives. These aimed to investigate intervention implementation process and fidelity. The Consolidated Framework for Implementation Research and the Consolidated Framework for Intervention Fidelity informed interview topic guides and underpinned the thematic framework analysis using a combined inductive and deductive approach. Results Themes provided information about intervention fidelity and implementation that were mapped across the sub processes of implementation: planning, execution, reflection and evaluation, and engagement. Interviewees described factors such as lack of training, awareness, clarity on the service specification, governance and monitoring and information and feedback which caused significant issues with the process of intervention implementation and suboptimal intervention fidelity. Conclusions This provides in-depth insight into the implementation process and fidelity of a ToC intervention, and the extant barriers and facilitators. The findings offer learning to inform the design and implementation of similar interventions, contribute to the evidence base about barriers and facilitators to such interventions and provides in-depth description of the implementation and mechanisms of impact which have the potential to influence clinical and economic outcome evaluation.
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Affiliation(s)
- Sarah M. Khayyat
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Clinical Pharmacy, Faculty of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Zachariah Nazar
- Clinical Pharmacy and Practice Department, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
- * E-mail:
| | - Hamde Nazar
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, United Kingdom
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Luetsch K, Maidment I, Twigg M, Rowett D. Realist research to inform pharmacy practice and policy. Res Social Adm Pharm 2021; 17:2075-2081. [PMID: 34246570 DOI: 10.1016/j.sapharm.2021.06.026] [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: 11/20/2020] [Revised: 05/21/2021] [Accepted: 06/29/2021] [Indexed: 11/28/2022]
Abstract
Theory-driven implementation and evaluation of pharmacy services can enhance their contribution to overall healthcare. As complex interventions most pharmacy practice programmes and services will be adopted and modified during their implementation into various healthcare contexts and systems. Realist approaches to theory-driven evaluation consider these variations in programmes, interventions and the contexts of their implementation and establish theories on how they work best, for whom and why. This paper illustrates the practical application of the realist philosophy of science to pharmacy practice relevant areas of healthcare using two case studies, a realist synthesis of existing literature on medication reviews and a realist review and evaluation related to medicines management. Applying realist logic establishes causative explanations of what could be essential factors in the success of programmes, enabling policy makers in their decision-making and pharmacy practice researchers as well as practitioners in optimising service design.
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Affiliation(s)
- Karen Luetsch
- School of Pharmacy, The University of Queensland, 20 Cornwall St, Woolloongabba, Qld, 4102, Australia; School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, 5000, Australia.
| | - Ian Maidment
- College of Health and Life Sciences, Aston University, Birmingham, B4 7ET, United Kingdom.
| | - Michael Twigg
- School of Pharmacy, University of East Anglia, Norwich, NR47TJ, United Kingdom.
| | - Debra Rowett
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, 5000, Australia.
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Khayyat S, Walters P, Whittlesea C, Nazar H. Patient and public perception and experience of community pharmacy services post-discharge in the UK: a rapid review and qualitative study. BMJ Open 2021; 11:e043344. [PMID: 33664077 PMCID: PMC7934750 DOI: 10.1136/bmjopen-2020-043344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To investigate the perception and experience of patients and the public (PP) about community pharmacy (CP) services and other primary care services after hospital discharge back home. DESIGN AND SETTING A rapid review and qualitative study exploring PP perceptions of primary care, focusing on CP services in the UK. METHODS A mixed-methods approach was adopted including a rapid review undertaken between 24 April and 8 May 2019 across four databases (MEDLINE, EMBASE, PsycINFO and CINAHL). Semistructured interviews were then conducted investigating for shifts in current PP perception, but also nuanced opinion pertaining to CP services. A convenience sampling technique was used through two online PP groups for recruitment. Thematic framework analysis was applied to interview transcripts. PARTICIPANTS Any consenting adults ≥18 years old were invited regardless of their medical condition, and whether they had used post-discharge services or not. RESULTS Twenty-five studies met the inclusion criteria. Patients were generally supportive and satisfied with primary care services. However, some barriers to the use of these services included: resource limitations; poor communication between healthcare providers or between patient and healthcare providers; and patients' lack of awareness of available services. From the 11 interviewees, there was a lack of awareness of CP post-discharge services. Nevertheless, there was general appreciation of the benefit of CP services to patients, professionals and wider healthcare system. Potential barriers to uptake and use included: accessibility, resource availability, lack of awareness, and privacy and confidentiality issues related to information-sharing. Several participants felt the uptake of such services should be improved. CONCLUSION There was alignment between the review and qualitative study about high patient acceptance, appreciation and satisfaction with primary care services post-discharge. Barriers to the use of CP post-discharge services identified from interviews resonated with the existing literature; this is despite developments in pharmacy practice in recent times towards clinical and public health services.
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Affiliation(s)
- Sarah Khayyat
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | | | - Cate Whittlesea
- Research Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UK
| | - Hamde Nazar
- School of Pharmacy, Newcastle University, Newcastle, UK
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