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Livori AC, Prosser A, Levkovich B. Clinical outcome measures in the assessment of impact of pharmacists in cardiology ambulatory care: A systematic review. Res Social Adm Pharm 2023; 19:432-444. [PMID: 36253283 DOI: 10.1016/j.sapharm.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 09/01/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022]
Abstract
AIMS Pharmacists are involved in the care of patients with cardiac disease within the ambulatory setting across multiple modes of delivery and practice settings. There is a lack of consensus surrounding the assessments used to measure the impact of pharmacist care. This heterogeneity may undermine confidence and limit utilisation of pharmacists in cardiology ambulatory care. A systematic review was conducted to understand how pharmacist interventions in cardiology ambulatory care were assessed and the impacts of these interventions on patient-centred outcomes. METHODS AND RESULTS A comprehensive search was conducted of MEDLINE, CINAHL Plus, Cochrane Register of Randomised Controlled Trials and EMBASE from 2000 to 2020 with search terms involving pharmacist interventions among cardiology patients in the ambulatory care setting; with studies restricted to randomised controlled trials. Search results were independently screened by two reviewers. The Cochrane Risk of Bias in Randomised Trials tool was used for quality assessment of the included studies. Assessments of pharmacist impact were analysed and compared to established quality indicators of cardiology care. The search produced 3380 individual studies, following screening, 26 studies involving 9013 participants met inclusion criteria. Across the 26 included studies, eleven different intervention types were identified. Four main outcome measures assessing the impact of these interventions were identified: direct measure of cardiovascular disease risk factor, major adverse cardiovascular events, medication adherence, validated risk score for cardiovascular events. There was a high degree of variance in both the way these interventions influenced the outcome as well the outcome measures selected to assess the impact of the intervention. Of the 26 studies, sixteen listed positive impacts on primary outcomes and the remaining 10 listed neutral effects. CONCLUSION Several outcome measures have been used to assess the impact of pharmacist intervention in cardiology ambulatory care. Aligning outcome measures with known indicators of cardiology care quality, as well as more detailed descriptions of intervention, will provide clinicians vital information in designing effective and measurable interventions in cardiology ambulatory care.
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Affiliation(s)
- Adam C Livori
- Ballarat Health Services, Victoria, Australia; Monash University, Victoria, Australia.
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McGrath A, Richardson N, Murphy N. Strategies for effective implementation and scale-up of a multi-level co-designed men's health initiative "Sheds for Life" in Irish Men's Sheds. FRONTIERS IN HEALTH SERVICES 2022; 2:940031. [PMID: 36925798 PMCID: PMC10012692 DOI: 10.3389/frhs.2022.940031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
Sheds for Life is a gender-specific tailored men's health initiative engaging "hard-to-reach" men in the Men's Shed setting in Ireland. It is implemented by multiple stakeholders at individual, provider, organization and systems level and thus multiple contextual factors influence its scalability. This research used established implementation science frameworks to guide participatory research approaches that captured the process and identified facilitators of and barriers to implementation and scale-up. Active recruitment, co-design processes, leadership and stakeholder engagement emerged as key facilitators of implementation. Prominent barriers were institutional capacity and funding. Acceptability, adoption and appropriateness of the initiative were high among stakeholders with sustainability largely contingent on funding and staff resources. Findings make a valuable contribution to knowledge by capturing the process involved in the implementation of a complex multi-level men's health intervention. It provides a "how to" guide of strategies to engage hard-to-reach men with health promotion, the operationalization and application of implementation frameworks in community-based health promotion, and the implementation of health promotion in Men's Sheds. Documented barriers and facilitators that impact implementation of a community-based men's health program are rare and provide a valuable blueprint for practitioners, researchers and policy makers in the field.
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Affiliation(s)
- Aisling McGrath
- School of Health Sciences, South East Technological University, Waterford, Ireland
| | - Noel Richardson
- National Centre for Men's Health, South East Technological University, Carlow, Ireland
| | - Niamh Murphy
- School of Health Sciences, South East Technological University, Waterford, Ireland
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Olmos-Ochoa TT, Fenwick KM, Ganz DA, Chawla N, Penney LS, Barnard JM, Miake-Lye IM, Hamilton AB, Finley EP. Reflective writing: a tool to support continuous learning and improved effectiveness in implementation facilitators. Implement Sci Commun 2021; 2:98. [PMID: 34479654 PMCID: PMC8417958 DOI: 10.1186/s43058-021-00203-z] [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: 03/01/2021] [Accepted: 08/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implementation facilitators support the adoption of evidence-based practices and other improvement efforts in complex healthcare settings. Facilitators are trained to develop essential facilitation skills and facilitator effectiveness is typically evaluated post-implementation, but little is known about how facilitators apply and adapt didactic knowledge after training, or how learning and refining experiential knowledge occurs during the facilitation process. We propose the use of reflective writing as a tool to document and support facilitator learning and facilitator effectiveness. METHODS Using an instrumental case study of the Coordination Toolkit and Coaching (CTAC) project, we explore the use of reflective writing by facilitators to support their learning and effectiveness. Six primary care clinics participated in weekly hour-long facilitation calls over a 12-month period to implement quality improvement projects related to care coordination. Two facilitators completed templated reflections after each facilitation call for their assigned sites, totaling 269 reflections. We used the declarative-procedural-reflective model, which defines the process of skill development in clinical practice, to qualitatively analyze the reflections. Two independent coders used content analysis principles to code text that captured facilitators' observations, evaluations, interpretations, and communication. Descriptive statistics were used to analyze reflections by facilitator and by code within and across reflections. RESULTS CTAC facilitators primarily used the reflections to summarize the calls (observation), assess the facilitation process and the tasks and activities they used (evaluation), document their thoughts about how to improve their own effectiveness (interpretation), and describe their communication with implementing teams. Ninety-one percent of reflections included observations, 42% interpretation, 41% evaluation, and 44% facilitator communication. In total, we coded 677 segments of text within reflections: 39% represented observation, 20% interpretation, 18% evaluation, and 23% facilitator communication. CONCLUSIONS The process of reflective writing allowed the CTAC facilitators the time and structure to evaluate their facilitation and to think critically about how to adjust their facilitation in response to their observations and interpretations. Reflective writing is a feasible and acceptable tool to support and document facilitator learning and effectiveness. TRIAL REGISTRATION The project was registered with ClinicalTrials.gov ( NCT03063294 ) on February 24, 2017.
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Affiliation(s)
- Tanya T Olmos-Ochoa
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System - Sepulveda, 16111 Plummer Street (152), North Hills, CA, 91343, USA.
| | - Karissa M Fenwick
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System - Sepulveda, 16111 Plummer Street (152), North Hills, CA, 91343, USA
| | - David A Ganz
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System - Sepulveda, 16111 Plummer Street (152), North Hills, CA, 91343, USA.,David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Neetu Chawla
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System - Sepulveda, 16111 Plummer Street (152), North Hills, CA, 91343, USA.,Department of Health Policy and Management, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA
| | - Lauren S Penney
- Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, South Texas Veterans Health Care System, San Antonio, TX, USA.,Departments of Medicine and Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Jenny M Barnard
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System - Sepulveda, 16111 Plummer Street (152), North Hills, CA, 91343, USA
| | - Isomi M Miake-Lye
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System - Sepulveda, 16111 Plummer Street (152), North Hills, CA, 91343, USA.,Department of Health Policy and Management, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA
| | - Alison B Hamilton
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System - Sepulveda, 16111 Plummer Street (152), North Hills, CA, 91343, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Erin P Finley
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System - Sepulveda, 16111 Plummer Street (152), North Hills, CA, 91343, USA.,Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, South Texas Veterans Health Care System, San Antonio, TX, USA.,Departments of Medicine and Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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