A community pharmacy practice-based research network: A protocol for a realist evaluation

BACKGROUND

Community pharmacists' active participation in research is essential to build a robust, translatable evidence base. Practice-based research networks (PBRNs) have been established to support collaborative research and knowledge translation in community pharmacies. However, PBRNs' effectiveness in supporting research engagement and knowledge translation remains unexplored. A new PBRN will be implemented in southeast Queensland, Australia. This realist evaluation seeks to explain whether, how, why, for whom, in what context and over what duration the PBRN supports community pharmacists to engage in research.

OBJECTIVES

1. to generate transferable knowledge about the different circumstances in which-and the mechanisms by which-a PBRN influences research engagement outcomes for different community pharmacists, in the form of a program theory. 2. To use the program theory to develop evidence-informed recommendations for use by PBRN stakeholders.

METHODS

A realist evaluation will be conducted in four iterative phases: (1) theory development, (2) hypothesis generation, (3) observations, and (4) theory refinement. A two-year multi-method study will be conducted, including interviews with pharmacists, surveys, participatory and observational data collection. The evidence will be used to confirm, refute, and/or refine the program theory. The evaluation will adhere to the Realist And Meta-Narrative Evidence Synthesis (RAMESES) publication and quality standards.

CONCLUSIONS

The evaluation will contribute to the body of knowledge by generating a realist program theory to explain how, why, for whom, in what contexts, to what extent, in what respects, and over what duration the PBRN supports community pharmacists to engage in research. The findings will support the broader implementation of PBRNs and future network activities.

Patients' opinions on participation in patient-centered outcomes research in community pharmacies: A qualitative study

BACKGROUND

Patient-centered outcomes research (PCOR) often brings patient voices, thoughts, and opinions into the research process, allowing patients to have a say in the research process from project inception to dissemination of results. Community pharmacy teams are well-situated to engage patients in their own health and in research, given their trusting relationships with patients and access in communities.

OBJECTIVE

To gather patients' opinions on participation in PCOR at their local community pharmacy.

METHODS

Four regional focus groups representing western, central, northeastern, and southeastern Pennsylvania were conducted. A single community pharmacy in each region recruited patients to participate in each focus group. A focus group discussion guide was developed and reviewed by a Stakeholder Advisory Board that consisted patients, pharmacists, and researchers. Questions focused on patients' relationships with their pharmacy and pharmacist, perceptions of research occurring at their local pharmacy, and patient engagement methods. Focus group sessions were audio-recorded, transcribed verbatim, and independently coded by 2 investigators. Coding discrepancies were reconciled through discussion, and a qualitative inductive thematic analysis was conducted by the research team.

RESULTS

A total of 44 patients participated in one of 4 focus groups. Patients provided insights into what would make them more likely to participate in PCOR at their local community pharmacy. Four themes emerged from the discussions: (1) Understanding the impact to one's health or community affects participation; (2) Patients prefer to schedule research activities at times outside of prescription pick-up or drop-off; (3) Trusted relationships can be leveraged for recruitment; and (4) Face-to-face engagement is preferred for participant recruitment.

CONCLUSION

Patients want to engage in research in a way that is respectful of their time and matters to them. Strong patient-pharmacist relationships are essential for patient engagement in and acceptance of PCOR opportunities in community pharmacies. Community pharmacies may be rich locations to engage patients in PCOR.

Impact of a Multicomponent Educational Intervention on Community Pharmacy-Based Naloxone Services Implementation: A Pragmatic Randomized Controlled Trial

BACKGROUND

Despite US naloxone access laws, community pharmacists lack training and confidence in providing naloxone.

OBJECTIVE

To assess the impact of the Empowering Community Pharmacists program on pharmacists' knowledge, perceived barriers, attitudes, confidence, and intentions regarding naloxone services implementation, as well as naloxone prescriptions dispensed.

METHODS

A 3-month pragmatic randomized controlled trial was conducted from December 2018 to March 2019. Alabama community pharmacists were recruited by mail, email, phone, and fax and randomized to intervention (monthly resources/reminders + educational webinar) or control (monthly reminders only). Outcome measures were assessed via online surveys at baseline (T1), immediately post-intervention (T2), and 3 months post-intervention (T3), including naloxone knowledge (%correct); perceived barriers, attitudes, confidence, and intention regarding naloxone services implementation (7-point Likert-type scale; 1 = strongly disagree, 7 = strongly agree); and number of naloxone prescriptions dispensed. Mean differences between control and intervention from T1 to T3 were assessed using 2-way mixed analysis of variance and adjusted analyses were conducted using generalized estimating equations with negative binomial distribution to assess associations between variables.

RESULTS

Of 55 participants (n = 27 intervention, n = 28 control), most were female (80.3%), white (80.6%), in independently owned pharmacies (39.1%). Increases in mean [SD] confidence (5.52 [1.03]-6.16 [0.74], P < 0.0005) and intention (5.35 [1.51]-6.10 [0.96], P = 0.023) occurred from pre- to post-program within the intervention group and were statistically significant compared with control (confidence P = 0.016, intention P = 0.014). Confidence (exp(β) = 1.46, P = 0.031) and perceived barriers (exp(β) = 0.75, P = 0.022) were associated with number of naloxone prescriptions dispensed.

CONCLUSION AND RELEVANCE

The Empowering Community Pharmacists program improved community pharmacists' confidence and intention regarding naloxone services implementation. Other states can adapt program elements according to their laws.

CLINICALTRIALS.GOV IDENTIFIER

NCT05093309.

The Danish Network for Community Pharmacy Practice Research and Development

The community pharmacy has a number of attributes that makes it an excellent setting for research and development projects, as it is a highly accessible part of the healthcare system and is staffed by highly trained health care professionals. The big turnover in patients in the community pharmacy makes it possible to reach a great number of patients and collect a lot of data in a relatively short time. However, conducting nation-wide research and development projects can be a rather time-consuming process for the individual community pharmacy, and can thus require collaboration with other community pharmacies and researchers. This will help ensure strong results and better implementation. Thus, the Danish Network for Community Pharmacy Practice for Research and Development (NUAP) was established in Denmark by a number of highly committed community pharmacies and researchers. NUAP consists of 102 member pharmacy owners in addition to a number of researchers. The aim of the network is to strengthen pharmacy practice and pharmacy practice research in Denmark by providing a forum where community pharmacy practitioners and researchers meet and work together. The network is led by a steering committee elected by the members in the network.

Formation of a statewide community pharmacy practice-based research network: Pharmacist opinions on research participation and engagement

OBJECTIVE

To gather the insights and opinions of pharmacist stakeholders to inform the creation of a community pharmacy practice-based research network (PBRN) in Pennsylvania.

DESIGN

A stakeholder advisory board of pharmacists, patients, and researchers was established to guide this research. This was a qualitative study using a semistructured interview guide.

SETTING AND PARTICIPANTS

Community pharmacists from the Pennsylvania Pharmacist Care Network.

OUTCOME MEASURES

Themes were identified that describe pharmacist insights and opinions on research participation and preferences for engagement in the PBRN.

RESULTS

A total of 16 pharmacists participated in the study. The pharmacists believed that participating in research would help demonstrate their value and commitment to improving patients' health. Enhancing patient-pharmacist relationships and driving innovation were additional benefits that were reported. The pharmacists believed that they could effectively leverage their relationships with patients to engage them in research opportunities. The pharmacists reported that they would like to share research ideas and successful research practices with other members of the PBRN.

CONCLUSION

Gathering pharmacists' opinions on participating in research was an important step in developing a community pharmacy PBRN that meets stakeholder needs. The results of this study can help others who seek to form community pharmacy PBRNs that facilitate stakeholder-driven research.

Improving Recruitment and Retention of Pharmacists in a Practice-Based Research Network

Pharmacy practice-based research networks (PBRNs) are relatively new compared to their primary care forebears, representing a unique set of research challenges. Recruitment and retention of network members are essential to maintaining the integrity of the network and achieving its research goals. Many studies have evaluated recruitment and retention of practitioners to individual studies, while far fewer have reported on recruitment and retention to the network itself. This literature review summarizes current practices for PBRN member recruitment and retention from a pharmacy perspective.

Valuable Lessons for Pharmacist PBRNs: Insights and Experiences from Physician PBRN Members

Practice-based research networks (PBRNs) rely on a cadre of engaged members to participate in research projects. As pharmacist PBRNs increase in number, it is helpful to understand how members of other professions view their own participation in PBRNs and potential collaborative research endeavors with pharmacists. Due to their longer history of PBRN experience, physician PBRN members may have helpful advice for the establishment of pharmacy networks. The objectives of this study were to describe perceptions among a group of physician PBRN members about: Advice for developing a pharmacist PBRN, practice aspects that might benefit from collaborating with pharmacists who are part of a PBRN, and benefits and challenges of PBRN member participation. This study employed qualitative research methods. Semi-structured interviews were conducted with physician members of the Oklahoma Physicians Resource/Research Network, a primary care PBRN. Advice for establishing a pharmacist PBRN included identifying a champion, recruiting a core group, and conducting a needs assessment. Collaborative areas of interest included medication use management, patient education on chronic disease states, and physician education on new therapies. Participation benefits were categorized as personal satisfaction, improvement in practice quality improvement, advancement of specialty, peer interaction and learning, and real-time information and support. These findings offer insight into strategies for developing and sustaining pharmacist PBRNs and may inform pharmacist PBRN initiatives related to development, member recruitment and retention, and interprofessional project planning with physician PBRNs.

Factors Associated With an Interest in Practice-Based Research Among Pharmacists in Nigeria

Background: Practice-based research (PBR) is employed in the pharmacy profession to improve the quality and efficiency of health care delivery. Although widely practiced in developed countries, it is rarely used in developing countries, including Nigeria. Objectives: To determine the factors associated with Nigerian pharmacists’ interest in PBR. Methods: This is a cross-sectional study utilizing an online survey. Pharmacists currently practicing in Nigeria were invited to participate. A hyperlink to the online questionnaire was shared with members of relevant professional bodies via Facebook, WhatsApp, and Twitter. Reminders were sent to facilitate a high response rate. Factors associated with pharmacists’ interest in PBR were determined using multiple logistic regression. Results: Two hundred and three completed responses were received from the survey. The majority, 94.6% (192), expressed an interest in PBR and believed that it would enhance their pharmacy practice and role in patient care. The multivariable analysis showed that pharmacists’ interest in publishing their research findings in peer-reviewed journals (odds ratio = 0.004, 95% confidence interval = 0.00-0.05, P < .001) and their knowledge of the professional relevance of research pertaining to their area of practice within the health care system (odds ratio = 0.02, 95% confidence interval = 0.00-0.47, P = .015) were found to be independent predictors of pharmacists’ interest in PBR. Conclusion: There is an interest in PBR among practicing pharmacists in Nigeria. The provision of evidence-based pharmaceutical services in Nigeria will be enhanced by interventions that encourage the conduct of research and publication of research findings, and by improving knowledge of the professional relevance of PBR in pharmacy practice areas.

Recruitment of caregivers into health services research: lessons from a user-centred design study

BACKGROUND

With patient and public engagement in many aspects of the healthcare system becoming an imperative, the recruitment of patients and members of the public into service and research roles has emerged as a challenge. The existing literature carries few reports of the methods - successful and unsuccessful - that researchers engaged in user-centred design (UCD) projects are using to recruit participants as equal partners in co-design research. This paper uses the recruitment experiences of a specific UCD project to provide a road map for other investigators, and to make general recommendations for funding agencies interested in supporting co-design research.

METHODS

We used a case study methodology and employed Nominal Group Technique (NGT) and Focus Group discussions to collect data. We recruited 25 family caregivers.

RESULTS

Employing various strategies to recruit unpaid family caregivers in a UCD project aimed at co-designing an assistive technology for family caregivers, we found that recruitment through caregiver agencies is the most efficient (least costly) and effective mechanism. The nature of this recruitment work - the time and compromises it requires - has, we believe, implications for funding agencies who need to understand that working with caregivers agencies, requires a considerable amount of time for building relationships, aligning values, and establishing trust.

CONCLUSIONS

In addition to providing adaptable strategies, the paper contributes to discussions surrounding how projects seeking effective, meaningful, and ethical patient and public engagement are planned and funded. We call for more evidence to explore effective mechanisms to recruit family caregivers into qualitative research. We also call for reports of successful strategies that other researchers have employed to recruit and retain family caregivers in their research.

Community pharmacist participation in a practice-based research network: a report from the Medication Safety Research Network of Indiana (Rx-SafeNet)

OBJECTIVE

To describe the experiences and opinions of pharmacists serving as site coordinators for the Medication Safety Research Network of Indiana (Rx-SafeNet).

SETTING

Retail chain, independent, and hospital/health system outpatient community pharmacies throughout Indiana, with a total of 127 pharmacy members represented by 26 site coordinators.

PRACTICE DESCRIPTION

Rx-SafeNet, a statewide practice-based research network (PBRN) formed in 2010 and administered by the Purdue University College of Pharmacy.

MAIN OUTCOME MEASURES

Barriers and facilitators to participation in available research studies, confidence participating in research, and satisfaction with overall network communication.

RESULTS

22 of 26 site coordinators participated, resulting in an 85% response rate. Most (72.2%) of the respondents had received a doctor of pharmacy degree, and 13.6% had postgraduate year (PGY)1 residency training. The highest reported benefits of PBRN membership were an enhanced relationship with the Purdue University College of Pharmacy (81% agreed or strongly agreed) and enhanced professional development (80% agreed or strongly agreed). Time constraints were identified as the greatest potential barrier to network participation, reported by 62% of respondents. In addition, the majority (59%) of survey respondents identified no prior research experience. Last, respondents' confidence in performing research appeared to increase substantially after becoming network members, with 43% reporting a lack of confidence in engaging in research before joining the network compared with 90% reporting confidence after joining the network.

CONCLUSION

In general, Rx-SafeNet site coordinators appeared to experience increased confidence in research engagement after joining the network. While respondents identified a number of benefits associated with network participation, concerns about potential time constraints remained a key barrier to participation. These findings will assist network leadership in identifying opportunities to positively increase member participation in the future.

Practice-based research networks: Keeping the highway running through the pharmacy community

This issue of the Journal of the American Pharmacists Association focuses on a topic vital to the pharmacy profession-practice-based research networks (PBRNs) of pharmacy practitioners and researchers. Now, vital is a pretty value-based word and is in the eye of the beholder. Why do we think pharmacy practice-based research is vital? During our many years as practitioners, faculty members, and pharmacy leaders, the phrase "pharmacy is at a crossroad" has been overused regularly. One could say that we are now at another professional crossroad, but crossroads probably understates the seriousness of the times; potentially, we are at a "bypass." Let us use an analogy to illustrate our concerns and then tell you why we think the profession is at a bypass.

Involving community pharmacists in pharmacy practice research: experiences of peer interviewing

BACKGROUND

Translation of interest in research into active engagement of community pharmacists as research partners/co-researchers remains a challenge. Involving pharmacists in specific research techniques such as peer interviewing, however, may enhance validity of the results.

OBJECTIVE

To enhance community pharmacists' involvement in pharmacy practice research through peer interview training.

METHOD

A subgroup of participants in a multi-phase pharmacy practice research project trained to do peer interviews. These pharmacist interviewers attended a workshop and were mentored. Comments from their feedback forms and ongoing engagement with the Research Associate were thematically analysed.

RESULTS

Positive themes from five interviewers included the importance of the topic and their wish to learn skills beyond their everyday role. The small group format of the training day helped to build confidence. Interviewers felt their shared professional background helped them to capture relevant comments and probe effectively. There were challenges, however, for interviewers to balance research activities with their daily work. Interviewers experienced difficulty in securing uninterrupted time with interviewees which sometimes affected data quality by 'rushing'.

CONCLUSION

Community pharmacists can be engaged as peer interviewers to the benefit of the volunteers and research team, but must be well resourced and supported.

Pharmacists' involvement in and attitudes toward pharmacy practice research: A systematic review of the literature

BACKGROUND

The role of pharmacists in health care has evolved toward patient-centered care. Pharmacy practice-based research is essential to the advancement of practice; however, literature addressing attitudes and involvement of pharmacists in practice research indicates reluctance among them. An account of studies undertaken thus far is warranted.

OBJECTIVE

This systematic review aims to summarize and evaluate the views and attitudes of pharmacists regarding their involvement in pharmacy practice research as well as the barriers and enablers to such research.

METHODS

A systematic review of original studies published mainly in MEDLINE, PubMed, EBSCO, ScienceDirect, ProQuest, and Google Scholar was conducted to identify published studies that report pharmacists' attitudes and involvement in research as well as perceived facilitators and barriers. Data were independently extracted by two reviewers using a standardized data abstraction tool.

RESULTS

Fifteen studies utilizing questionnaire-based surveys, focus groups or interviews were identified and included in the review. The majority of studies (10 of 15) involved community pharmacists, while only 6 involved hospital pharmacists. Studies were mostly conducted in the UK (5 of 15), followed by Australia and Canada (3 of 15 each). Early studies focused on pharmacists' attitudes on practice-based research, but most recently there was attention on practice-based research networks (PBRNs). Pharmacists' awareness, interest and willingness to participate in practice research, their actual involvement in research projects, and positive attitude toward research have increased over time. Pharmacists generally believed that practice-based research was needed for professional development of pharmacy and agreed with the importance of research to support evidence-based practice and to improve the quality of patient care and outcomes. The most commonly reported barriers to participation in research across the reviewed studies were: lack of time and workload; insufficient or lack of funds; and lack of research knowledge, training, mentorship and support.

CONCLUSIONS

Pharmacists recognize the value of research in advancing pharmacy practice and indicate their willingness to be involved in independent research and in PBRNs. Lack of time, training and support were identified as the greatest limitations to participation in practice research. These findings have important implications on promoting research capacity building through the development of PBRNs involving academic and pharmacy practitioners as well as informal research training programs.

Intervention research to enhance community pharmacists' cognitive services: a systematic review

BACKGROUND

Positive impact of community pharmacists' cognitive pharmaceutical services (CPS) is well documented. However, community pharmacists have been slow to expand CPS roles. This systematic review explores how community pharmacy intervention research can help inform efforts to expand cognitive pharmaceutical service delivery.

OBJECTIVES

To: 1) identify community pharmacy CPS intervention studies that report data on pharmacist behaviors, either as a final study outcome itself or as a fidelity measure in patient outcome studies, and 2) describe the state of this research to help frame future research agendas.

METHODS

Empirical articles examining improvement or expansion of community pharmacist cognitive services published through December 2010 were searched using various search engines, bibliography searches and authors' libraries. Studies were included if they: 1) reported findings on pharmacist behaviors during cognitive service delivery, 2) employed a minimum of pre-post design or two study arms for pharmacists/pharmacies, and 3) were in community-based pharmacies.

RESULTS

A total of 50 studies evaluated impact of community pharmacy based CPS delivery; however, only 21 included a pharmacist behavior outcome measure as a final outcome or as a fidelity measure. The majority (14 out of 21) of studies used a randomized controlled trial design. Nearly half (10 of 21) addressed asthma or tobacco cessation. Limited details were provided about interventions to prepare pharmacists for CPS delivery. The most frequent measures of pharmacist behavior were patient surveys and observation of pharmacists' behavior by secret shoppers; electronic data sets were rarely used.

CONCLUSIONS

There is a need for well-designed intervention research that evaluates how interventions impact on pharmacist cognitive service behavior. Positive findings from this review reinforce that planned interventions have the potential to improve and expand pharmacist cognitive service delivery; however, more detail is needed in study publications for this potential to be fully realized.

The willingness of community pharmacists to participate in a practice-based research network

BACKGROUND

Practice-based research networks (PBRNs) are groups of practitioners and researchers with an interest in designing, evaluating and disseminating solutions to the real-world problems of clinical practices.

OBJECTIVE

To evaluate the level of interest of community pharmacists in participating in a PBRN and to document the services such a network should offer.

METHOD

In a survey of community pharmacists in Montreal, Quebec, and surrounding areas, a questionnaire was mailed to a random sample of 1250 pharmacists. Two of the 28 questions were related to PBRNs: one assessed the pharmacists' interest in participating in a PBRN; the other sought their views on which services and activities this network should offer.

RESULTS

In total, 571 (45.7%) pharmacists completed the questionnaire, but 6 did not answer the questions about the PBRN. Of the respondents, 58.9% indicated they were "very interested" or "interested" in joining a PBRN, while 41.1% reported little or no interest. The most popular potential services identified were access to clinical tools developed in research projects (77.0%), access to continuing education training programs developed in research projects (75.9%), information about conferences on pharmacy practice research (64.1%) and participation in the development of new pharmaceutical practices (56.1%).

CONCLUSION

This study suggests that the level of interest that community pharmacists have in PBRNs is sufficient to further evaluate how such networks may optimize and facilitate pharmacy practice research. Can Pharm J 2013;146:47-54.

Independent community pharmacist interest in participating in community pharmacy research networks

OBJECTIVES

To assess the interest of American Pharmacy Services Corporation (APSC) independent community pharmacists in participating in a community pharmacy research network (CPRN) and to identify perceived barriers to participation in a CPRN.

DESIGN

Descriptive, exploratory, nonexperimental study.

SETTING

University of Kentucky and APSC during 2009-10.

PARTICIPANTS

65 APSC independent community pharmacists in Kentucky.

INTERVENTION

Single-mode survey.

MAIN OUTCOME MEASURE

Independent community pharmacists' willingness to participate in community-based research and perceived barriers to participation.

RESULTS

A total of 65 independent community pharmacists from 191 pharmacies returned the survey. The majority of independent community pharmacists were "interested" or "very interested" (83.8%) in participating in a CPRN. Respondents were willing to participate for a mean (±SD) of 6.5 ± 5.8 hours per week. However, they reported only being able participate in a CPRN for 5.2 ± 4.1 hours per week, with time being the greatest limitation to participation. An overwhelming percentage of respondents (92.1%) were interested in learning more about opportunities to participate in a CPRN in the future.

CONCLUSION

CPRNs are an emerging interest in community pharmacy practice. A CPRN is an opportunity for independent community pharmacies to collaborate and use resources as a group to conduct research to solve issues in the community pharmacy setting.

Going the distance: overcoming challenges in recruitment and retention of Black and White women in multisite, longitudinal study of predictors of coronary heart disease

High recruitment and retention rates are hallmarks of scientifically rigorous longitudinal research. However, recruitment and retention are challenging, especially with older adults and minorities. In this article, we discuss strategies that have enabled us to retain more than 80% of both Black and White women in a 5-year observational study. To overcome challenges such as staff turnover and introduction of computerized record systems, we developed a time-saving handout, streamlined procedures for documenting contact information, and motivated site staff through weekly personal contact. We responded to problems with mailed privacy consent forms by garnering approval for verbal consent that allowed immediate response to participants' questions. In addition to standard steps to minimize attrition, we encouraged ongoing participation with personal letters following interviews, "refrigerator reminders" of the next interview date, and "missing you" letters following missed appointments. We believe these and other strategies described in this article were responsible for our high retention rate.