1
|
Snoswell CL, De Guzman KR, Barras M. Advanced-scope pharmacist roles in medical outpatient clinics: a cost-consequence analysis. Intern Med J 2024; 54:404-413. [PMID: 38050932 DOI: 10.1111/imj.16280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 10/19/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND There is a growing body of evidence that supports the clinical effectiveness of pharmacist roles in outpatient settings. However, limited studies have investigated the economic efficiency of advanced-scope outpatient pharmacist roles, particularly in the Australian setting. Assessing the overall costs and benefits of these outpatient pharmacist roles is needed to ensure service sustainability. AIMS To use a cost-consequence approach to evaluate the advanced-scope outpatient pharmacist roles across multiple clinic disciplines from the hospital perspective. METHODS A cost-consequence analysis was undertaken using data from a previous clinical-effectiveness study. All outpatient pharmacist consults conducted from 1 June 2019 to 31 May 2020 across 18 clinic disciplines were evaluated. Consequences from the pharmacist services included number of consults conducted, number of medication-related activities and number of resolved recommendations. RESULTS The overall cost to the hospital for the outpatient pharmacist service across all clinics was AU$1 991 122, with a potential remuneration of AU$3 895 247. There were 10 059 pharmacist consults undertaken for the 12-month period. Medication-related activities performed by pharmacists primarily included 6438 counselling and education activities and 4307 medication list activities. When the specialist pharmacist roles were added to the outpatient clinics, several health service benefits were also realised. CONCLUSIONS The addition of pharmacist roles to outpatient clinics can increase the cost of services; however, they also can increase medication optimisation activities. Future research should examine a societal perspective that includes broader cost and effectiveness outcomes. This study could justify the implementation of advanced-scope outpatient pharmacist roles in other Australian hospitals.
Collapse
Affiliation(s)
- Centaine L Snoswell
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
| | - Keshia R De Guzman
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
| | - Michael Barras
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
2
|
Weng Y, Miao B, Hong D, Zhang M, Wang B, Zhao Q, Wang H. Effects of pharmacist-led interventions on glycaemic control, adherence, disease management and health-related quality of life in patients with type 2 diabetes: a protocol for a network meta-analysis. BMJ Open 2023; 13:e072960. [PMID: 37898486 PMCID: PMC10619031 DOI: 10.1136/bmjopen-2023-072960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 10/10/2023] [Indexed: 10/30/2023] Open
Abstract
INTRODUCTION The increase in the number of patients with uncontrolled type 2 diabetes mellitus (T2DM) is in need of effective management interventions. However, research to date has been limited to the evaluation of the outcomes of community pharmacists alone. Therefore, the aim of the study protocol is to compare the effects of clinical pharmacist-led intervention strategies for the management of T2DM in the outpatient settings. METHOD AND ANALYSIS The study will collect and analyse data applying standard Cochrane methodological procedures. A search for eligible studies and ongoing trials will be conducted using PubMed, Embase, Medline (via Ovid), EBSCO (via Ovid), Lippincott Williams & Wilkins (LWW) Journals (via Ovid), ProQuest Health and Medical Complete, and ClinicalTrials.gov (clinicaltrials.gov) from database inception to December 2023. Clinical and health outcomes will be measured using both glycaemic control related indicators (eg, glycated haemoglobin, fasting blood glucose, postprandial glucose) and general indicators (eg, adherence, disease management and health-related quality of life). The meta-analysis will conduct pairwise meta-analysis using random effects models and network meta-analysis (NMA) employing the Bayesian hierarchical model. The visualisation and statistical analysis will be carried out using RevMan, R Studio and ADDIS. Additionally, we will evaluate the certainty of the evidence by using Grading of Recommendations Assessment, Development and Evaluation system. ETHICS AND DISSEMINATION There will be no primary data collection from NMA participants, and there is no requirement for formal ethical review. Our aim is to present the results of this NMA in a peer-reviewed scientific journal, at conferences, and in the mainstream media. PROSPERO REGISTRATION NUMBER CRD42022355368.
Collapse
Affiliation(s)
- Yiqing Weng
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Binghui Miao
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dongsheng Hong
- Department of Clinical Pharmacy, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, China
- Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, China
| | - Mengdie Zhang
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Beijia Wang
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qingwei Zhao
- Department of Clinical Pharmacy, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, China
- Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, China
| | - Hongmei Wang
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
3
|
Price E, Shirtcliffe A, Fisher T, Chadwick M, Marra CA. A systematic review of economic evaluations of pharmacist services. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2023; 31:459-471. [PMID: 37543960 DOI: 10.1093/ijpp/riad052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 07/07/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Challenges to the provision of health care are occurring internationally and are expected to increase in the future, further increasing health spending. As pharmacist roles are evolving and expanding internationally to provide individualised pharmaceutical care it is important to assess the cost-effectiveness of these services. OBJECTIVES To systematically synthesise the international literature regarding published economic evaluations of pharmacy services to assess their cost-effectiveness and clinical outcomes. METHODS A systematic review of economic evaluations of pharmacy services was conducted in MEDLINE, EMBASE, PubMed, Scopus, Web of Science, CINAHL, IPA and online journals with search functions likely to publish economic evaluations of pharmacy services. Data were extracted regarding the interventions, the time horizon, the outcomes and the incremental cost-effectiveness ratio. Studies' quality of reporting was assessed using the Consolidated Health Economic Evaluation Reporting Standard (CHEERS) statement. RESULTS Seventy-five studies were included in the systematic review, including 67 cost-effectiveness analyses, 6 cost-benefit analyses and 2 cost-consequence analyses. Of these, 57 were either dominant or cost-effective using a willingness-to-pay threshold of NZ$46 645 per QALY. A further 11 studies' cost-effectiveness were unable to be evaluated. Interventions considered to be most cost-effective included pharmacist medication reviews, pharmacist adherence strategies and pharmacist management of type 2 diabetes mellitus, hypertension and warfarin/INR monitoring. The quality of reporting of studies differed with no studies reporting all 28 items of the CHEERS statement. CONCLUSIONS There is strong economic evidence to support investment in extended pharmacist services, particularly those focussed on long-term chronic health conditions.
Collapse
Affiliation(s)
- Emilia Price
- Division of Health Sciences, School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Andi Shirtcliffe
- Allied Health Office of the Chief Clinical Officers System Performance and Monitoring Ministry of Health, Wellington, New Zealand
| | - Thelma Fisher
- Centre for Pacific Health Information Services, University Library, University of Otago, Dunedin, New Zealand
| | - Martin Chadwick
- Office of the Chief Clinical Officers, Ministry of Health, Wellington, New Zealand
| | - Carlo A Marra
- Division of Health Sciences, School of Pharmacy, University of Otago, Dunedin, New Zealand
| |
Collapse
|
4
|
Hassan F, Hatah E, Ali AM, Wen CW. The intervention strategies and service model for pharmacist-led diabetes management: a scoping review. BMC Health Serv Res 2023; 23:46. [PMID: 36653832 PMCID: PMC9847048 DOI: 10.1186/s12913-022-08977-1] [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] [Received: 06/26/2022] [Accepted: 12/16/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND There is increasing intervention activities provided during pharmacist-led diabetes management. Nevertheless, there is an unclear definition of the activities involved during the intervention. Thus, this study aimed to describe the type of intervention strategies and service model provided during pharmacist-led type 2 diabetes management and service outcomes. METHODS This study utilized the scoping review methodology of the Joanna Briggs Institute Reviewers' Manual 2015. Articles on pharmacist-led diabetes management focusing on the service content, delivery methods, settings, frequency of appointments, collaborative work with other healthcare providers, and reported outcomes were searched and identified from four electronic databases: Ovid Medline, PubMed, Scopus, and Web of Science from 1990 to October 2020. Relevant medical subject headings and keywords, such as "diabetes," "medication adherence," "blood glucose," "HbA1c," and "pharmacist," were used to identify published articles. RESULTS The systematic search retrieved 4,370 articles, of which 61 articles met the inclusion criteria. The types of intervention strategies and delivery methods were identified from the studies based on the description of activities reported in the articles and were tabulated in a summary table. CONCLUSION There were variations in the descriptions of intervention strategies, which could be classified into diabetes education, medication review, drug consultation/counseling, clinical intervention, lifestyle adjustment, self-care, peer support, and behavioral intervention. In addition, most studies used a combination of two or more intervention strategy categories when providing services, with no specific pattern between the service model and patient outcomes.
Collapse
Affiliation(s)
- Fahmi Hassan
- grid.412113.40000 0004 1937 1557Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia ,grid.415759.b0000 0001 0690 5255Pharmacy Services Program, Ministry of Health Malaysia, Lot 36 Jalan Universiti, 46350 Petaling Jaya, Selangor Malaysia
| | - Ernieda Hatah
- grid.412113.40000 0004 1937 1557Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Adliah Mhd Ali
- grid.412113.40000 0004 1937 1557Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Chong Wei Wen
- grid.412113.40000 0004 1937 1557Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| |
Collapse
|
5
|
Price A, de Bell S, Shaw N, Bethel A, Anderson R, Coon JT. What is the volume, diversity and nature of recent, robust evidence for the use of peer support in health and social care? An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2022; 18:e1264. [PMID: 36909883 PMCID: PMC9316011 DOI: 10.1002/cl2.1264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Background Peer support interventions involve people drawing on shared personal experience to help one another improve their physical or mental health, or reduce social isolation. If effective, they may also lessen the demand on health and social care services, reducing costs. However, the design and delivery of peer support varies greatly, from the targeted problem or need, the setting and mode of delivery, to the number and content of sessions. Robust evidence is essential for policymakers commissioning peer support and practitioners delivering services in health care and community settings. This map draws together evidence on different types of peer support to support the design and delivery of interventions. Objectives The aim of this map was to provide an overview of the volume, diversity and nature of recent, high quality evidence on the effectiveness and cost-effectiveness of the use of peer support in health and social care. Search Methods We searched MEDLINE, seven further bibliographic databases, and Epistemonikos for systematic reviews (in October 2020), randomised controlled trials (in March 2021) and economic evaluations (in May 2021) on the effectiveness of peer support interventions in health and social care. We also conducted searches of Google Scholar, two trial registers, PROSPERO, and completed citation chasing on included studies. Selection Criteria Systematic reviews, randomised controlled trials and economic evaluations were included in the map. Included studies focused on adult populations with a defined health or social care need, were conducted in high-income countries, and published since 2015. Any measure of effectiveness was included, as was any form of peer support providing the peer had shared experience with the participant and a formalised role. Data Collection and Analysis Data were extracted on the type of peer support intervention and outcomes assessed in included studies. Standardised tools were used to assess study quality for all studies: assessing the methodological quality of systematic reviews 2 for systematic reviews; Cochrane risk of bias tool for randomised controlled trials; and consensus health economic criteria list for economic evaluations. Main Results We included 91 studies: 32 systematic reviews; 52 randomised controlled trials; and 7 economic evaluations. Whilst most included systematic reviews and economic evaluations were assessed to be of low or medium quality, the majority of randomised controlled trials were of higher quality. There were concentrations of evidence relating to different types of peer support, including education, psychological support, self-care/self-management and social support. Populations with long-term health conditions were most commonly studied. The majority of studies measured health-related indicators as outcomes; few studies assessed cost-effectiveness. Studies were unevenly distributed geographically, with most being conducted in the USA. Several gaps were evident regarding the delivery of peer support, particularly the integration of peers and professionals in delivering support and interventions of longer duration. Authors' Conclusions Although there is evidence available to inform the commissioning and delivery of peer support in health and social care, there are also clear gaps that need to be addressed to further support provision, particularly regarding cost-effectiveness. The effectiveness of peer support in different countries, with varying health and social care systems, is a priority for future research, as is the integration of peers with professionals in delivering peer support.
Collapse
Affiliation(s)
- Anna Price
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
| | - Siân de Bell
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
| | - Naomi Shaw
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
| | - Alison Bethel
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
| | - Rob Anderson
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
| | - Jo Thompson Coon
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
| |
Collapse
|
6
|
Snoswell CL, Cossart AR, Chevalier B, Barras M. Benefits, challenges and contributors to the introduction of new hospital-based outpatient clinic pharmacist positions. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 5:100119. [PMID: 35478521 PMCID: PMC9029912 DOI: 10.1016/j.rcsop.2022.100119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 12/08/2021] [Accepted: 02/23/2022] [Indexed: 11/15/2022] Open
Abstract
Background Pharmacists working within interprofessional teams in the outpatient setting are well placed to address medication-related problems before and after hospital admission. Therefore, exploration of these roles is warranted. Objective(s) To explore pharmacists' and other health professionals' perspectives of the impact of pharmacists working within interprofessional teams in outpatient clinics. Furthermore, we endeavoured to identify both the challenges and contributors to success with the introduction of pharmacists into these settings. Methods This qualitative study involved semi-structured interviews with both hospital outpatient clinic pharmacists and other clinic health professionals to gain an in-depth understanding of how the introduction of pharmacists into clinics impacted clinic processes, patient care, and relationships with other health professionals. Participants were recruited from the outpatient clinics who had recently added a pharmacist to their service. Participants involved in setting up the roles were invited to participate in a voluntary interview, the transcripts from which were analysed into themes and sub-themes using an inductive and deductive approach. Results A total of 34 staff were interviewed of which 68% were female and 74% were aged between 31 and 50 years. The cohort included 16 outpatient pharmacists, nine pharmacist team leaders, five clinic nurses and four clinic doctors (specialist consultant or registrar). Three overall themes were identified: the benefits, the contributors, and the challenges of introducing clinical pharmacy services to outpatient clinics. When establishing a clinic role, pharmacists' awareness, adaptability, and strong communication were shown to be key traits to building rapport and trustworthiness with the established clinic team. Conclusions When pharmacists are integrated into multidisciplinary outpatient clinics they and their colleagues believe that they provide benefits to the patients and the clinics. Decision makers need to be cognizant of factors that contribute to, as well as those that impede, the successful implementation of outpatient pharmacist roles.
Collapse
Affiliation(s)
- Centaine L. Snoswell
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- School of Pharmacy, The University of Queensland, Brisbane, Australia
- Corresponding author at: Centre for Online Health, Centre for Health Services Research, The University of Queensland, Ground Floor Building 33, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia.
| | - Amelia R. Cossart
- School of Pharmacy, The University of Queensland, Brisbane, Australia
| | - Bernadette Chevalier
- School of Pharmacy, The University of Queensland, Brisbane, Australia
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | - Michael Barras
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Australia
- School of Pharmacy, The University of Queensland, Brisbane, Australia
| |
Collapse
|
7
|
Mozu IE, Marfo AFA, OPARE-Addo M, Buabeng KO, Owusu-Daaku FT. Exploring the role of pharmacists in improving blood pressure control among hypertensive patients at the workplace. SCIENTIFIC AFRICAN 2021. [DOI: 10.1016/j.sciaf.2021.e00983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
8
|
Ahumada-Canale A, Vargas C, Martinez-Mardones F, Plaza-Plaza JC, Benrimoj S, Garcia-Cardenas V. Cost-utility analysis of medication review with follow-up for cardiovascular outcomes: A microsimulation model. Health Policy 2021; 125:1406-1414. [PMID: 34579954 DOI: 10.1016/j.healthpol.2021.09.004] [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: 12/14/2020] [Revised: 09/02/2021] [Accepted: 09/13/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cardiovascular diseases are the leading cause of death. Pharmacist-led medication review with follow-up might be cost-effective preventing cardiovascular diseases. OBJECTIVE To undertake a cost-utility analysis of the addition of pharmacist-led medication review with follow-up to usual care compared to usual care alone for cardiovascular outpatients. MATERIALS AND METHODS A state-transition microsimulation model was built to project outcomes over a lifetime time horizon. Inputs from a cluster randomized controlled trial conducted in primary health care centers in Chile with full-time pharmacists were used. Probabilities were estimated using patient-level data. Utilities and costs associated with each health state were obtained from the literature, whereas the intervention costs were retrieved from the trial. The public third-party payer perspective was used. Uncertainty was evaluated through one-way and probabilistic sensitivity analyses. RESULTS For the base case analysis, an incremental cost-effectiveness ratio of $963 per quality-adjusted life-year was observed which was considered cost-effective. The results were robust to sensitivity analyses and were driven by decreased cardiovascular events resulting in lower mortality. CONCLUSIONS Medication review with follow-up was deemed a cost-effective addition to usual care with low uncertainty.
Collapse
Affiliation(s)
- Antonio Ahumada-Canale
- Graduate School of Health, University of Technology Sydney, Sydney, Australia; Centre for the Health Economy, Macquarie University, Sydney, Australia.
| | - Constanza Vargas
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | | | | | - Shalom Benrimoj
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Granada, Spain
| | | |
Collapse
|
9
|
Ahumada-Canale A, Vargas C, Balmaceda C, Martinez-Mardones F, Plaza-Plaza JC, Benrimoj S, Garcia-Cardenas V. Medication review with follow-up for cardiovascular outcomes: a trial based cost-utility analysis. J Comp Eff Res 2021; 10:229-242. [PMID: 33543637 DOI: 10.2217/cer-2020-0171] [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] [Indexed: 11/21/2022] Open
Abstract
Aim: To assess the trial-based cost-effectiveness of medication review with follow-up compared with usual care in primary care. Materials & methods: A cluster randomized controlled trial included patients if they were independent older adults, receiving five or more prescriptions, with moderate or high cardiovascular risk. Costs were estimated from the public healthcare sector perspective, and health benefits were measured as quality-adjusted life years. Both of which were used to calculate the incremental cost-effectiveness ratio. Results: Twelve centers completed the study, six (146 patients) in the intervention group and six (145 patients) in the control group. The base-case analysis showed an incremental cost-effectiveness ratio of US$ (2019) 434.4/quality-adjusted life year (95% CI 64.20-996.03). Conclusion: The intervention was cost-effective in the public primary care setting.
Collapse
Affiliation(s)
- Antonio Ahumada-Canale
- Graduate School of Health, University of Technology Sydney, NSW 2008, Australia.,Centre for the Health Economy, Macquarie University, NSW 2109, Australia
| | - Constanza Vargas
- Centre for Health Economics Research & Evaluation, University of Technology Sydney, NSW 2000, Australia
| | - Carlos Balmaceda
- Unidad de Evaluación de Tecnologías en Salud, Centro de Investigación Clínica, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330005, Chile
| | | | - José Cristian Plaza-Plaza
- Facultad de Química y de Farmacia, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile
| | - Shalom Benrimoj
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Granada 18071, Spain
| | | |
Collapse
|
10
|
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
|