Understanding the dissemination of appointment-based synchronization models using the CFIR framework

BACKGROUND

The appointment based model (ABM) is a innovative model of pharmacy practice that combines medication synchronization with scheduled monthly appointments to improve patient medication adherence and convenience. It is being implemented in many pharmacies across the United States.

OBJECTIVE

The purpose of this article is to use the Consolidated Framework for Implementation Research (CFIR) to discuss the barriers and facilitators of ABM implementation in community pharmacies while identifying priorities for additional implementation research.

METHODS

A review of current evidence of ABM was examined using the five domains within the CFIR taxonomy. Interactions between these domains (the intervention, the individuals involved, the process used to implement the intervention, the inner setting, and the outer setting) and their sub domains were used to explain the current success of ABM and future barriers.

RESULTS

The CFIR is an effective theoretical framework for assessing ABM. It helps identify key constructs in ABM implementation and their relationships. It also suggests future research to facilitate its adoption as a standard of pharmacy practice.

CONCLUSIONS

The adoption of ABM by pharmacies will be facilitated by better evidence of its clinical and economic impact on patient health outcomes, standardization of ABM, and integrating it into current workflows.

Public health in community pharmacy: a systematic review of pharmacist and consumer views

Background

The increasing involvement of pharmacists in public health will require changes in the behaviour of both pharmacists and the general public. A great deal of research has shown that attitudes and beliefs are important determinants of behaviour. This review aims to examine the beliefs and attitudes of pharmacists and consumers towards pharmaceutical public health in order to inform how best to support and improve this service.

Methods

Five electronic databases were searched for articles published in English between 2001 and 2010. Titles and abstracts were screened by one researcher according to the inclusion criteria. Papers were included if they assessed pharmacy staff or consumer attitudes towards pharmaceutical public health. Full papers identified for inclusion were assessed by a second researcher and data were extracted by one researcher.

Results

From the 5628 papers identified, 63 studies in 67 papers were included. Pharmacy staff: Most pharmacists viewed public health services as important and part of their role but secondary to medicine related roles. Pharmacists' confidence in providing public health services was on the whole average to low. Time was consistently identified as a barrier to providing public health services. Lack of an adequate counselling space, lack of demand and expectation of a negative reaction from customers were also reported by some pharmacists as barriers. A need for further training was identified in relation to a number of public health services. Consumers: Most pharmacy users had never been offered public health services by their pharmacist and did not expect to be offered. Consumers viewed pharmacists as appropriate providers of public health advice but had mixed views on the pharmacists' ability to do this. Satisfaction was found to be high in those that had experienced pharmaceutical public health

Conclusions

There has been little change in customer and pharmacist attitudes since reviews conducted nearly 10 years previously. In order to improve the public health services provided in community pharmacy, training must aim to increase pharmacists' confidence in providing these services. Confident, well trained pharmacists should be able to offer public health service more proactively which is likely to have a positive impact on customer attitudes and health.

A tailored intervention to support pharmacy-based counseling for smoking cessation

INTRODUCTION

Pharmacists are uniquely positioned within the community to provide smoking cessation counseling to their patients. However, pharmacists experience significant barriers to providing counseling, including limited time, reimbursement, and training in counseling techniques. We tested a computer-driven software system, "Exper_Quit" (EQ), that provided individually tailored interventions to patients who smoke and matching tailored reports for pharmacists to help guide cessation counseling.

METHODS

A two-phase design was used to recruit an observation-only group (OBS; n = 100), followed by participants (n = 200) randomly assigned to receive either EQ-assisted pharmacist counseling or EQ plus 8 weeks of nicotine transdermal patch (EQ+). Both treatment groups were scheduled to receive two follow-up counseling calls from pharmacists.

RESULTS

Most participants in the EQ and EQ+ groups reported receiving counseling from a pharmacist, including follow-up calls, while none of the OBS participants reported speaking with the pharmacist about cessation. At 6 months, fewer OBS participants reported a quit attempt (42%) compared with EQ (76%) or EQ+ (65%) participants (p < .02). At 6 months, 7-day point-prevalence abstinence was 28% and 15% among the EQ+ and EQ groups, respectively, compared with 8% among OBS participants (p < .01), and EQ+ participants were twice as likely to be quit than were EQ participants (p < .01).

DISCUSSION

A tailored software system can facilitate the delivery of smoking cessation counseling to pharmacy patients. Results suggest that EQ was successful in increasing (a) the delivery of cessation counseling, (b) quit attempts, and (c) quit rates. Pharmacists can play an important role in the effective delivery of smoking cessation counseling.