Implementation Strategies for Patient Care Services in Community Pharmacy: A Systematic Review Jennifer Bacci, Kyle Bigham, Geoffrey Curran, Stefanie Ferreri, Caity Frail, Cory Hamada, Terry Jankowski , Wendy Lantaff, Melissa Somma McGivney, Margie Snyder
The “New” Community Pharmacist
Objectives To describe strategies used to (1) implement and (2) evaluate the implementation of patient care services in community pharmacies
Search Strategy International PubMed Pharmaceutical EMBASE (thru 3/9/16) Abstracts (IPA) (thru 4/20/16) (thru 4/5/16) Innovations in Implementation Article reference Pharmacy Science lists
Eligibility Criteria > Written in English > Published in 1985 or later > Describe a peer-reviewed empirical study or practice experience implementing a patient care service in a community pharmacy > Explicitly or implicitly describe at least one strategy used to implement and/ or evaluate service implementation
Implementation Strategies > Terminology defined in Expert Recommendations for Implementation Change (ERIC) study: – Use evaluative and – Train and educate iterative strategies stakeholders – Provide interactive – Support clinicians assistance – Engage consumers – Adapt and tailor to – Utilize financial strategies context – Change infrastructure – Develop stakeholder interrelationships Waltz TJ, Powell BJ, Matthieu MM, et al. Use of concept mapping to characterize relationships among implementation strategies and assess their feasibility and importance: results from the Expert Recommendations for Implementing Change (ERIC) study. Implementation Science . 2015; 10:109.
Study Selection Search Strategy PubMed (n=784) IPA (n=954) Excluded EMBASE (n=1,269) Duplicate (n=185) Innovations in Pharmacy (n=14) Article Not Available (n=12) Implementation Science (n=7) Language (n=7) Reference Lists (n=31) Publication Date (n=27) Article Type (n=1,770) Community Pharmacy (n=381) Patient Care Service (n=274) No Implementation (n=83) No Strategies (n=83) 237 articles included
Article Characteristics
Patient Care Services Reported (n=237 articles) 100 90 80 70 # Articles 60 50 40 30 20 10 0 Medication Screening Disease State Immunizations Multiple Other Therapy Management Services Management (MTM) Patient Care Service
Publication Year (n=237 articles) 40 35 30 25 # Articles 20 15 10 5 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Publication Year MTM Screening Disease State Management Immunizations Multiple Services Other
Countries (n =237 articles) 120 100 80 # Articles 60 40 20 0 Country
Implementation Strategies
Number of Implementation Strategies Reported per Article (n=223 articles) 35 30 25 # Articles 20 15 10 5 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 # Strategies Reported per Article Medication Therapy Management Screenings Disease State Management Immunizations Multiple Services Other
Implementation Strategies Reported (n=223 articles) Adapt and tailor to context Implementation Strategies Provide interactive assistance Change infrastructure Utilize financial strategies Support clinicians Develop stakeholder interrelationships Use of evaluative and iterative strategies Engage consumers Train and educate stakeholders 0 100 200 300 400 500 600 # Times Reported MTM Screenings Disease State Management Immunizations Multiple Services Other
Evaluation Strategies
Number of Implementation Outcomes Reported per Article (n= 223 articles) 90 80 70 60 # Articles 50 40 30 20 10 0 1 2 3 4 5 6 # Implementation Outcomes Evaluated per Article Medication Therapy Management Screenings Disease State Management Immunizations Multiple Services Other
Implementation Outcomes Reported (n= 223 articles) Penetration Sustainability Implementation Outcomes Fidelity Appropriateness Cost Feasibility Adoption Acceptability Reach 0 20 40 60 80 100 120 140 # Times Evaluated MTM Screenings Disease State Management Immunizations Multiple Services Other
Conceptual Models/ Frameworks Reported (n=22 articles) 14 12 12 10 # Articles 8 8 6 4 3 2 1 1 1 0 Model/ Framework
Key Findings > Train and educate stakeholders most reported implementation strategy > What are the most effective and efficient training strategies to produce sustainable pharmacist and staff behavior change? Training + ….? > > Reach, acceptability, adoption, and feasibility most reported implementation outcomes – HOWEVER, depth of analysis limited and variable – Demonstrating feasibility vs. evaluating feasibility > Limited use of conceptual models
Limitations > All experiences implementing patient care services may not be represented in the primary literature > Potential variability in data extraction – Extracting implicit data – Multiple reviewers > Did not account for multifaceted and blended implementation strategies
Conclusions > We are at the beginning… – Baseline understanding of current implementation efforts in community pharmacy practice > To get where we need to go… – Broader application of implementation science – Increase and enhance evaluation of implementation outcomes – Expand meaningful use of conceptual models
Acknowledgements > Research Team: > Additional Thanks: – – Kyle Bigham, PharmD Candidate Hannah Renner, PharmD – – Geoffrey Curran, PhD Chelsea Renfro, PharmD – – Stefanie Ferreri, PharmD Crystal Felice, PharmD Candidate – – Caity Frail, PharmD, MS, BCACP Ryan Yoo – Cory Hamada, PharmD Candidate – Terry Jankowski, MLS, AHIP, FMLA – Wendy Lantaff, PharmD – Melissa Somma McGivney, PharmD, FCCP, FAPhA – Margie Snyder, PharmD, MPH Questions? jbacci@uw.edu
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