Implementation Science In Community Pharmacy


Download Implementation Science In Community Pharmacy


Preview text

IMPLEMENTATION SCIENCE IN COMMUNITY PHARMACY
Development of frameworks, models and tools for introducing and integrating professional services
Joanna C Moullin
[email protected]

COMMUNITY PHARMACY
~ 47 million population

~ 23 million population 5 457 community pharmacies

21 854 community pharmacies 68 381 pharmacists
~ 2 150 people/pharmacy ~ 3.1 pharmacists/ pharmacy

28 950 pharmacists ~ 4 300 people/pharmacy

~ 8 million population 1 744 community pharmacies

~ 5.3 pharmacists/pharmacy

~ 4 300 pharmacists ~ 4 600 people/pharmacy

~ 2.5 pharmacists/ pharmacy

EVIDENCE PATHWAY

Definition Evaluation
Service

Communication

Awareness

Sustainment

Westfall J., Mold J., Fagna, L. JAMA 2007. 297(4):403-406.

PROFESSIONAL PHARMACY SERVICES
Hierarchical Model of Cognitive Pharmaceutical Services
1. Medicines Information 2. Compliance, adherence and/or concordance 3. Disease screening 4. Disease prevention 5. Clinical intervention or drug related problems 6. Medication Use Reviews (MUR) 7. Medication Management/Medication Therapy Management
a. Home Medication Review (HMR) b. Residential Care Medication Reviews (RMMR) c. Medication Review with follow-up (Seguimiento Farmacoterapéutico, SFT)
8. Disease State Management for Chronic Conditions 9. Participation in Therapeutic Decisions with Medical Practitioners
a. Clinical setting b. Pharmacy setting
10. Prescribing
a. Supplementary b. Dependent
Benrimoj, S.I., Feletto, E. & Gastelurrutia, M.A. 2010. Ars Pharm, vol. 51, no. 2, pp. 69-87.

MEDICATION REVIEW
 Aim defined  Types classified  Clinical effectiveness studied  Cost-effectiveness studied
X Fidelity of provision X Reach including representativeness X Degree of integration into practice X Cost of implementation X Effectiveness of implementation strategies
 We don´t know the “real World” situation

EVIDENCE PATHWAY

Definition Evaluation

Service

Communication

Awareness

Gap

Sustainment
Westfall J., Mold J., Fagna, L. JAMA 2007. 297(4):403-406.

JUSTIFICATION

• There is an international movement towards the development, diffusion, implementation and sustainability of professional pharmacy services, however there appears to be an pervasive struggle to achieving widespread integration into routine practice.1

• There appears to be no theoretical framework that incorporates all the elements that are involved in the implementation process in the community pharmacy setting.2

• Together with a theoretical framework there is a need for a model for the evaluation to be designed to assess the implementation and provision of such services.3

• A practical application of implementation frameworks, models and tools for the implementation of professional pharmacy services is to provide researchers, academics, professional organisations and pharmacists a base from which to develop implementation protocols and programs.

• Implementation evidence may help community pharmacy achieve their overall goal of professional service provision and subsequent improvement of health outcomes for the communities they serve.

1 Houle, S.K., et al. 2014, Can Pharm J (Ott), vol. 147, no. 4, pp. 209-32.3 Brownson, R., Colditz, G. & Proctor, E. 2012, Dissemination and Implementation

2 Moullin, J.C., et al. Health Res Policy Syst, vol. 13, p. 16.

Research in Health: translating science to practice, Oxford University Press, NY.

OBJECTIVES
The thesis covered the synthesis, analysis and progression of knowledge concerning implementation science as well as its contextualisation and application for the implementation of professional services in community internationally. The research conceptualised and defined the process, influences and indicators for the implementation of professional pharmacy services in community pharmacy.
Specific Objectives
1. Identify the extent to which existing implementation frameworks include implementation concepts and determine if frameworks vary depending on the innovation they target.
2. Explore the implementation process occurring in community pharmacy and to assess the factors, strategies and evaluations influencing this process, in order to tailor a framework for the implementation of services in pharmacy.
3. Develop two tools to measure fidelity, specifically an adherence index and a patient responsiveness scale for medication review with follow-up service.

Sequence
Define Professional Pharmacy Services
Determine the concepts involved in the implementation of an innovation in healthcare
Delineate the implementation process into a series of stages and
activities
Categorise levels that influence implementation in pharmacy
Propose factors, strategies, and evaluations implicated in implementation
Design measures to conduct implementation research and
projects

Methodology
Theoretical work

Article
1

Systematic Literature review

2

Semi-structured interviews

3

Theoretical work

4

Quantitative study

5

RESULTS
Pharmacy Services

Pharmacy Services

Professional Pharmacy Services
Non-professional Pharmacy Services

Pharmacist Services
Other Healthcare Practitioner Services

Pharmaceutical Services
Other Healthcare Services

Professional Pharmacy Service
…is an action or set of actions undertaken in or organised by a pharmacy, delivered by a pharmacist or other health practitioner, who applies their specialised health knowledge personally or via an intermediary, with a patient/client, population or other health professional, to optimise the process of care, with the aim to improve health outcomes and the value of healthcare.
Moullin, JC., Sabater-Hernández, D., Fernandez-Llimos, F., Benrimoj, SI. Res Social Adm Pharm 2013 Nov-Dec; 9(6): 989-995

Preparing to load PDF file. please wait...

0 of 0
100%
Implementation Science In Community Pharmacy