Strategies for Patient Care Services in Community Pharmacy: A - - PowerPoint PPT Presentation

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

PubMed (thru 3/9/16) International Pharmaceutical Abstracts (IPA) (thru 4/5/16) EMBASE (thru 4/20/16) Innovations in Pharmacy Implementation Science Article reference 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 iterative strategies – Provide interactive assistance – Adapt and tailor to context – Develop stakeholder interrelationships – Train and educate stakeholders – Support clinicians – Engage consumers – Utilize financial strategies – Change infrastructure

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) EMBASE (n=1,269) Innovations in Pharmacy (n=14) Implementation Science (n=7) Reference Lists (n=31) 237 articles included Excluded Duplicate (n=185) Article Not Available (n=12) Language (n=7) 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)

Article Characteristics

Patient Care Services Reported (n=237 articles)

10 20 30 40 50 60 70 80 90 100

Medication Therapy Management (MTM) Screening Disease State Management Immunizations Multiple Services Other

# Articles Patient Care Service

Publication Year (n=237 articles)

5 10 15 20 25 30 35 40 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 # Articles Publication Year

MTM Screening Disease State Management Immunizations Multiple Services Other

Countries (n =237 articles)

20 40 60 80 100 120 # Articles Country

Implementation Strategies

Number of Implementation Strategies Reported per Article (n=223 articles)

5 10 15 20 25 30 35 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 # Articles # Strategies Reported per Article

Medication Therapy Management Screenings Disease State Management Immunizations Multiple Services Other

Implementation Strategies Reported (n=223 articles)

100 200 300 400 500 600 Train and educate stakeholders Engage consumers Use of evaluative and iterative strategies Develop stakeholder interrelationships Support clinicians Utilize financial strategies Change infrastructure Provide interactive assistance Adapt and tailor to context # Times Reported Implementation Strategies

MTM Screenings Disease State Management Immunizations Multiple Services Other

Evaluation Strategies

Number of Implementation Outcomes Reported per Article (n= 223 articles)

10 20 30 40 50 60 70 80 90 1 2 3 4 5 6 # Articles # Implementation Outcomes Evaluated per Article Medication Therapy Management Screenings Disease State Management Immunizations Multiple Services Other

Implementation Outcomes Reported (n= 223 articles)

20 40 60 80 100 120 140 Reach Acceptability Adoption Feasibility Cost Appropriateness Fidelity Sustainability Penetration # Times Evaluated Implementation Outcomes MTM Screenings Disease State Management Immunizations Multiple Services Other

Conceptual Models/ Frameworks Reported (n=22 articles)

8 3 1 1 1 12 2 4 6 8 10 12 14 # Articles 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

• utcomes

– Expand meaningful use of conceptual models

Acknowledgements

> Research Team:

– Kyle Bigham, PharmD Candidate – Geoffrey Curran, PhD – Stefanie Ferreri, PharmD – Caity Frail, PharmD, MS, BCACP – Cory Hamada, PharmD Candidate – Terry Jankowski, MLS, AHIP, FMLA – Wendy Lantaff, PharmD – Melissa Somma McGivney, PharmD, FCCP, FAPhA – Margie Snyder, PharmD, MPH

> Additional Thanks:

– Hannah Renner, PharmD – Chelsea Renfro, PharmD – Crystal Felice, PharmD Candidate – Ryan Yoo

Questions? jbacci@uw.edu