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Background
Pharmacy practice research often focuses on the design, implementation and evaluation of pharmacy services and interventions. The use of behavioural theory in intervention research allows understanding of interventions’ mechanisms of action and are more likely to result in effective and sustained interventions.
Aim
To collate, summarise...
Context in source publication
Similar publications
Community pharmacists’ roles have expanded globally to address the COVID-19 pandemic. Given the limited information available on public satisfaction regarding pharmacy preparedness and services during this crisis in Jordan, our study aimed to assess public contentment with community pharmacists’ readiness for the pandemic. Not to forget the educati...
Citations
... The Theoretical Domains Framework (TDF) guided interview guide development, data collection, and analysis. 32 Although numerous psychological theories have been utilized to explain health care providers' behavior, 33,34 the TDF framework is a validated framework specifically designed for application in health care settings to investigate the barriers ...
Purpose
This study aimed to investigate the current practices of VTE prophylaxis in patients undergoing abdominal-pelvic surgery (PAS) and to identify the factors that influence surgeons’ practice of VTE prophylaxis.
Patients and Methods
This two-phase explanatory sequential mixed-method study used chart audits followed by semi-structured interviews based on the theoretical domain framework (TDF). During Phase I, quantitative data from 240 medical records of patients with PAS in April 2023 were audited to measure adherence rates to the standard thromboprophylaxis guidelines. In Phase II, in-depth interviews with 16 surgeons were conducted and analyzed using thematic content analysis based on the TDF framework to understand the determinants of thromboprophylaxis in patients with PAS.
Results
Audits of 240 medical records of patients showed the rate of appropriate prophylactic methods was low (11.7%). For patients on anticoagulant prophylaxis, adherence rates regarding drug selection and dosage were high (100% and 89.3%, respectively), whereas adherence rates regarding time of initiation and length of prophylaxis were low (50% and 28.6%, respectively). A qualitative analysis identified 12 theoretical domains relevant to thromboprophylaxis practices among surgeons. The most encountered barriers included concerns about bleeding risk, resource issues, low beliefs about preventive benefits for certain patients with PAS, inadequate knowledge and training, and a lack of protocol and policy. The most encountered enablers included positive beliefs in prophylaxis benefits, mandatory policy and computerized supportive tools, thromboprophylaxis set as patient safety goals, leadership and multidisciplinary working, and training.
Conclusion
Significant quality gaps were present in VTE prevention practice for abdominal-pelvic surgical patients, and multiple coexisting factors prevented the full adoption of practice standards. The implementation of an anticoagulation stewardship program is essential for addressing practical issues.
... The TDF is among the most used frameworks also in pharmacy practice [11]. This framework has been applied in various pharmacy settings, including immunization provision [12], counselling and management of the homeless population [13], prescribing practices [14], and the adoption of full-scope services [15]. ...
Background
There is a lack of validated Theoretical Domains Framework (TDF) based instruments to investigate barriers and facilitators for community pharmacists (CPs) to provide effective care for breastfeeding women.
Aim
The aim of this study was to evaluate the psychometric properties of a TDF-14 (v2) based questionnaire to identify barriers and facilitators faced by Turkish CPs in provision of pharmaceutical care to breastfeeding women.
Method
This observational study was carried out among CPs in Türkiye. After generating the English form of the questionnaire, translation and cultural adaptation of the questionnaire, an expert panel and pilot study were conducted. Data were collected through an online survey between October 2023 and January 2024. The psychometric properties of the questionnaire were tested by performing test–retest reliability, confirmatory factor analysis (CFA), and internal consistency analysis.
Results
The test–retest reliability analysis (n = 30) indicated that the intraclass correlation coefficient values of each domain were between 0.75 and 0.96 ( p < 0.001). Four hundred and sixteen CPs completed the questionnaire (response rate: 37.5%). Out of a total of 36 items, six items were excluded. The final questionnaire covered 13 out of the 14 TDF (v2) domains. Chi square/degree of freedom ( χ ² /df), comparative fit index (CFI), root mean square error of approximation (RMSEA), and standardized root mean square residual (SRMR) were 2.01, 0.96, 0.05, and 0.04; respectively. Cronbach's alpha values of each domain ranged from 0.63–0.90.
Conclusion
This TDF-based questionnaire is a valid and reliable tool for evaluating CPs’ enablers and barriers to providing pharmaceutical care to breastfeeding women.
... One strength of this study was the use of CFIR to provide theoretical underpinning hence enhancing the likelihood of comprehensive coverage of implementation facilitators and barriers. This also adds to the evidence base of the application of theory in pharmacy related research [54]. Attention throughout was paid to the aspect of qualitative research trustworthiness (i.e., credibility, dependability, confirmability and transferability), as described earlier. ...
Background
Inappropriate polypharmacy arises through many factors including deficiencies in prescribing processes. Most research has focused on solutions at the clinician/patient levels with less at the organisational level.
Aim
To explore key stakeholder identified barriers and facilitators to implementation of an organisational level polypharmacy management framework.
Method
Qualitative data were collected within the Ministry of Health in Oman. Key stakeholders were purposively sampled encompassing senior representatives of pharmacy, medicine, and nursing directors; healthcare policymakers; patient safety leaders; and academic leaders. A semi-structured interview schedule was developed informed by a recent scoping review and underpinned by the Consolidated Framework for Implementation Research (CFIR). Interviews, which continued until data saturation, were audio-recorded, transcribed and analysed using the Framework Approach.
Results
Thirteen key stakeholders were interviewed, with representation of each target group. Facilitators largely mapped to the CFIR domain of inner setting (i.e., aspects of stakeholder awareness, the electronic health system and national leadership), intervention characteristic (evidence gaps), characteristics of individuals (stakeholders and champions) and process (change strategy). Barriers also largely mapped to the inner setting (policy absence, communication and health professional practice) and outer setting (resource needs).
Conclusion
This study has illuminated the facilitators and barriers to the implementation of an organisational level polypharmacy management framework. Further work is required to translate these themes into an actionable plan to implement the framework. Particular attention is required for aspects of the CFIR domain of inner setting (i.e., the internal context within which implementation occurs) as most barriers mapped to this domain.
... With an explicit theoretical rationale, interventions could be more effective and better replicated in other contexts if the mechanism of action was better understood. [57][58][59][60] The absence of reporting of the theoretical underpinnings of the included interventions prevented us from drawing any conclusions in regard to the impact of theory-informed interventions in this area. Michie et al. elucidated that even if the theory-driven intervention does not yield a favorable findings in favor of the intervention, it helps to identify, from a huge array, the intervention components that might work. ...
... 86 It is imperative that future interventions utilize behavioral theories to strengthen the impact and ensure the sustainability of interventions. 87 This is of extreme importance as the follow-up duration for studies included in our review was short, which could raise concerns regarding the long-term effect of these interventions. Additionally, the various interacting components in behavior change research makes it challenging to identify the active, effective components within interventions and for others to replicate them. ...
Background
The perioperative arena is a unique and challenging environment that requires coordination of the complex processes and involvement of the entire care team. Pharmacists’ scope of practice has been evolving to be patient-centered and to expand to variety of settings including perioperative settings.
Objectives
To critically appraise, synthesize, and present the available evidence of the characteristics and impact of pharmacist-led interventions on clinically important outcomes in the perioperative settings.
Design
A systematic review and meta-analysis.
Methods
We searched PubMed, Embase, and CINAHL from index inception to September 2023. Included studies compared the effectiveness of pharmacist-led interventions on clinically important outcomes (e.g. length of stay, readmission) compared to usual care in perioperative settings. Two independent reviewers extracted the data using the DEPICT-2 (Descriptive Elements of Pharmacist Intervention Characterization Tool) and undertook quality assessment using the Crowe Critical Appraisal (CCAT). A random-effect model was used to estimate the overall effect [odds ratio (OR) for dichotomous and standard mean difference (SMD) for continuous data] with 95% confidence intervals (CIs).
Results
Twenty-five studies were eligible, 20 (80%) had uncontrolled study design. Most interventions were multicomponent and continuous over the perioperative period. The intervention components included clinical pharmacy services (e.g. medication management/optimization, medication reconciliation, discharge counseling) and education of healthcare professionals. While some studies provided a minor description in regards to the intervention development and processes, only one study reported a theoretical underpinning to intervention development. Pooled analyses showed a significant impact of pharmacist care compared to usual care on length of stay (11 studies; SMD −0.09; 95% CI −0.49 to −0.15) and all-cause readmissions (8 studies; OR 0.60; 95% CI 0.39–0.91). The majority of included studies (n = 21; 84%) were of moderate quality.
Conclusion
Pharmacist-led interventions are effective at improving clinically important outcomes in the perioperative setting; however, most studies were of moderate quality. Studies lacked the utilization of theory to develop interventions; therefore, it is not clear whether theory-derived interventions are more effective than those without a theoretical element. Future research should prioritize the development and evaluation of multifaceted theory-informed pharmacist interventions that target the whole surgical care pathway.
... Constrained resources, workforce pressures and the need to rebuild following the Covid-19 pandemic, further compound the unprecedented challenges faced by healthcare systems worldwide. Innovation in medicines optimisation, embracing pathway redesign, behavioural science, sustainability, pharmacogenomics, artificial intelligence and integrated technology solutions, including companion diagnostics, is needed to transform healthcare systems, supporting the delivery of high quality, safe, effective and sustainable person-centred care [8][9][10]. ...
Background
Sub-optimal medicines use is a challenge globally, contributing to poorer health outcomes, inefficiencies and waste. The Medicines Optimisation Innovation Centre (MOIC) was established in Northern Ireland by the Department of Health (DH) in 2015 to support implementation of the Medicines Optimisation Quality Framework.
Aim
To demonstrate how MOIC informs policy and provides support to commissioners to improve population health and wellbeing.
Setting
MOIC is a regional centre with multidisciplinary and multi-sector clinical expertise across Health and Social Care and patient representation.
Development
Core funded by DH, MOIC has a robust governance structure and oversight programme board. An annual business plan is agreed with DH. Rigorous processes have been developed for project adoption and working collaboratively with industry.
Implementation
MOIC has established partnerships with academia, industry, healthcare and representative organisations across Europe, participating in research and development projects and testing integrated technology solutions. A hosting programme has been established and evaluation and dissemination strategies have been developed.
Evaluation
MOIC has established numerous agreements, partnered in three large EU projects and strengthened networks globally with extensive publications and conference presentations. Informing pathway redesign, sustainability and COVID response, MOIC has also assisted in the development of clinical pharmacy services and antimicrobial stewardship in Europe and Africa. Northern Ireland has been recognised as a 4-star European Active and Healthy Ageing Reference Site and the Integrated Medicines Management model as an example of best practice in Central and Eastern Europe.
Conclusion
MOIC has demonstrated considerable success and sustainability and is applicable to health systems globally.
... 79,80 Emerging studies should construct pharmacist interventions grounded in theoretical frameworks, taking into account the distinctive characteristics of surgical settings and the workflow of surgeons. 81,82 We urge subsequent research to furnish comprehensive descriptions of interventions, covering structures, processes, and outcomes to enhance reproducibility, with the additional recommendation of employing the DEPICT-2 tool. Furthermore, there is a need for additional exploration into the implications of pharmacist prescribing in clinical pharmacy practice, given its potential benefits, including accelerated access to medications and alleviation of physician workload. ...
Disclaimer
In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
Purpose
Integration of pharmacists into the perioperative practice has the potential to improve patients’ clinical outcomes. The aim of this systematic review is to systematically investigate the evidence on the roles of pharmacists in perioperative settings and the effects of pharmacist interventions on clinical outcomes and therapy optimization.
Methods
A protocol-led (CRD42023460812) systematic review was conducted using search of PubMed, Embase, CINAHL and Google Scholar databases. Studies that investigated the roles and impact of pharmacist-led interventions in the perioperative settings on clinical outcomes were included. Data were extracted and quality assessed independently by two reviewers using the DEPICT-2 (Descriptive Elements of Pharmacist Intervention Characterization Tool) and the Crowe Critical Appraisal Tool (CCAT), respectively. Studies were grouped according to the clinical area into 5 sections: (1) pain control and opioid consumption; (2) venous thromboembolism (VTE); (3) surgery-related gastrointestinal complications; (4) postoperative medication management; and (5) total parenteral nutritional.
Results
Nineteen studies involving a total of 7,168 patients were included; most studies were conducted in gastrointestinal (n = 7) and orthopedics (n = 6) surgical units. Most included studies (n = 14) employed a multicomponent intervention including pharmaceutical care, education, guideline development, drug information services, and recommendations formulation. The processes of developing the implemented interventions and their structures were seldom reported. Positive impacts of pharmacist intervention on clinical outcomes included significant improvement in pain control and reductions in the incidence of VTE, surgery-related stress ulcer, nausea, and vomiting. There is inconsistency in the findings related to medication management (ie, achieving desired therapeutic ranges) and management of chronic conditions (hypertension and type 2 diabetes).
Conclusion
Whilst there is some evidence of positive impacts of pharmacist intervention on clinical outcomes and optimizing drug therapy, this evidence is generally of low quality and insufficient volume. While this review suggests that pharmacists have essential roles in improving the care of patients undergoing surgery, more research with rigorous designs is required.
... While the discussions mainly centre around the ethical implications of the academic writing skills of such generative AI models, it raises the question what novel opportunities generative AI presents for clinical pharmacy research [2]. As clinical pharmacy practice operates in a complex interdisciplinary healthcare system, clinical pharmacy practice research is equally complex and transdisciplinary, potentially opening up a lot of opportunity for bridging the disciplines using artifical intelligence in new ways [3]. One such potential application for artificial intelligence is the development of delirium prescribing resources across different patient groups. ...
The advent of artificial intelligence (AI) technologies has taken the world of science by storm in 2023. The opportunities of this easy to access technology for clinical pharmacy research are yet to be fully understood. The development of a custom-made large language model (LLM) (DELSTAR) trained on a wide range of internationally recognised scientific publication databases, pharmacovigilance sites and international product characteristics to help identify and summarise medication related information on delirium, as a proof-of-concept model, identified new facilitators and barriers for robust clinical pharmacy practice research. This technology holds great promise for the development of much more comprehensive prescribing guidelines, practice support applications for clinical pharmacy, increased patient and prescribing safety and resultant implications for healthcare costs. The challenge will be to ensure its methodologically robust use and the detailed and transparent verification of its information accuracy.
Fragmented healthcare systems hinder pharmacists’ access to comprehensive patient data, limiting their clinical role and posing health risks. Enhancing system interoperability and evaluating factors influencing pharmacists' readiness for technology-driven practice change is a crucial step.
This systematic review aimed to investigate the digital determinants of pharmacists’ readiness for technology-oriented practice change and interoperability.
A systematic search of PubMed, Scopus, and Cochrane Library was conducted on August 7, 2023, with registration number INPLASY202380071. Search method was developed, and quality was assessed using the Boynton and Greenhalgh Quality Checklist (BGQC) and Critical Appraisal Skills Programme (CASP).
The review included 13 studies, of which 7 (53.8%) included the study’s setting. Of the seven studies, most discussed the community pharmacy setting (n = 3, 23.1%), followed by hospital pharmacy (n = 1, 7.6%), and both settings (n = 3, 23.1%). The studies included several countries: the United Kingdom (UK), Canada, the United States of America (USA), Australia, India, Sweden, and Saudi Arabia. The studies discussed several medical health informatic technologies such as electronic health records and e-prescribing. The three most reported technology-related influencing factors were related to digital literacy and technology-oriented tailored training (n = 9, 69.2%), followed by technical system features (n = 6, 46.2%) and technology operations (n = 5, 38.5%). The overall readiness level for technology-related practice change was intermediate (n = 7, 53.8%), high (n = 3, 23.1%), and low (n = 3, 23.1%).
Digital literacy, tailored training, and system features are crucial for enhancing pharmacists’ readiness for technology adoption, highlighting the need for improved digital infrastructure and interoperability in clinical practice.
Family caregivers face many problems during administration of medications. Pharmacists are reliable and accessible healthcare providers in addressing family caregivers’ medication related inquiries in primary care.
This study aimed to evaluate the short-term outcome of a personalized theory-based pharmaceutical care service on the medication administration problems of family caregivers.
This pre-post intervention study was carried out among family caregivers at a community pharmacy in Istanbul, Türkiye from May through December 2022. The service was developed by mapping problems using the Theoretical Domains Framework and selecting related behavioural change techniques. The primary outcome was the change in the scores on the Turkish version of the Family Caregiver Medication Administration Hassles Scale (FCMAHS-TR) from baseline to the one-month follow-up assessment. Secondary outcomes were their ability to read health related materials, care burden, and satisfaction.
Among family caregivers (n = 100), total score of FCMAHS-TR was significantly reduced after receiving theory based pharmaceutical care service (median [IQR] 23.0 [17.0–27.0] vs 17.0 [10.3–20.0]; p < 0.001). The proportion of family caregivers with high ability to read health related materials was significantly increased (34.0% vs 48.0%; p < 0.05) with non-significant change in the proportion of family caregiver with high burden (97.0% vs 94.0%; p > 0.05). Younger family caregivers had significantly higher scores on the Turkish version of Patient-Oriented Pharmacy Services Questionnaire (PSPSQ) 2.0 when compared with the older ones (≥ 65 y) (p < 0.05).
Family caregivers’ medication administration problems were reduced after receiving the theory based pharmaceutical care service. Long term impact and national implementation of this service should be assessed in the further studies.
