Post hoc evaluation of a common-sense intervention for asthma management in community pharmacy

Abstract

ObjectivesThe aim was to evaluate a common-sense, behavioural change intervention to implement clinical guidelines for asthma management in the community pharmacy setting.DesignThe components of the common-sense intervention were described in terms of categories and dimensions using the Intervention Taxonomy (ITAX) and Behaviour Change Techniques (BCTs) using the Behaviour Change Wheel (BCW), Capability, Opportunity and Motivation-Behaviour (COM-B) System and Behaviour Change Techniques Taxonomy (BCTTv1). The retrospective application of these existing tools facilitated evaluation of the mechanism, fidelity, logistics and rationale of the common-sense intervention.InterventionThe initial intervention study was conducted in 336 community pharmacies in the metropolitan area of Perth, Western Australia. Small-group workshops were conducted in 25 pharmacies; 162 received academic detailing and 149 acted as controls. The intervention was designed to improve pharmacy compliance with guidelines for a non-prescription supply of asthma reliever medications.ResultsRetrospective application of ITAX identified mechanisms for the short-acting β agonists intervention including improving knowledge, behavioural skills, problem-solving skills, motivation and self-efficacy. All the logistical elements were considered in the intervention design but the duration and intensity of the intervention was minimal. The intervention was delivered as intended (as a workshop) to 13.4% of participants indicating compromised fidelity and significant adaptation. Retrospective application of the BCW, COM-B system and BCTTv1 identified 9 different behaviour change techniques as the rationale for promoting guideline-based practice change.ConclusionsThere was a sound rationale and clear mechanism for all the components of the intervention but issues related to logistics, adaptability and fidelity might have affected outcomes. Small group workshops could be a useful implementation strategy in community pharmacy, if logistical issues can be overcome and less adaptation occurs. Duration, intensity and reinforcement need consideration for successful wider implementation. Further qualitative evaluations, triangulation of research and evaluations across interventions should be used to provide a greater understanding of unresolved issues.

Implementation fidelity of an intervention programme to enhance adherence to antihypertensive medication in Dutch community pharmacies

“…In addition to the changes suggested to allow successful implementation of the present intervention programme in daily practice, some general factors relevant to fidelity of pharmaceutical care implementation in community pharmacies should be considered. Alongside strong methodological designs of intervention studies, including a tailored approach and a theoretical framework, it is important to consider factors like adaptability, context and climate, logistics support by staff and sustainability of the community pharmacy setting [11, 13, 24].…”

Considering pharmacy workflow in the context of Australian community pharmacy: A pilot time and motion study

“…1 Given the increasing time pressures on primary care physicians, 1 utilising pharmacists in a model of care is being currently proposed for chronic diseases such as asthma, cardiovascular disease, and HIV, through novel interventions implemented at the pharmacy level. [2][3][4] Such interventions can improve patient understanding, adherence to medications, and ultimately clinical outcomes with collaborative pharmacy interventions already showing improvements in lipid levels and blood pressure for cardiovascular disease.…”

“…While professional bodies such as the Pharmacy Guild of Australia and the Pharmaceutical Society of Australia provide guidelines for community pharmacists about the delivery of professional services, 6,7 concerns have been raised about pharmacists not fulfilling the roles of the guidelines, and difference in implementation standards between pharmacies. 4,8 Furthermore, pharmacists report time management issues and privacy concerns as significant barriers to implementing new pharmacy services for chronic diseases. 9,10 To tackle such issues, the limited evidence base describing how Australian community pharmacists operate must be expanded.…”

Baby Buddy App for Breastfeeding and Behavior Change: Retrospective Study of the App Using the Behavior Change Wheel (Preprint)

“…Using the BCW has inherent coding, interpretation, and application limitations. However, like other studies, we do believe that there is benefit in "retrofitting" interventions to the BCW even though it may have not been used in the design phase [33][34][35]. Prospective analysis of the app development using the BCW and scientific research would potentially result in a higher quality behavior change intervention tool; however, Baby Buddy was not primarily designed to change behavior and was rather designed as a resource to inform and empower pregnant women.…”