Qualitative study on the implementation of professional pharmacy services in Australian community pharmacies using framework analysis

Abstract

BackgroundMultiple studies have explored the implementation process and influences, however it appears there is no study investigating these influences across the stages of implementation. Community pharmacy is attempting to implement professional services (pharmaceutical care and other health services). The use of implementation theory may assist the achievement of widespread provision, support and integration. The objective was to investigate professional service implementation in community pharmacy to contextualise and advance the concepts of a generic implementation framework previously published.MethodsPurposeful sampling was used to investigate implementation across a range of levels of implementation in community pharmacies in Australia. Twenty-five semi-structured interviews were conducted and analysed using a framework methodology. Data was charted using implementation stages as overarching themes and each stage was thematically analysed, to investigate the implementation process, the influences and their relationships. Secondary analyses were performed of the factors (barriers and facilitators) using an adapted version of the Consolidated Framework for Implementation Research (CFIR), and implementation strategies and interventions, using the Expert Recommendations for Implementing Change (ERIC) discrete implementation strategy compilation.ResultsSix stages emerged, labelled as development or discovery, exploration, preparation, testing, operation and sustainability. Within the stages, a range of implementation activities/steps and five overarching influences (pharmacys' direction and impetus, internal communication, staffing, community fit and support) were identified. The stages and activities were not applied strictly in a linear fashion. There was a trend towards the greater the number of activities considered, the greater the apparent integration into the pharmacy organization. Implementation factors varied over the implementation stages, and additional factors were added to the CFIR list and definitions modified/contextualised for pharmacy. Implementation strategies employed by pharmacies varied widely. Evaluations were lacking.ConclusionsThe process of implementation and five overarching influences of professional services implementation in community pharmacy have been outlined. Framework analysis revealed, outside of the five overarching influences, factors influencing implementation varied across the implementation stages. It is proposed at each stage, for each domain, the factors, strategies and evaluations should be considered. The Framework for the Implementation of Services in Pharmacy incorporates the contextualisation of implementation science for pharmacy.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1689-7) contains supplementary material, which is available to authorized users.

Combined use of the Consolidated Framework for Implementation Research (CFIR) and the Theoretical Domains Framework (TDF): a systematic review

“…1). We identified 12 CFIR + TDF articles; the final list of included studies comprised five protocols for empirical studies (Gould [22], Prior [23], Manca [24], Graham-Rowe [25], Sales [26]) and seven completed empirical studies (Murphy [27], English [28], Bunger [29], Moullin [30], Newlands [31], Templeton [32], Elouafkaoui [33]).

Fig. 1PRISMA flow diagram

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“…Two completed studies and two protocols described intervention design and/or implementation plans (Gould [22], Sales [26], Murphy [27], English [28]); one protocol described a comparison of the effectiveness of an intervention relative to standard care (Prior [23]), and two protocols and five completed studies evaluated interventions (Manca [24], Sales [26], Bunger [29], Moullin [30], Newlands [31], Templeton [32], Elouafkaoui [33]). Several of the included studies had multiple objectives (e.g., effectiveness study and concurrent qualitative process evaluation [23, 33]).…”

“…Ostensibly, protocols may yield future intervention development papers and results papers that apply CFIR + TDF to additional intervention phases. Five completed studies and two protocols applied CFIR + TDF to the intervention evaluation phase (Manca [24], Graham-Rowe [25], Bunger [29], Moullin [30], Newlands [31], Templeton [32]).…”

“…(Note that Gould et al used CFIR + TDF in only one of their three sub-studies in which only qualitative (interview and observation) methods were used [22]. ) Two studies were qualitative (Moullin [30], Newlands [31]), and one protocol was a systematic literature review (Graham-Rowe [25]).…”

“…A third completed study (Bunger [29]) applied neither the CFIR nor the TDF during data collection. One protocol (Manca [24]) and one completed study (Moullin [30]) planned to collect qualitative interview data but did not state how CFIR + TDF would be used during data collection. Three protocols and two completed studies (Gould [22], Prior [23], Sales [26], Newlands [31], Elouafkaoui [33]) developed or planned to develop (Sales [26]) interview topic guides using CFIR + TDF, and one completed study developed a provider questionnaire using CFIR + TDF (Templeton [32]); however, none fully specified which constructs or domains would be used or how constructs or domains would be selected.…”