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Health services research
Original research
Pharmacist and Data-Driven Quality Improvement in Primary Care (P-DQIP): a qualitative study of anticipated implementation factors informed by the Theoretical Domains Framework
  1. Jason Tang1,
  2. Madalina Toma1,
  3. Nicola M Gray1,
  4. Joke Delvaux1,2,
  5. Bruce Guthrie3,4,
  6. Aileen Grant5,
  7. Eilidh M Duncan6,
  8. Tobias Dreischulte1,7
  1. 1Scottish Improvement Science Collaborating Centre (SISCC), School of Nursing and Health Sciences, University of Dundee, Dundee, Angus, UK
  2. 2Physiotherapy Department, NHS Tayside, Dundee, Angus, UK
  3. 3Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
  4. 4Population Health Sciences Division, Medical Research Institute, University of Dundee, Dundee, UK
  5. 5School of Nursing and Midwifery, Robert Gordon University, Aberdeen, UK
  6. 6Health Services Research Unit, University of Aberdeen, Aberdeen, UK
  7. 7Institute of General Practice and Family Medicine, University Hospital of Ludwig-Maximilians-University, Munchen, Bayern, Germany
  1. Correspondence to Dr Tobias Dreischulte; tobias.dreischulte{at}med.uni-muenchen.de

Abstract

Objectives The quality and safety of drug therapy in primary care are global concerns. The Pharmacist and Data-Driven Quality Improvement in Primary Care (P-DQIP) intervention aims to improve prescribing safety via an informatics tool, which facilitates proactive management of drug therapy risks (DTRs) by health-board employed pharmacists with established roles in general practices. Study objectives were (1) to identify and prioritise factors that could influence P-DQIP implementation from the perspective of practice pharmacists and (2) to identify potentially effective, acceptable and feasible strategies to support P-DQIP implementation.

Design Semistructured face-to-face interviews using a Theoretical Domains Framework informed topic guide. The framework method was used for data analysis. Identified implementation factors were prioritised for intervention based on research team consensus. Candidate intervention functions, behavioural change techniques (BCTs) and policies targeting these were identified from the behavioural change wheel. The final intervention content and modes of delivery were agreed with local senior pharmacists.

Setting General practices from three Health and Social Care Partnerships in National Health Service (NHS) Tayside.

Participants 14 NHS employed practice pharmacists.

Results Identified implementation factors were linked to thirteen theoretical domains (all except intentions) and six (skill, memory/attention/decision making, behavioural regulation, reinforcement, environmental context/resources, social influences) were prioritised. Three intervention functions (training, enablement and environmental restructuring) were relevant and were served by two policy categories (guidelines, communication/marketing) and eight BCTs (instructions on how to perform a behaviour, problem solving, action planning, prompt/cues, goal setting, self-monitoring, feedback and restructuring the social environment). Intervention components encompass an informatics tool, written educational material, a workshop for pharmacists, promotional activities and small financial incentives.

Conclusions This study explored pharmacists’ perceptions of implementation factors which could influence management of DTRs in general practices to inform implementation of P-DQIP, which will initially be implemented in one Scottish health board with parallel evaluation of effectiveness and implementation.

  • quality improvement
  • behavioural change wheel
  • theoretical domains framework
  • behavioural change techniques
  • polypharmacy review
  • prescribing safety
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2019-033574

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    Footnotes

    • Twitter @mada_toma84, @aileenmgrant

    • Contributors JT, MT and TD designed the study and conducted the qualitative analysis supported by JD. JT and TD jointly wrote the first draft of the manuscript, with all remaining authors, MT, NMG, JD, BG, AG and EMD providing critical feedback and editing to subsequent drafts. All authors read and approved the final manuscript.

    • Funding This work was supported by the Scottish Improvement Science Collaborating Centre (SISCC) which is funded by the Scottish Funding Council (SFC), Chief Scientist’s Office, NHS Education for Scotland and The Health Foundation with in kind contributions from participating partner universities and health boards. grant number 242343290.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The study was approved by the University Research Ethics Committee of the University of Dundee (REC reference number: 2016017_Toma) before any participant was approached.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as online supplementary information. All materials used in this study can be found in the online supplemental material.