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Health services research
Original research
Evaluating an implementation programme for medication review with follow-up in community pharmacy using a hybrid effectiveness study design: translating evidence into practice
  1. Raquel Varas-Doval1,
  2. Miguel A Gastelurrutia2,
  3. Shalom I Benrimoj2,
  4. Maria Jose Zarzuelo2,
  5. Victoria Garcia-Cardenas3,
  6. Beatriz Perez-Escamilla2,
  7. Fernando Martínez-Martínez4
  1. 1 Department of Pharmaceutical Services, Spanish General Council of Official Colleges of Pharmacists, Madrid, Spain
  2. 2 Pharmaceutical Care Research Group, CTS-131, University of Granada Faculty of Pharmacy, Granada, Spain
  3. 3 Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
  4. 4 Clinical Pharmacy Section, Pharmacy Department, Universidad de Granada, Granada, Spain
  1. Correspondence to Dr Miguel A Gastelurrutia; magastelu{at}farmanorte.org

Abstract

Objectives To evaluate an implementation programme of a community pharmacy medication review with follow-up (MRF) service using a hybrid effectiveness-implementation study design, and to compare the clinical and humanistic outcomes with those in a previously conducted cluster randomised controlled trial (cRCT).

Setting Community pharmacies in Spain.

Participants 135 community pharmacies and 222 pharmacists providing MRF to polymedicated patients aged 65 or over.

Intervention The intervention was an implementation programme for the MRF service. A national level group was established, mirrored with a provincial level group. A series of interventions were defined (1) to engage pharmacy owners with the implementation model and (2) to provide training to pharmacists consisting of clinical case studies, process of MRF, communication skills and data collection methods and (3) practice change facilitators.

Primary and secondary outcome measures The primary outcomes for the implementation programme were progress, reach, fidelity and integration. The secondary outcomes were number of medications, non-controlled health problems, emergency visits, hospitalisations and health-related quality of life, which were compared with a previous 6-month cluster RCT.

Results 55% of pharmacies reached the implementation phase and 35.6% remained in the testing phase at 12 months. A reach of 89.3% (n=844) was achieved. Fidelity average score was 8.45 (min: 6.2, max: 9.3) out of 10. The integration mean score was 3.39 (SD: 0.72) out of 5. MRF service outcomes were similar to the cluster RCT study; however, the magnitude of the outcomes was delayed.

Conclusions The implementation of pharmacy services is a complex multifactorial process, conditioned by numerous implementation factors. In the absence of remuneration, the implementation of the MRF service is a slow process, taking at least 12 months to complete.

Trial registration number CGFTRA-2017-01.

  • health services administration & management
  • change management
  • primary care
  • public health
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-2019-036669

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    Footnotes

    • Contributors All authors were part of the implementation team. RV-D, VGC, MAG, SIB and FM-M contributed to study design, fieldwork, data analysis and writing of the manuscript. M-JZ contributed to fieldwork and writing of the manuscript. BPE contributed to study design and fieldwork. All authors have read and approved the final manuscript.

    • Funding This work was supported by the Spanish General Council of Official Colleges of Pharmacists through a grant from Cinfa Pharmaceuticals. Neither of these organisations influenced the study design, interpretation of data, writing of the manuscript, nor the decision to submit this manuscript for publication. The Spanish General Council of Official Colleges of Pharmacy assisted with the selection of the study locations and contacting community pharmacies (contract number 21/1/204 UGR.CGCOF).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The study protocol was approved by the ethics committee of the Virgen de las Nieves University Hospital (approval number 13/C-11).

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

    • Data availability statement The data that support the findings of this study are available from the Spanish General Council of Official Colleges of Pharmacy but restrictions apply to the availability of these data, which were used under licence for the current study and so are not publicly available. Data are however available from the authors upon reasonable request and with permission.