Pharmacist and Data-Driven Quality Improvement in Primary Care (P-DQIP): a qualitative study of anticipated implementation factors informed by the Theoretical Domains Framework
Pharmacist and Data-Driven Quality Improvement in Primary Care (P-DQIP): a qualitative study of anticipated implementation factors informed by the Theoretical Domains Framework
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DOI：
10.1136/bmjopen-2019-033574
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发表时间：
2020-02-01
期刊：
影响因子：
2.9
通讯作者：
Dreischulte, Tobias
中科院分区：
文献类型：
--
作者：
Tang, Jason;Toma, Madalina;Dreischulte, Tobias
目标 初级保健中药物治疗的质量和安全性是全球关注的问题。初级保健药剂师和数据驱动的质量改进 (P-DQIP) 干预旨在通过信息学工具提高处方安全性，促进健康委员会雇用的在全科实践中具有既定角色的药剂师对药物治疗风险 (DTR) 进行主动管理。研究目标是 (1) 从执业药剂师的角度确定可能影响 P-DQIP 实施的因素并对其进行优先排序，以及 (2) 确定支持 P-DQIP 实施的潜在有效、可接受和可行的策略。使用理论领域框架知情主题指南设计半结构化面对面访谈。采用框架法进行数据分析。根据研究团队的共识，优先考虑已确定的实施因素进行干预。候选干预功能、行为改变技术（BCT）和针对这些的政策是从行为改变轮中确定的。最终的干预内容和实施方式与当地高级药剂师达成一致。设置来自泰赛德国家卫生服务 (NHS) 三个健康和社会护理合作伙伴关系的一般做法。参与者 14 名 NHS 雇用的执业药剂师。结果确定的实施因素与 13 个理论领域（除意图外的所有）相关，其中 6 个理论领域（技能、记忆/注意力/决策、行为调节、强化、环境背景/资源、社会影响）被优先考虑。三个干预功能（培训、支持和环境重组）是相关的，并由两个政策类别（指南、沟通/营销）和八个 BCT（关于如何执行行为、解决问题、行动计划、提示/提示、目标设定、自我监控、反馈和重建社会环境的说明）提供服务。干预措施包括信息学工具、书面教育材料、药剂师研讨会、促销活动和小型经济激励措施。 结论 这项研究探讨了药剂师对可能影响一般实践中 DTR 管理的实施因素的看法，为 P-DQIP 的实施提供信息，该计划最初将在一个苏格兰卫生委员会实施，同时评估有效性和实施情况。
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.