A qualitative dual-site analysis of the pharmacist discharge care (PHARM-DC) intervention using the CFIR framework.
A qualitative dual-site analysis of the pharmacist discharge care (PHARM-DC) intervention using the CFIR framework.
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DOI：
10.1186/s12913-022-07583-5
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发表时间：
2022-02-12
影响因子：
2.8
通讯作者：
PHARM-DC Group
中科院分区：
文献类型：
--
作者：
Murry LT;Keller MS;Pevnick JM;Schnipper JL;Kennelty KA;PHARM-DC Group
老年人在从急性医院过渡到社区护理时面临着一些挑战。PHARMacist出院护理（PHARM-DC）干预是一项由药剂师领导的护理过渡（TOC）计划，旨在减少两家大型医院30天的再入院和急诊室就诊。本研究使用实施研究的综合框架（CFIR）框架来评估药剂师对PHARM-DC干预的看法。干预药剂师和药房管理员是有目的地招募的研究小组成员位于每个参与机构。位于每个机构内的研究小组成员与两名与实施干预的机构无关的研究作者协调，通过电信软件远程进行访谈和焦点小组。访谈进行了记录和转录，转录输入NVivo进行定性分析。使用迭代过程进行定性分析，以确定基于CFIR域（干预特征，外部设置，内部设置，所涉及的个人的特征和实施过程）的“先验”结构，并创建编码过程中确定的总体主题。在两所医院中，共完成了10次半结构化访谈和一个焦点小组。在站点A，对干预药剂师和担任行政职务的药剂师进行了六次访谈。同样在研究中心A，进行了一个由五名干预药剂师组成的焦点小组。在研究中心B，对4名干预药剂师和担任行政职务的药剂师进行了访谈。确定了三个首要主题：PHARM-DC和机构背景，PHARM-DC适应性的重要性，以及PHARM-DC改进和可持续性的建议。增加药剂师对技术任务的支持和克服药剂师与患者的语言障碍对干预措施的实施和交付非常重要。在考虑如何维持和扩大PHARM-DC干预时，确定干预的成本节约和量化结果尤为重要。PHARM-DC干预可以在TOC倡议、资源和人员配备差异很大的两个机构成功实施。PHARM-DC干预措施的未来实施应考虑所确定的主题，包括检查机构特定的背景因素，如药房技术人员在TOC干预措施中可能发挥的作用，干预适应性对患者需求和机构资源的重要性，以及药剂师对干预措施改进和可持续性的建议。NCT 04071951。在线版本包含补充材料，可通过10.1186/s12913-022-07583-5获得。
Older adults face several challenges when transitioning from acute hospitals to community-based care. The PHARMacist Discharge Care (PHARM-DC) intervention is a pharmacist-led Transitions of Care (TOC) program intended to reduce 30-day hospital readmissions and emergency department visits at two large hospitals. This study used the Consolidated Framework for Implementation Research (CFIR) framework to evaluate pharmacist perceptions of the PHARM-DC intervention. Intervention pharmacists and pharmacy administrators were purposively recruited by study team members located within each participating institution. Study team members located within each institution coordinated with two study authors unaffiliated with the institutions implementing the intervention to conduct interviews and focus groups remotely via telecommunication software. Interviews were recorded and transcribed, with transcriptions imported into NVivo for qualitative analysis. Qualitative analysis was performed using an iterative process to identify “a priori” constructs based on CFIR domains (intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation) and to create overarching themes as identified during coding. In total, ten semi-structured interviews and one focus group were completed across both hospitals. At Site A, six interviews were conducted with intervention pharmacists and pharmacists in administrative roles. Also at Site A, one focus group comprised of five intervention pharmacists was conducted. At Site B, interviews were conducted with four intervention pharmacists and pharmacists in administrative roles. Three overarching themes were identified: PHARM-DC and Institutional Context, Importance of PHARM-DC Adaptability, and Recommendations for PHARM-DC Improvement and Sustainability. Increasing pharmacist support for technical tasks and navigating pharmacist-patient language barriers were important to intervention implementation and delivery. Identifying cost-savings and quantifying outcomes as a result of the intervention were particularly important when considering how to sustain and expand the PHARM-DC intervention. The PHARM-DC intervention can successfully be implemented at two institutions with considerable variations in TOC initiatives, resources, and staffing. Future implementation of PHARM-DC interventions should consider the themes identified, including an examination of institution-specific contextual factors such as the roles that pharmacy technicians may play in TOC interventions, the importance of intervention adaptability to account for patient needs and institutional resources, and pharmacist recommendations for intervention improvement and sustainability. NCT04071951. The online version contains supplementary material available at 10.1186/s12913-022-07583-5.
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