Exploring long term implementation of cognitive services in community pharmacies - a qualitative study

  • Susanne Kaae
  • Søren T. Christensen

Abstract

Implementing cognitive services in community pharmacies faces certain obstacles. One approach aimed at improving long-term implementation is to consider the implementation process as consisting of different stages, all of which require tailored initiatives. Taking this approach into account, there is a marked need for increased knowledge regarding the initiatives necessary to support especially the later phases of the implementation process.

Objective: The aim of this project was to develop insight into factors pertaining to the later phases of implementing cognitive services in community pharmacies.

Methods: A qualitative study was conducted, consisting of semi-structured interviews with 12 Danish pharmacy staff members, who were all in charge of improving the implementation of the Inhaler Technique Assessment Service (ITAS) in the 5 years following its introduction. The interviews were used to explore which implementation barriers had been identified by the staff and how they had sought to overcome them. The interviews were analyzed by combining content and critical common sense analysis with theoretical interpretations based on Rogers “Diffusion of innovation” theory.

Results: The most predominant long-term barrier was the staff members’ adoption of the ITAS at very different rates. The problem of laggards was not lack of competencies, but a lack of self-efficacy in believing that their actual competencies were sufficient to provide the service. Lack of time and attention to the service and obtaining support from the more senior members of the pharmacy were also problematic. Both individual and group activities were launched to overcome the identified challenges belonging to different phases of the implementation process.

Conclusion: Those in charge of ensuring long term implementation of cognitive services in community pharmacies should consider the necessity to handle several simultaneous actions of both an individual and collective kind at the same time. Hence, the implementation process should be perceived as a series of interrelated stages rather than a linear process where one stage succeeds the other.

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References

1. Bradley F, Wagner, AC, Elvey RE, Noyce PR, Ashcroft DM. Determinants of the uptake of medicine use reviews (MURs) by community pharmacies in England: a multi-method study. Health Policy. 2008;88(2-3):258-268.

2. Roughead EE, Barratt JD, Ramsay E, Pratt N, Ryan P, Peck R, Killer G, Gilbert AL. The effectiveness of collaborative medicine reviews in delaying time to next hospitalization for patients with heart failure in the practice setting: results of a cohorte study. Circ Heart Fail. 2009;2(5):424-428.

3. Gastelurrutia MA, Benrimoj SI, Castrillon CC, de Amezua MJ, Fernandez-Llimos F, Faus MJ. Facilitators for practice change in Spanish community pharmacies. Pharm World Sci. 2009;31(1):32-39.

4. Krska J, Veitch GBA. Perceived factors influencing the development of primary care-based pharmaceutical care in Scotland. Int J Pharm Pract. 2001;9(4):243-252.

5. Rossing C, Hansen EH, Krass I. Barriers and facilitators in pharmaceutical care: perceptions and experiences among Danish community pharmacies. J Soc Admin Pharm. 2002;19:55-64.

6. Kröger E, Moisan J, Grégoire JP. Billing for cognitive services. Ann Pharmacother. 2000;34(3):309-316.

7. Pronk MCM, Blom LTG, Jonkers R, Bakker A. Effects of a management technician on structured working in Dutch community pharmacies. Pharm World Sci. 2004;26(4):221-226.

8. Saini B, Krass I, Armour C. Specialisation in asthma: current practice and future roles - a qualitative study of practising community pharmacists. J Soc Admin Pharm, 2001;18:169-177.

9. McAnaw JJ, McGregor AM, Hudson SA. The pharmaceutical care of patients with hypertension: an examination of service models in primary care in US. Pharm World Sci. 2001;23(5):189-194.

10. Sias JJ, Bennett MS. A Reimbursable Education Service for Patients with Hepatitis C. J Am Pharm Assoc. 2001;41(3):448-453.

11. Fedder DO, Levine DL, Patterson Russell R, Lewis C, Lamy PP. Strategies to implement a patient counseling and medication tickler system - a study of Maryland pharmacists and their hypertensive patients. Patient Educ Couns. 1998;11(1):53-64.

12. Garrett DG, Martin LA. The Asheville project: participants' perceptions of factors contributing to the success of a patient self-management diabetes program. J Am Pharm Assoc. 2003;43(2):185-190.

13. Barnes JM, Riedlinger JE, McCloskey WW, Montagne M. Barriers to compliance with OBRA'90 regulations in community pharmacy. Ann Pharmacother. 1996;30(10):1101-1105.

14. Hopp TR, Sørensen EW, Herborg H, Roberts AS. Implementation of cognitive pharmaceutical services (CPS) in professionally active pharmacies. Int J Pharm Pract. 2005;13(1):21-31.

15. Doucette WR, Koch YD. An exploratory study of community pharmacy practice change. J Am Pharm Assoc. 2000;40(3):384-391.

16. Kaae S, Søndergaard B, Haugbølle LS, Traulsen JM. The relationship between leadership style and provision of the first Danish publicly reimbursed CPS - a qualitative multi-case study. Res Social Adm Pharm. 2011;7(2):113-121.

17. Armour C, Smith L, Saini B, Bosnic-Nticevich S, Krass I, Alles C, Lemay K, Song Y, Reddell H, Burton D, Cooke J, Stewart K, Soma J, Emmerton L, Jarvis V. Lessons learned from implementation of an asthma management service in community pharmacy. Pharm Pract. 2010;8(suppl 1):110-111.

18. Kaae S, Søndergaard B, Haugbølle LS, Traulsen JM. Sustaining delivery of the first publicly reimbursed cognitive service in Denmark: a cross-case analysis. Int J Pharm Pract. 2010;18(1):21-27.

19. Rogers EM. Diffusion of Innovation. 5th ed. New York:Free Press,2003.

20. Dualde E, Faus MJ, Santoja FJ, Fernandez-Llimos F. Effectiveness of a videoconference training course on implementing pharmacy services. Pharm World Sci. 2009;31(6):638-642.

21. Pronk MCM, Blom LTG, Jonkers R, Van Burg A. The diffusion process of patient education in Dutch community pharmacy: an exploration. Patient Educ Couns. 2001;42(2):115-121.

22. Pronk MC, Blom LT, Jonkers R, Rogers EM, Bakker A, de Blaey KJ. Patient oriented activities in Dutch community pharmacy: an exploration. Pharm World Sci. 2002;24(4):154-161.

23. Albrecht LC, Roberts AS, Benrimoj SI, Williams KA, Chen TF, Aslani P. Cognitive pharmaceutical services: financial facilitators. Pharmacist. 2006;25:809-816.

24. Roberts AS, Benrimoj SI, Chen TF, Williams KA, Aslani P. Practice change in community pharmacy: quantification of facilitators. Ann Pharmacother. 2008;42(6):861-868.

25. Barner JC, Bennett RW. Pharmaceutical Care Certificate Program: Assessment of Pharmacists' Implementation into Practice. J Am Pharm Assoc. 1999;39(3):362-367.

26. Kaae S. Analyse af lokale organisatoriske forholds betydning for varig implementering af den første offentligt betalte apoteksydelse "Tjek på inhalation" - et eksplorativt case studie af syv danske apoteker [Analysis of local organisational factors' influence on sustained implementation of the first publicly reimbursed cognitive service in community pharmacy the "Inhaler Technique Assessment Service" - an exploratory case-study of seven Danish pharmacies] 2009.

27. Sørensen EW, Haugbølle LS, Herborg H, Tomsen DV. Improving situated learning in pharmacy internship. Pharm Educ, 2005;5(3/4):223-233.

28. Sørensen EW, Haugbølle LS. Using an action research process in pharmacy practice research - a coorporative project between university and internship pharmacies. Res Social Adm Pharm. 2008;4(4):384-401.

29. Roberts AS, Benrimoj SI, Chen TF, Williams KA, Hopp TR, Aslani P. Understanding practice change in community pharmacy: a qualitative study in Australia. Res Social Adm Pharm. 2005;1(4):546-564.

30. Kvale S. Interview - En introduktion til det kvalitative forskningsinterview [Interviewing - an introduction to the qualitative research interview]. Copenhagen:Hans Reitzels Forlag, 1997.

31. Roberts A, Benrimoj S, Chen T, Williams K, Aslani P. Implementing cognitive services in community pharmacy: a review of facilitators used in practice change. Int J Pharm Pract. 2006;14(3):163-170.

32. Capurso KA, Powers MF. Barriers to implementing a pharmacists-run- immunization service, as perceived by pharmacists, in a community pharmacy chain. J Pharm Technol. 2006;22(2):91-94.

33. MacKeigan LD, Marshman JA, Kruk-Romanus D, Milovanovic DA, Jackevicius C, Naglie G, Einarson TR. Clinical Pharmacy Services in the Home: Canadian Case Studies. J Am Pharm Assoc. 2002;42(5):735-742.

34. Bandura A. Theoretical Perspectives. Self-efficacy: the exercise of control.New York:W.H. Freeman,1997.

35. Martin BA, Chui MA, Thorpe JM, Mott DA, Kreling DH. Development of a scale to measure pharmacists' self-efficacy in performing medication therapy management services Res Social Adm Pharm. 2010;6(2):155-161.

36. Martin BA, Bruskiewitz RH, Chui MA. Effect of a tobacco cessation continuing professional education program of pharmacists' confidence, skills and practice-change behaviours. J Am Pharm Assoc. 2010;50(1):9-16.
Published
2012-09-17
Section
Original Research