eHealth Research Group, Centre for Population Health Sciences, The University of Edinburgh, Scotland, UK.
Trials. 2012 Jun 8;13:78. doi: 10.1186/1745-6215-13-78.
There is a need to shed light on the pathways through which complex interventions mediate their effects in order to enable critical reflection on their transferability. We sought to explore and understand key stakeholder accounts of the acceptability, likely impact and strategies for optimizing and rolling-out a successful pharmacist-led information technology-enabled (PINCER) intervention, which substantially reduced the risk of clinically important errors in medicines management in primary care.
Data were collected at two geographical locations in central England through a combination of one-to-one longitudinal semi-structured telephone interviews (one at the beginning of the trial and another when the trial was well underway), relevant documents, and focus group discussions following delivery of the PINCER intervention. Participants included PINCER pharmacists, general practice staff, researchers involved in the running of the trial, and primary care trust staff. PINCER pharmacists were interviewed at three different time-points during the delivery of the PINCER intervention. Analysis was thematic with diffusion of innovation theory providing a theoretical framework.
We conducted 52 semi-structured telephone interviews and six focus group discussions with 30 additional participants. In addition, documentary data were collected from six pharmacist diaries, along with notes from four meetings of the PINCER pharmacists and feedback meetings from 34 practices. Key findings that helped to explain the success of the PINCER intervention included the perceived importance of focusing on prescribing errors to all stakeholders, and the credibility and appropriateness of a pharmacist-led intervention to address these shortcomings. Central to this was the face-to-face contact and relationship building between pharmacists and a range of practice staff, and pharmacists' explicitly designated role as a change agent. However, important concerns were identified about the likely sustainability of this new model of delivering care, in the absence of an appropriate support network for pharmacists and career development pathways.
This embedded qualitative inquiry has helped to understand the complex organizational and social environment in which the trial was undertaken and the PINCER intervention was delivered. The longitudinal element has given insight into the dynamic changes and developments over time. Medication errors and ways to address these are high on stakeholders' agendas. Our results further indicate that pharmacists were, because of their professional standing and skill-set, able to engage with the complex general practice environment and able to identify and manage many clinically important errors in medicines management. The transferability of the PINCER intervention approach, both in relation to other prescribing errors and to other practices, is likely to be high.
为了能够对复杂干预措施的作用途径进行批判性反思，有必要阐明这些途径，以了解它们如何发挥作用。我们试图探索和理解关键利益相关者对成功的药剂师主导的信息技术支持（PINCER）干预措施的可接受性、可能的影响以及优化和推广该措施的策略的看法，该措施大大降低了初级保健中药物管理中临床重要错误的风险。
通过在英格兰中部的两个地理位置进行的一对一纵向半结构化电话访谈（试验开始时进行一次，试验进行时进行一次）、相关文件以及在提供 PINCER 干预措施后进行的焦点小组讨论，收集了数据。参与者包括 PINCER 药剂师、全科医生工作人员、参与试验管理的研究人员以及初级保健信托工作人员。在提供 PINCER 干预措施期间，PINCER 药剂师在三个不同时间点接受了采访。分析采用主题分析方法，创新传播理论提供了理论框架。
我们对 30 名额外参与者进行了 52 次半结构化电话访谈和 6 次焦点小组讨论。此外，还从六名药剂师的日记中收集了文件数据，以及来自 PINCER 药剂师的四次会议和 34 次实践的反馈会议的笔记。有助于解释 PINCER 干预措施成功的主要发现包括所有利益相关者都认为关注处方错误非常重要，以及药剂师主导的干预措施来解决这些缺陷的可信度和适当性。这主要是因为药剂师与各种实践工作人员之间的面对面接触和关系建立，以及药剂师作为变革推动者的明确角色。然而，在没有为药剂师提供适当的支持网络和职业发展途径的情况下，人们对这种提供护理的新模式的可持续性表示关注。
这项嵌入式定性研究有助于了解试验进行和提供 PINCER 干预措施的复杂组织和社会环境。纵向元素深入了解了随时间的动态变化和发展。药物错误及其解决方法是利益相关者议程上的重中之重。我们的结果进一步表明，由于药剂师的专业地位和技能，他们能够与复杂的全科医生环境接触，并能够识别和管理药物管理中许多临床重要的错误。PINCER 干预措施方法的可转移性，无论是与其他处方错误还是与其他实践相关，都可能很高。
