Watkins Kim, Wood Helen, Schneider Carl R, Clifford Rhonda
School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
Faculty of Pharmacy, The University of Sydney, Sydney, Australia.
Implement Sci. 2015 Oct 29;10:151. doi: 10.1186/s13012-015-0337-7.
The clinical role of community pharmacists is expanding, as is the use of clinical guidelines in this setting. However, it is unclear which strategies are successful in implementing clinical guidelines and what outcomes can be achieved. The aim of this systematic review is to synthesise the literature on the implementation of clinical guidelines to community pharmacy. The objectives are to describe the implementation strategies used, describe the resulting outcomes and to assess the effectiveness of the strategies.
A systematic search was performed in six electronic databases (Medline, EMBASE, CINAHL, Web of Science, Informit, Cochrane Library) for relevant articles. Studies were included if they reported on clinical guidelines implementation strategies in the community pharmacy setting. Two researchers completed the full-search strategy, data abstraction and quality assessments, independently. A third researcher acted as a moderator. Quality assessments were completed with three validated tools. A narrative synthesis was performed to analyse results.
A total of 1937 articles were retrieved and the titles and abstracts were screened. Full-text screening was completed for 36 articles resulting in 19 articles (reporting on 22 studies) included for review. Implementation strategies were categorised according to a modified version of the EPOC taxonomy. Educational interventions were the most commonly utilised strategy (n = 20), and computerised decision support systems demonstrated the greatest effect (n = 4). Most studies were multifaceted and used more than one implementation strategy (n = 18). Overall outcomes were moderately positive (n = 17) but focused on process (n = 22) rather than patient (n = 3) or economic outcomes (n = 3). Most studies (n = 20) were rated as being of low methodological quality and having low or very low quality of evidence for outcomes.
Studies in this review did not generally have a well thought-out rationale for the choice of implementation strategy. Most utilised educational strategies, but the greatest effect on outcomes was demonstrated using computerised clinical decision support systems. Poor methodology, in the majority of the research, provided insufficient evidence to be conclusive about the best implementation strategies or the benefit of clinical guidelines in this setting. However, the generally positive outcomes across studies and strategies indicate that implementing clinical guidelines to community pharmacy might be beneficial. Improved methodological rigour in future research is required to strengthen the evidence for this hypothesis.
PROSPERO 2012: CRD42012003019 .
社区药剂师的临床作用正在扩大，临床指南在该领域的应用也是如此。然而，尚不清楚哪些策略能成功实施临床指南以及能取得何种成果。本系统评价的目的是综合有关社区药房实施临床指南的文献。目标是描述所采用的实施策略，描述产生的结果并评估这些策略的有效性。
在六个电子数据库（Medline、EMBASE、CINAHL、Web of Science、Informit、Cochrane图书馆）中进行系统检索以查找相关文章。如果研究报告了社区药房环境中的临床指南实施策略，则纳入研究。两名研究人员独立完成全面检索策略、数据提取和质量评估。第三名研究人员担任主持人。使用三种经过验证的工具完成质量评估。进行叙述性综合分析结果。
共检索到1937篇文章，并对标题和摘要进行了筛选。对36篇文章完成了全文筛选，最终纳入19篇文章（报告22项研究）进行综述。实施策略根据EPOC分类法的修改版本进行分类。教育干预是最常用的策略（n = 20），计算机化决策支持系统显示出最大效果（n = 4）。大多数研究是多方面的，使用了不止一种实施策略（n = 18）。总体结果呈中度积极（n = 17），但侧重于过程（n = 22）而非患者（n = 3）或经济结果（n = 3）。大多数研究（n = 20）被评为方法学质量低，结果的证据质量低或非常低。
本综述中的研究通常对实施策略的选择缺乏深思熟虑的理由。大多数采用教育策略，但使用计算机化临床决策支持系统对结果产生的影响最大。大多数研究的方法学较差，提供的证据不足以确定最佳实施策略或临床指南在该环境中的益处。然而，各项研究和策略总体上呈现的积极结果表明，在社区药房实施临床指南可能是有益的。未来研究需要提高方法学的严谨性，以加强这一假设的证据。
PROSPERO 2012：CRD42012003019
