Hossain Lutfun N, Fernandez-Llimos Fernando, Luckett Tim, Moullin Joanna C, Durks Desire, Franco-Trigo Lucia, Benrimoj Shalom I, Sabater-Hernández Daniel
Graduate School of Health, University of Technology, Sydney, New South Wales, Australia.
Department of Social Pharmacy, Faculty of Pharmacy, Research Institute for Medicines, University of Lisbon, Lisboa, Portugal.
BMJ Open. 2017 Sep 5;7(9):e015471. doi: 10.1136/bmjopen-2016-015471.
The integration of community pharmacy services (CPSs) into primary care practice can be enhanced by assessing (and further addressing) the elements that enable (ie, facilitators) or hinder (ie, barriers) the implementation of such CPSs. These elements have been widely researched from the perspective of pharmacists but not from the perspectives of other stakeholders who can interact with and influence the implementation of CPSs. The aim of this study was to synthesise the literature on patients', general practitioners' (GPs) and nurses' perspectives of CPSs to identify barriers and facilitators to their implementation in Australia.
A meta-synthesis of qualitative studies was performed. A systematic search in PubMed, Scopus and Informit was conducted to identify studies that explored patients', GPs' or nurses' views about CPSs in Australia. Thematic synthesis was performed to identify elements influencing CPS implementation, which were further classified using an ecological approach.
Twenty-nine articles were included in the review, addressing 63 elements influencing CPS implementation. Elements were identified as a barrier, facilitator or both and were related to four ecological levels: individual patient (n=14), interpersonal (n=24), organisational (n=16) and community and healthcare system (n=9). It was found that patients, nurses and GPs identified elements reported in previous pharmacist-informed studies, such as pharmacist's training/education or financial remuneration, but also new elements, such as patients' capability to follow service's procedures, the relationships between GP and pharmacy professional bodies or the availability of multidisciplinary training/education.
Patients, GPs and nurses can describe a large number of elements influencing CPS implementation. These elements can be combined with previous findings in pharmacists-informed studies to produce a comprehensive framework to assess barriers and facilitators to CPS implementation. This framework can be used by pharmacy service planners and policy makers to improve the analysis of the contexts in which CPSs are implemented.
通过评估（并进一步解决）促进（即推动因素）或阻碍（即障碍因素）社区药房服务（CPS）实施的因素，可加强社区药房服务与初级医疗实践的整合。这些因素已从药剂师的角度进行了广泛研究，但尚未从其他能够与CPS实施进行互动并影响其实施的利益相关者的角度进行研究。本研究的目的是综合关于患者、全科医生（GP）和护士对CPS看法的文献，以确定在澳大利亚实施CPS的障碍和促进因素。
对定性研究进行元综合分析。在PubMed、Scopus和Informit中进行系统检索，以识别探讨澳大利亚患者、全科医生或护士对CPS看法的研究。进行主题综合分析以确定影响CPS实施的因素，并使用生态方法进一步分类。
该综述纳入了29篇文章，涉及影响CPS实施的63个因素。这些因素被确定为障碍、促进因素或两者兼具，并与四个生态层面相关：个体患者（n = 14）、人际层面（n = 24）、组织层面（n = 16）以及社区和医疗保健系统层面（n = 9）。研究发现，患者、护士和全科医生识别出了先前药剂师主导研究中报告的因素，如药剂师的培训/教育或经济报酬，但也发现了新的因素，如患者遵循服务程序的能力、全科医生与药房专业机构之间的关系或多学科培训/教育的可获得性。
患者、全科医生和护士能够描述大量影响CPS实施的因素。这些因素可与先前药剂师主导研究的结果相结合，以形成一个全面的框架，用于评估CPS实施的障碍和促进因素。该框架可供药房服务规划者和政策制定者用于改进对CPS实施背景的分析。
