Graduate School of Health, University of Technology Sydney, Australia.
Graduate School of Health, University of Technology Sydney, Australia; Academic Centre in Pharmaceutical Care, University of Granada, Granada, Spain; Faculty of Pharmacy, Campus Universitario Cartuja S/N, 18071, Granada, Spain; La Unión Community Pharmacy, Gran Canaria, Spain.
Res Social Adm Pharm. 2018 Aug;14(8):765-775. doi: 10.1016/j.sapharm.2017.10.001. Epub 2017 Oct 5.
A key early step to enhance the integration of community pharmacy services (CPSs) into primary care practice is identifying key determinants of practice (i.e., critical circumstances that influence the implementation of such services). Involving relevant stakeholders in identifying key determinants enables findings to be more relevant to the context in which CPSs will be implemented.
To identify key determinants of practice that can influence the implementation of government-funded CPSs in a primary health network in Australia.
A stakeholder collaborative approach was used, encompassing two phases. In the first phase, semi-structured interviews were conducted with ground-level stakeholders in Western Sydney between August 2016 to October 2016. Framework analysis was used to code and analyse the data from the interviews into determinants of pharmacy practice. In the second phase, a workshop was conducted with a mixed-group of ground-level and system-level stakeholders from the primary health network to identify key determinants. A four-quadrant prioritization matrix was employed in the workshop to classify determinants based on their importance and feasibility.
Sixty-five determinants of practice that can influence CPS implementation were identified in Phase 1. These determinants were allocated at different levels of the healthcare system, and can exist as a barrier or facilitator or both. Twenty-two key determinants were selected in Phase 2, of which three were agreed to be addressed initially: (1) Patient understanding of the aims of the service; (2) Commitment of the organization and its leaders to provide services; (3) Coordination of the healthcare system to prompt collaboration between pharmacists and GPs.
This collaborative stakeholder approach identified a set of key determinants of pharmacy practice in this Australian primary care setting. To enhance the implementation of CPSs in this region, initial efforts should be aimed at developing implementation strategies based on these key determinants of practice.
将社区药房服务（CPS）融入基层医疗实践的关键早期步骤是确定实践的关键决定因素（即影响此类服务实施的关键情况）。让相关利益相关者参与确定关键决定因素可以使研究结果更符合 CPS 将实施的环境。
确定实践的关键决定因素，这些因素可能会影响澳大利亚一个初级保健网络中政府资助的 CPS 的实施。
采用利益相关者合作方法，包括两个阶段。在第一阶段，2016 年 8 月至 10 月期间，在西悉尼对基层利益相关者进行了半结构式访谈。采用框架分析方法对访谈数据进行编码和分析，以确定药房实践的决定因素。在第二阶段，与来自初级保健网络的基层和系统层面的混合利益相关者举办了一次研讨会，以确定关键决定因素。研讨会采用了四象限优先排序矩阵，根据重要性和可行性对决定因素进行分类。
在第一阶段确定了 65 个可能影响 CPS 实施的实践决定因素。这些决定因素分配在医疗保健系统的不同层次，可以作为障碍或促进因素存在，也可以同时存在。在第二阶段选择了 22 个关键决定因素，其中 3 个被认为是需要优先解决的：（1）患者对服务目标的理解；（2）组织及其领导层提供服务的承诺；（3）协调医疗保健系统，促使药剂师和全科医生之间的合作。
这种合作的利益相关者方法确定了一组在澳大利亚这种基层医疗环境中影响药房实践的关键决定因素。为了在该地区加强 CPS 的实施，最初的努力应该旨在基于这些实践的关键决定因素制定实施策略。
