Steenkamer Betty, Baan Caroline, Putters Kim, van Oers Hans, Drewes Hanneke
Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University , Tilberg, The Netherlands.
Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
J Health Organ Manag. 2018 Apr 9;32(2):224-245. doi: 10.1108/JHOM-06-2017-0146. Epub 2018 Mar 26.
Purpose A range of strategies to improve pharmaceutical care has been implemented by population health management (PHM) initiatives. However, which strategies generate the desired outcomes is largely unknown. The purpose of this paper is to identify guiding principles underlying collaborative strategies to improve pharmaceutical care and the contextual factors and mechanisms through which these principles operate. Design/methodology/approach The evaluation was informed by a realist methodology examining the links between PHM strategies, their outcomes and the contexts and mechanisms by which these strategies operate. Guiding principles were identified by grouping context-specific strategies with specific outcomes. Findings In total, ten guiding principles were identified: create agreement and commitment based on a long-term vision; foster cooperation and representation at the board level; use layered governance structures; create awareness at all levels; enable interpersonal links at all levels; create learning environments; organize shared responsibility; adjust financial strategies to market contexts; organize mutual gains; and align regional agreements with national policies and regulations. Contextual factors such as shared savings influenced the effectiveness of the guiding principles. Mechanisms by which these guiding principles operate were, for instance, fostering trust and creating a shared sense of the problem. Practical implications The guiding principles highlight how collaboration can be stimulated to improve pharmaceutical care while taking into account local constraints and possibilities. The interdependency of these principles necessitates effectuating them together in order to realize the best possible improvements and outcomes. Originality/value This is the first study using a realist approach to understand the guiding principles underlying collaboration to improve pharmaceutical care.
目的 人口健康管理（PHM）举措已实施了一系列改善药学服务的策略。然而，哪些策略能产生预期效果在很大程度上尚不清楚。本文的目的是确定改善药学服务的协作策略所依据的指导原则，以及这些原则发挥作用的背景因素和机制。
设计/方法/途径 该评估采用了现实主义方法，研究PHM策略、其结果以及这些策略发挥作用的背景和机制之间的联系。通过将特定背景下的策略与特定结果进行分组来确定指导原则。
研究结果 总共确定了十条指导原则：基于长期愿景达成共识并做出承诺；在董事会层面促进合作与代表性；采用分层治理结构；在各级提高认识；在各级建立人际联系；营造学习环境；组织共同责任；根据市场情况调整财务策略；组织互利共赢；使区域协议与国家政策法规保持一致。诸如共享节约等背景因素影响了指导原则的有效性。这些指导原则发挥作用的机制，例如，促进信任并营造对问题的共同认识。
实际意义 指导原则强调了如何在考虑当地限制和可能性的同时，通过促进合作来改善药学服务。这些原则的相互依存性使得必须共同实施它们，以实现尽可能好的改进和结果。
原创性/价值 这是第一项采用现实主义方法来理解改善药学服务协作背后的指导原则的研究。
