Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom.
NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom.
PLoS One. 2018 Oct 26;13(10):e0205419. doi: 10.1371/journal.pone.0205419. eCollection 2018.
Developments in information technology offer opportunities to enhance medication safety in primary care. We evaluated the implementation and adoption of a complex pharmacist-led intervention involving the use of an electronic audit and feedback surveillance dashboard to identify patients potentially at risk of hazardous prescribing or monitoring of medicines in general practices. The intervention aimed to create a rapid learning health system for medication safety in primary care. This study aimed to explore how the intervention was implemented, adopted and embedded into practice using a qualitative process evaluation.
Twenty two participants were purposively recruited from eighteen out of forty-three general practices receiving the intervention as well as clinical commissioning group staff across Salford UK, which reflected the range of contexts in which the intervention was implemented. Interviews explored how pharmacists and GP staff implemented the intervention and how this affected care practice. Data analysis was thematic with emerging themes developed into coding frameworks based on Normalisation Process Theory (NPT).
Engagement with the dashboard involved a process of sense-making in which pharmacists considered it added value to their work. The intervention helped to build respect, improve trust and develop relationships between pharmacists and GPs. Collaboration and communication between pharmacists and clinicians was primarily initiated by pharmacists and was important for establishing the intervention. The intervention operated as a rapid learning health system as it allowed for the evidence in the dashboard to be translated into changes in work practices and into transformations in care.
Our study highlighted the importance of the combined use of information technology and the role of pharmacists working in general practice settings. Medicine optimisation activities in primary care may be enhanced by the implementation of a pharmacist-led electronic audit and feedback system. This intervention established a rapid learning health system that swiftly translated data from electronic health records into changes in practice to improve patient care. Using NPT provided valuable insights into the ways in which developing relationships, collaborations and communication between health professionals could lead to the implementation, adoption and sustainability of the intervention.
信息技术的发展为提高初级保健中的药物安全提供了机会。我们评估了一项复杂的药剂师主导的干预措施的实施和采用情况，该干预措施涉及使用电子审核和反馈监测仪表板来识别一般实践中可能存在潜在危险药物处方或药物监测风险的患者。该干预措施旨在为初级保健中的药物安全创建一个快速学习的健康系统。本研究旨在探讨干预措施如何通过定性过程评估来实施、采用和融入实践。
从英国索尔福德的 43 家参与干预的一般实践和临床委托组工作人员中，有针对性地招募了 22 名参与者，这反映了干预实施的各种背景。访谈探讨了药剂师和全科医生工作人员如何实施干预措施，以及这对护理实践的影响。数据分析采用主题分析方法，根据规范进程理论（NPT）将出现的主题发展成编码框架。
仪表板的参与涉及一个意义建构的过程，药剂师认为这为他们的工作增加了价值。该干预措施有助于建立药剂师和全科医生之间的尊重、信任和关系。药剂师和临床医生之间的合作和沟通主要由药剂师发起，这对于建立干预措施非常重要。该干预措施作为一个快速学习的健康系统运作，因为它允许将仪表板中的证据转化为工作实践的变化，并转化为护理的转变。
我们的研究强调了信息技术的综合使用和在一般实践环境中工作的药剂师的作用。通过实施以药剂师为主导的电子审核和反馈系统，可以增强初级保健中的药物优化活动。该干预措施建立了一个快速学习的健康系统，能够迅速将电子健康记录中的数据转化为实践中的变化，以改善患者护理。使用 NPT 为我们提供了有价值的见解，了解了在卫生专业人员之间建立关系、合作和沟通的方式如何导致干预措施的实施、采用和可持续性。
