Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, 310 S Perimeter Park Drive, Suite 220, Nashville, TN, 37211, USA.
Department of Health Services Research, Management & Policy, College of Public Health & Health Professions, University of Florida, Gainesville, USA.
Implement Sci. 2019 Nov 27;14(1):99. doi: 10.1186/s13012-019-0946-7.
(1) To develop an adaptation framework for MTM delivery for pharmacists (the MTM Adaptability Framework), (2) to examine the impact of an educational intervention informed by the MTM Adaptability Framework on MTM completion rates over a 2-year period, and (3) to explore pharmacists' perceptions regarding knowledge and beliefs about MTM and MTM implementation self-efficacy pre- and post-intervention.
This study is a prospective, mixed-methods research study including a quasi-experimental, one-group pretest-posttest quantitative study with a sequential explanatory qualitative study arm featuring semi-structured key informant interviews. US supermarket pharmacy chain setting included 93 community pharmacy sites located in Tennessee, Kentucky, and Alabama. MTM completion rates are reported as percentage of completed comprehensive medication reviews (CMRs) and targeted medication reviews (TMRs) and pharmacist perceptions.
An 11.4% absolute increase in MTM completion rates was seen after the educational intervention targeting adaptation of MTM in the community pharmacy setting. This was found to be significant (46.92% vs. 58.3%; p < 0.001). Responses to the semi-structured interviews were mapped against CFIR and included themes: "knowledge and beliefs about MTM (pre-intervention)," "self-efficacy for MTM implementation (pre-intervention)," "knowledge and beliefs about MTM (post-intervention)," and "self-efficacy for MTM implementation (post-intervention)." Data convergence was found across these methodologies and suggested that targeting adaptability of MTM delivery increases MTM completion rates (quantitative data) and positively changes perceptions of MTM feasibility and self-efficacy (interviews).
The use of an educational intervention about adaptation of MTM to influence adaptation of MTM to a chain community pharmacy setting part of an implementation strategy improved MTM completion rates significantly. Future research should investigate combined implementation strategies and their impact on MTM implementation success.
（1）为药剂师制定 MTM 实施的适应性框架（MTM 适应性框架），（2）在 2 年内，通过 MTM 适应性框架为指导的教育干预措施，调查 MTM 完成率的影响，（3）探索药剂师对 MTM 和 MTM 实施自我效能的知识和信念的看法，干预前后。
本研究是一项前瞻性的混合方法研究，包括一项准实验性的、单组的预-后测试量研究，以及一个具有半结构化关键信息访谈的顺序解释性定性研究部分。美国超市连锁药房包括田纳西州、肯塔基州和阿拉巴马州的 93 家社区药房。MTM 完成率报告为综合药物评估（CMR）和靶向药物评估（TMR）完成的百分比以及药剂师的看法。
在社区药房环境中，针对 MTM 适应性的教育干预措施后，MTM 完成率绝对增加了 11.4%。这是显著的（46.92%比 58.3%；p < 0.001）。半结构化访谈的回应与 CFIR 相对应，包括主题：“MTM 的知识和信念（干预前）”、“MTM 实施的自我效能（干预前）”、“MTM 的知识和信念（干预后）”和“MTM 实施的自我效能（干预后）”。这些方法之间的数据趋同表明，针对 MTM 传递的适应性可以提高 MTM 完成率（定量数据），并积极改变 MTM 可行性和自我效能的看法（访谈）。
使用关于 MTM 适应性的教育干预来影响 MTM 向连锁社区药房环境的适应性作为实施策略的一部分，显著提高了 MTM 完成率。未来的研究应该调查综合实施策略及其对 MTM 实施成功的影响。
