理解将社区药房纳入综合护理模式的认知：一项定性研究。
Understanding perceptions of involving community pharmacy within an integrated care model: a qualitative study.
机构信息
Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada.
Institute of Health, Policy Management and Evaluation, 155 College Street, Toronto, ON, M5T 1P8, Canada.
出版信息
BMC Health Serv Res. 2020 May 11;20(1):396. doi: 10.1186/s12913-020-05237-y.
BACKGROUND
Over the past several years, there has been more emphasis on integration within health care. Community pharmacy is often under-represented within integrated care models. This study explored stakeholder perceptions and enablers of including community pharmacy within an integrated care model.
METHODS
A qualitative study was undertaken. Participants were recruited through professional networks and social media, as well as snowball recruitment from other participants. They included community pharmacists, clinicians, and decision-makers working in Ontario, Canada. Data were collected using telephone interviews completed with a semi-structured interview guide based on Consolidated Framework for Implementation Research from June to September 2018. Data were analysed inductively and deductively following the Qualitative Analysis Guide of Leuven. An additional theoretical framework (Rainbow Model of Integrated Care) was used to categorize enablers.
RESULTS
Twenty-two participants were interviewed including nine pharmacists, seven clinicians, and six decision-makers. Three key themes were identified: 1) Positive value of including pharmacy in integrated care models; 2) One model does not fit all; and 3) Conflict of interest. Four key enablers were identified reflecting functional and normative factors: functional - 1) remuneration, 2) technology; normative - 3) engagement, and 4) relationships. While both functional and normative factors were discussed, the latter seemed to be more important to facilitate the inclusion of community pharmacy. Many participants characterized community pharmacists' lack of skills or confidence to provide patient care.
CONCLUSIONS
This study confirms previously known views about concerns with community pharmacy's conflict of interest. However, discordant perceptions of conflict of interest and negative perceptions about capabilities of community pharmacy need to be addressed for successful integration. Normative enablers, such as culture, are likely important for organizational integration and require additional inquiry.
背景
在过去的几年中，医疗保健领域更加注重整合。社区药房在综合护理模式中经常代表性不足。本研究探讨了将社区药房纳入综合护理模式的利益相关者的看法和促成因素。
方法
进行了一项定性研究。通过专业网络和社交媒体以及从其他参与者那里进行的滚雪球招募来招募参与者。他们包括在加拿大安大略省工作的社区药剂师、临床医生和决策者。数据收集使用电话访谈完成，访谈采用基于整合研究实施框架的半结构化访谈指南，时间为 2018 年 6 月至 9 月。根据鲁汶定性分析指南，对数据进行归纳和演绎分析。还使用了一个额外的理论框架（彩虹综合护理模型）来对促成因素进行分类。
结果
共采访了 22 名参与者，其中包括 9 名药剂师、7 名临床医生和 6 名决策者。确定了三个关键主题：1）将药房纳入综合护理模式的积极价值；2）一个模式不适合所有人；3）利益冲突。确定了四个关键促成因素，反映了功能和规范因素：功能 - 1）薪酬，2）技术；规范 - 3）参与度和 4）关系。虽然讨论了功能和规范因素，但后者似乎对促进社区药房的纳入更为重要。许多参与者认为社区药剂师缺乏提供患者护理的技能或信心。
结论
本研究证实了先前关于社区药房利益冲突的观点。然而，需要解决对利益冲突的不同看法和对社区药房能力的负面看法，以实现成功整合。规范促成因素，如文化，对于组织整合可能很重要，需要进一步研究。
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