Abdu-Aguye Samirah N, Mohammed Shafiu, Danjuma Nuhu M, Labaran Kamilu S
MClinPharm. Department of Clinical Pharmacy & Pharmacy Practice, Ahmadu Bello University. Zaria (Nigeria).
PhD. Health Systems and Policy Research Unit, Ahmadu Bello University. Zaria (Nigeria).
Pharm Pract (Granada). 2021 Apr-Jun;19(2):2271. doi: 10.18549/PharmPract.2021.2.2271. Epub 2021 May 24.
Despite the importance of medication counselling for patients, it is common knowledge that it is often sub-optimally carried out by pharmacy staff. While some interventions have been designed to help improve counselling, no study till date has used the Capability Opportunity and Motivation behavior model (COM-B) or Theoretical Domains Framework (TDF) as a basis for identifying evidence-based intervention strategies to improve medication counselling.
To understand barriers/facilitators to optimal medication counselling by conducting a behavioral analysis using the COM-B model and TDF, and use the Behavior Change Wheel (BCW) as a basis for identifying evidence-based intervention strategies and policy categories that could be used to improve outpatient medication counselling by pharmacy staff in hospital settings located within Northwest Nigeria.
Semi-structured interviews were used to collect data from 25 purposively sampled pharmacy staff working at eight major public hospitals, from January till March 2020. Data from the interviews were then transcribed and deductively coded using the COM-B model and TDF. These findings were then used to identify areas requiring change, as well as the intervention type and policy functions required to support these changes.
Findings from the behavioral analysis revealed shortfalls in pharmacy staff capability, opportunity and motivation with respect to outpatient medication counselling. To improve their counselling behaviors, change was identified as necessary in eight TDF domains namely 'knowledge', 'interpersonal skills', 'memory' 'environmental context', 'social influences', 'intentions', 'reinforcement' and 'beliefs about capabilities'. Seven intervention functions including 'education', 'training', 'modelling', 'enablement' and 'environmental restructuring', in addition to three policy categories ('guidelines', 'regulations' and 'environmental/social planning') were also identified as relevant to future intervention design.
Various factors were identified as affecting medication counselling by the pharmacy staff, with several of them requiring changes if counselling was to be improved upon. Multi-component interventions combining several of these intervention functions are recommended for hospital authorities and other relevant stakeholders to improve outpatient medication counselling.
尽管药物咨询对患者很重要，但众所周知，药房工作人员的咨询工作往往未达到最佳水平。虽然已经设计了一些干预措施来帮助改善咨询，但迄今为止，尚无研究使用能力-机会-动机行为模型（COM-B）或理论领域框架（TDF）作为确定循证干预策略以改善药物咨询的基础。
通过使用COM-B模型和TDF进行行为分析，了解优化药物咨询的障碍/促进因素，并以行为改变轮（BCW）为基础，确定可用于改善尼日利亚西北部医院药房工作人员门诊药物咨询的循证干预策略和政策类别。
2020年1月至3月，采用半结构式访谈从8家主要公立医院的25名有目的抽样的药房工作人员中收集数据。访谈数据随后进行转录，并使用COM-B模型和TDF进行演绎编码。然后，这些结果被用于确定需要改变的领域，以及支持这些改变所需的干预类型和政策功能。
行为分析结果显示，药房工作人员在门诊药物咨询方面的能力、机会和动机存在不足。为了改善他们的咨询行为，确定在TDF的八个领域进行改变，即“知识”“人际技能”“记忆”“环境背景”“社会影响”“意图”“强化”和“对能力的信念”。还确定了七种干预功能，包括“教育”“培训”“示范”“赋能”和“环境重组”，以及三类政策（“指南”“法规”和“环境/社会规划”）与未来的干预设计相关。
确定了多种影响药房工作人员药物咨询的因素，如果要改善咨询，其中一些因素需要改变。建议医院管理部门和其他相关利益攸关方采用结合多种干预功能的多成分干预措施，以改善门诊药物咨询。
