School of Pharmacy, Newcastle University, Newcastle upon Tyne, United Kingdom.
Department of Clinical Pharmacy, Faculty of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia.
PLoS One. 2021 Dec 28;16(12):e0260951. doi: 10.1371/journal.pone.0260951. eCollection 2021.
Hospital to community pharmacy transfer of care medicines-related interventions for inpatients discharged home aim to improve continuity of care and patient outcomes. One such intervention has been provided for seven years within a region in England. This study reports upon the implementation process and fidelity of this intervention.
The process evaluation guidance issued by the Medical Research Council has informed this study. A logic model to describe the intervention and causal assumptions was developed from preliminary semi-structured interviews with project team members. Further semi-structured interviews were undertaken with intervention providers from hospital and community pharmacy, and with patient and public representatives. These aimed to investigate intervention implementation process and fidelity. The Consolidated Framework for Implementation Research and the Consolidated Framework for Intervention Fidelity informed interview topic guides and underpinned the thematic framework analysis using a combined inductive and deductive approach.
Themes provided information about intervention fidelity and implementation that were mapped across the sub processes of implementation: planning, execution, reflection and evaluation, and engagement. Interviewees described factors such as lack of training, awareness, clarity on the service specification, governance and monitoring and information and feedback which caused significant issues with the process of intervention implementation and suboptimal intervention fidelity.
This provides in-depth insight into the implementation process and fidelity of a ToC intervention, and the extant barriers and facilitators. The findings offer learning to inform the design and implementation of similar interventions, contribute to the evidence base about barriers and facilitators to such interventions and provides in-depth description of the implementation and mechanisms of impact which have the potential to influence clinical and economic outcome evaluation.
针对出院回家的住院患者，将照护药品从医院转移至社区药房的相关干预措施旨在改善照护连续性和患者结局。在英格兰的一个地区，已经开展了此类干预措施七年。本研究报告了该干预措施的实施过程和保真度。
医学研究理事会发布的过程评估指南为本研究提供了依据。通过与项目团队成员进行初步半结构化访谈，开发了一个逻辑模型来描述干预措施和因果假设。随后，对来自医院和社区药房的干预提供者以及患者和公众代表进行了进一步的半结构化访谈，旨在调查干预措施的实施过程和保真度。实施研究综合框架和干预措施保真度综合框架为访谈主题指南提供了信息，并采用归纳和演绎相结合的方法为主题框架分析提供了依据。
主题提供了有关干预措施保真度和实施的信息，这些信息横跨实施的子过程：规划、执行、反思和评估以及参与。受访者描述了培训、意识、对服务规范的清晰性、治理和监测以及信息和反馈等方面的缺乏，这些因素导致干预措施实施过程中出现了严重问题，并且干预措施保真度欠佳。
这深入了解了 ToC 干预措施的实施过程和保真度，以及现有的障碍和促进因素。研究结果为类似干预措施的设计和实施提供了经验教训，为这类干预措施的障碍和促进因素的证据基础做出了贡献，并对实施和影响机制进行了深入描述，这些机制有可能影响临床和经济结局评估。
