RAND Corporation, Santa Monica, CA, USA.
Pardee RAND Graduate School, Los Angeles, CA, USA.
J Gen Intern Med. 2023 Nov;38(15):3381-3388. doi: 10.1007/s11606-023-08375-1. Epub 2023 Aug 24.
Pharmacist-led programs and clinics have been integrated into primary and specialty care clinics in a variety of ways, for example, to improve diabetes outcomes via patient education and counseling. However, factors important to the implementation of different outpatient pharmacy models have not been well elucidated.
To identify provider- and health system-level drivers of implementation and sustainability of pharmacy-led programs in the outpatient setting.
Qualitative study of key informants using semi-structured interviews of individuals working in various roles throughout a large health system, including ambulatory clinical pharmacists, pharmacy managers, medical directors and physician leaders, and operations and quality managers.
Key informants (n=19) with leadership roles in pharmacy programs and front-line experience providing integrated pharmacy care were selected purposively and with snowball sampling.
We coded the interviews using a codebook derived from the 2022 Consolidated Framework for Implementation Research (CFIR), which details various internal and external factors important for implementation.
We identified the following themes related to implementing ambulatory care pharmacy programs: (1) pharmacy programs varied in their level of embeddedness in the outpatient clinic, (2) establishing pharmacy program required leadership advocacy and coordination among stakeholders, (3) continued operations required integrated workflows and demonstrated value to the health system and clinicians, and (4) established revenue streams or added indirect value and continued improvement of integration sustained programs over time.
External policies and incentives such as new reimbursement codes and quality measurement programs that rely on pharmacy input play a significant role in shaping the design, implementation, and sustainability of health system outpatient pharmacy programs. Ensuring that quality metrics used in value-based contracts or programs demonstrate pharmacy benefits will be critical to supporting and growing pharmacy programs.
药剂师主导的项目和诊所已经以各种方式融入到基层医疗和专科诊所中，例如，通过患者教育和咨询来改善糖尿病的治疗效果。然而，对于不同的门诊药房模式实施的重要因素尚未得到充分阐明。
确定实施和维持门诊药房主导项目的提供者和卫生系统层面的驱动因素。
对关键信息提供者进行定性研究，采用半结构化访谈的方式对在大型卫生系统中从事各种角色的个体进行访谈，包括门诊临床药剂师、药房经理、医疗主任和医师领导以及运营和质量经理。
根据在药房项目中担任领导角色并具有提供综合药房护理的一线经验，有目的且通过滚雪球抽样选择了关键信息提供者（n=19）。
我们使用源自 2022 年实施研究综合框架（CFIR）的代码本对访谈进行编码，该框架详细说明了对实施非常重要的各种内部和外部因素。
我们确定了与实施门诊药房项目相关的以下主题：（1）药房项目在门诊诊所中的嵌入程度各不相同；（2）建立药房项目需要领导层的倡导和利益相关者之间的协调；（3）持续运营需要整合工作流程并向卫生系统和临床医生展示价值；（4）建立收入来源或增加间接价值并随着时间的推移持续改进整合将维持项目。
新的报销代码和质量衡量计划等外部政策和激励措施，这些措施依赖于药房的投入，对塑造卫生系统门诊药房项目的设计、实施和可持续性起着重要作用。确保在基于价值的合同或计划中使用的质量衡量标准能够体现药房的优势，对于支持和发展药房项目至关重要。
