Health Research Institute, University of Canberra, Bruce, ACT, 2617, Australia.
Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia.
BMC Health Serv Res. 2023 Oct 27;23(1):1166. doi: 10.1186/s12913-023-10172-9.
An on-site pharmacist (OSP) intervention was implemented which sought to improve medication management within residential aged care facilities (RACFs) in the Australian Capital Territory, Australia. The objectives of this mixed methods study were to evaluate the implementation fidelity of the OSP intervention and to determine the moderating factors which influenced delivery of this intervention.
This convergent parallel mixed methods study was underpinned by Hasson's conceptual framework for implementation fidelity. Implementation fidelity for seven intervention RACFs was quantitatively assessed using three quantitative data sets: (1) range of OSP intervention activities delivered; (2) random sample of 10% of medication reviews assessed for quality; (3) proportion of residents who received at least one medication review. Semi-structured interviews (n = 14) with managers and OSPs across the intervention RACFs were conducted to identify moderating factors which may have influenced OSP intervention delivery.
The OSP intervention was generally delivered as intended with overall medium levels of implementation fidelity. This delivery was supported by a range of facilitation strategies with most participants perceiving that the intervention was delivered to a high standard. RACF managers and OSPs were mostly well engaged and responsive. A number of potential barriers (including the part-time OSP role, COVID-19 pandemic, RACFs spread out over a large area with significant distance between resident dwellings) and facilitators (including the pharmacist support meetings, OSPs who took time to establish relationships, RACF managers who actively supported OSPs and worked with them) for OSP intervention delivery were identified which have potential implications for the roll out of OSPs within Australian RACFs.
In this study, the implementation fidelity of OSP intervention delivery was assessed with overall medium levels of fidelity found across the intervention RACFs. This suggested that the OSP intervention can generally be delivered as intended in real world RACFs. OSP intervention delivery was influenced by a range of moderating factors, some of which posed barriers and others which facilitated the OSP intervention being delivered as intended.
在澳大利亚首都领地，实施了一项现场药剂师（OSP）干预措施，旨在改善养老院（RACF）中的药物管理。本混合方法研究的目的是评估 OSP 干预措施的实施保真度，并确定影响该干预措施实施的调节因素。
本研究基于 Hasson 的实施保真度概念框架，采用三种定量数据集评估七个干预性 RACF 的实施保真度：（1）OSP 干预措施实施的范围；（2）对 10%的药物审查进行随机抽样评估质量；（3）接受至少一次药物审查的居民比例。对干预性 RACF 中的经理和 OSP 进行了 14 次半结构化访谈，以确定可能影响 OSP 干预措施实施的调节因素。
OSP 干预措施总体上按预期实施，整体实施保真度中等水平。这一实施得到了一系列促进策略的支持，大多数参与者认为干预措施实施标准较高。RACF 经理和 OSP 大多参与度高，反应灵敏。确定了一些潜在的障碍（包括 OSP 的兼职角色、COVID-19 大流行、RACF 分布在一个大区域，居民住所之间距离较远）和促进因素（包括药剂师支持会议、花时间建立关系的 OSP、积极支持 OSP 并与他们合作的 RACF 经理），这些都对澳大利亚 RACF 中 OSP 的推广具有潜在影响。
在这项研究中，对 OSP 干预措施实施的保真度进行了评估，发现干预性 RACF 的整体保真度中等水平。这表明 OSP 干预措施通常可以按预期在实际 RACF 中实施。OSP 干预措施的实施受到一系列调节因素的影响，其中一些因素构成障碍，而另一些因素则促进了 OSP 干预措施的实施。
