Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, CN, China.
Institute of Clinical Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, CN, China.
J Epidemiol Glob Health. 2024 Sep;14(3):974-986. doi: 10.1007/s44197-024-00244-2. Epub 2024 May 23.
Although physician-pharmacist collaborative clinics for diabetes management have been shown to be effective and cost-effective worldwide, there is limited understanding of the factors that influence their sustainable implementation. This study aims to identify the associated factors and provide sustainability strategy to better implement physician-pharmacist collaborative clinics for diabetes management in primary healthcare centers in China.
A sample of 43 participants were participated in face-to-face, in-depth, semi-structured interviews. Consolidated Framework for Implementation Research was used to identify facilitators and barriers to implementing physician-pharmacist collaborative clinics for diabetes management in primary healthcare centers, and to explore discriminating factors between low and high implementation units. A sustainable strategy repository based on dynamic sustainability framework was established to inform further implementation.
This study demonstrated that clear recognition of intervention benefits, urgent needs of patients, adaptive and tailored plan, highly collaborative teamwork and leadership support were the major facilitators, while the major barriers included process complexity, large number and poor health literacy of patients in primary areas, inappropriate staffing arrangements, weak financial incentives and inadequate staff competencies. Six constructs were identified to distinguish between high and low implementation units. Sixteen strategies were developed to foster the implementation of physician-pharmacist collaborative clinics, targeting Intervention, Practice setting, and Ecological system.
This qualitative study demonstrated facilitators and barriers to implementing physician-pharmacist collaborative clinics for diabetes management in primary healthcare centers and developed theory-based strategies for further promotion, which has the potential to improve the management of diabetes and other chronic diseases in under-resourced areas.
尽管在全球范围内，医生-药剂师合作的糖尿病管理诊所已被证明是有效且具有成本效益的，但对于影响其可持续实施的因素了解有限。本研究旨在确定相关因素，并提供可持续性策略，以在中国的基层医疗中心更好地实施医生-药剂师合作的糖尿病管理诊所。
对 43 名参与者进行了面对面、深入、半结构化访谈。采用实施研究综合框架来确定在基层医疗中心实施医生-药剂师合作的糖尿病管理诊所的促进因素和障碍，并探讨低实施单位和高实施单位之间的区别因素。基于动态可持续性框架建立了可持续性策略库，以为进一步实施提供信息。
本研究表明，明确认识到干预措施的益处、患者的迫切需求、适应性和定制计划、高度协作的团队合作和领导支持是主要促进因素，而主要障碍包括过程复杂性、基层地区患者数量多且健康素养低、人员配备安排不当、财务激励不足和员工能力不足。确定了六个构建体来区分高实施单位和低实施单位。制定了 16 项策略来促进医生-药剂师合作的糖尿病管理诊所的实施，针对干预措施、实践环境和生态系统。
这项定性研究表明了在基层医疗中心实施医生-药剂师合作的糖尿病管理诊所的促进因素和障碍，并制定了基于理论的进一步推广策略，这有可能改善资源匮乏地区的糖尿病和其他慢性病的管理。
