Ryan Marissa, Ward Elizabeth C, Burns Clare, Carrington Christine, Cuff Katharine, Mackinnon Mhairi, Snoswell Centaine L
Pharmacy Department, Princess Alexandra Hospital, Brisbane, Australia.
Centre for Health Services Research, The University of Queensland, Brisbane, Australia.
Explor Res Clin Soc Pharm. 2024 Sep 3;16:100501. doi: 10.1016/j.rcsop.2024.100501. eCollection 2024 Dec.
Medication history telepharmacy consults are conducted prior to patients commencing their systemic anti-cancer therapy. At the study institution, this has historically been carried out as an unscheduled telephone consult. However, due to challenges with telephone consults, a scheduled videoconsult model was established. Funding, time efficiency, and completion rate for videoconsults compared to telephone consults have been examined previously.
The aim of this study was to determine staff perceptions of the factors that influence implementation, including enablers and barriers, for videoconsults compared to telephone consults, to inform model sustainability.
Semi-structured interviews were conducted with staff ( = 14) involved with the videoconsult service, or who provided care for patients who had a videoconsult. Interviews were coded for positive or negative influence and strength using the Consolidated Framework for Implementation Research (CFIR) 2.0, to understand which constructs influence implementation.
Thirty-nine of the 79 constructs, from across four domains were identified as influences for the telephone and videoconsult models. Six constructs were strongly differentiating for videoconsults over telephone consults. Of the 25 positively influencing constructs for the videoconsult model, strongest ratings (+2) were given for innovation advantages, critical incidents, support persons assisting in the consult, financing related to funding reimbursement, and telehealth coordinator capability and motivation. Barriers unique to the videoconsult model included the many steps that were involved, compatibility with workflows, and pharmacist resource. Similarities and differences unique to each model were identified.
Findings demonstrated a number of strongly differentiating constructs highlighting superiority of the videoconsult model. However, implementation of both models had multiple enablers and barriers that may influence adoption. The potential of a hybrid service, using both telephone consults and videoconsults, may help optimise delivery of services.
在患者开始全身抗癌治疗之前会进行用药史远程药学咨询。在本研究机构，这一咨询过去一直以非预约电话咨询的形式进行。然而，由于电话咨询存在一些问题，于是建立了预约视频咨询模式。此前已经对视频咨询与电话咨询的资金、时间效率和完成率进行了研究。
本研究的目的是确定工作人员对影响视频咨询与电话咨询实施的因素的看法，包括促进因素和障碍，以为该模式的可持续性提供参考。
对参与视频咨询服务或为接受视频咨询的患者提供护理的工作人员（n = 14）进行了半结构式访谈。使用实施研究综合框架（CFIR）2.0对访谈内容进行积极或消极影响以及影响强度的编码，以了解哪些因素影响实施。
在四个领域的79个因素中，有39个被确定为对电话咨询和视频咨询模式有影响。有6个因素在视频咨询与电话咨询之间具有显著差异。在对视频咨询模式有积极影响的25个因素中，创新优势、关键事件、协助咨询的支持人员、与资金报销相关的资金、远程医疗协调员的能力和积极性获得了最高评分（+2）。视频咨询模式特有的障碍包括涉及的步骤繁多、与工作流程的兼容性以及药剂师资源。确定了每种模式独有的异同点。
研究结果表明，有一些显著不同的因素突出了视频咨询模式的优越性。然而，两种模式的实施都有多个促进因素和障碍，可能会影响采用率。同时使用电话咨询和视频咨询的混合服务模式可能有助于优化服务提供。
