Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
Drug Health Service, Western Sydney Local Health District, Sydney, Australia.
BMC Health Serv Res. 2024 Sep 29;24(1):1147. doi: 10.1186/s12913-024-11614-8.
Prescription Drug Monitoring Programs (PDMPs) are increasingly implemented across the globe with aims of managing and mitigating risks relating to high-risk prescription medicines. There is limited research focused on identifying strategies or processes for large-scale PDMP implementation. This study aimed to identify strategies perceived as necessary for successful state-wide implementation of a PDMP by exploring the experiences and perceptions of stakeholders responsible for the implementation in New South Wales (NSW), Australia: to identify (1) the drivers of implementation; (2) perceived strategies that worked well; (3) barriers to implementation; and (4) the elements needed for long-term success of SafeScript NSW.
This study used a qualitative descriptive design. Theoretical frameworks used to design interview questions and guide thematic analysis were the non-adoption, abandonment, scale-up, spread, and sustainability (NASSS) framework and Quadruple Aim framework. Participants were stakeholders responsible for PDMP implementation in NSW. Recruitment and data collection were completed between March and April 2022. Semi-structured interviews were audio-recorded and transcribed. Two researchers independently reviewed transcripts, generated codes from the data, and mapped these to each NASSS domain. They came together multiple times during data analysis to review the codes and grouped them into higher level themes via a discussion and consensus process. Themes were then organised according to the four objectives of the study.
Eight interviews were conducted and analysed after which thematic saturation was reached. All participants had a common understanding of the perceived benefits and drivers for PDMP implementation. Participants outlined ten key ingredients for perceived successful state-wide implementation. Strong and iterative engagement with a large number of stakeholder groups was viewed as critical, as was targeting user experience, ongoing monitoring and evaluation. These were facilitated by a phased roll-out strategy. Participants identified some barriers to implementation, particularly around poor usability and user experience of the tool.
This is one of the first studies focused on strategies for what was perceived to be successful state-wide implementation of PDMP. Successful implementation requires significant time and resourcing, with the design and configuration of the technology being only one component of a multi-strategy process. Knowledge and insights gained from this study may be useful for other implementations of similar digital health tools in large-scale jurisdictions.
处方药物监测计划（PDMP）在全球范围内得到了越来越多的实施，旨在管理和减轻与高风险处方药物相关的风险。针对 PDMP 大规模实施的策略或流程，目前的研究有限。本研究旨在通过探索澳大利亚新南威尔士州（NSW）负责实施 PDMP 的利益相关者的经验和看法，确定成功实施全州范围内 PDMP 所需的策略，从而识别：（1）实施的驱动力；（2）效果良好的策略；（3）实施障碍；（4）SafeScript NSW 长期成功所需的要素。
本研究采用定性描述设计。用于设计访谈问题和指导主题分析的理论框架是不采用、放弃、扩大、传播和可持续性（NASSS）框架和四重目标框架。参与者是 NSW PDMP 实施的利益相关者。招募和数据收集于 2022 年 3 月至 4 月进行。对半结构化访谈进行了录音和转录。两名研究人员独立审查了记录，从数据中生成了代码，并将这些代码映射到每个 NASSS 领域。在数据分析过程中，他们多次聚在一起，通过讨论和达成共识来审查代码，并将其分组为更高层次的主题。然后根据研究的四个目标组织主题。
进行了八次访谈并进行了分析，之后达到了主题饱和。所有参与者对 PDMP 实施的预期收益和驱动力有共同的理解。参与者概述了成功全州实施的十个关键要素。与大量利益相关者群体进行强有力和迭代的互动被认为至关重要，目标是用户体验，持续监测和评估。这是通过分阶段推出策略来实现的。参与者还确定了一些实施障碍，特别是工具的可用性和用户体验较差。
这是首次针对被认为是 PDMP 全州成功实施的策略进行的研究之一。成功实施需要大量的时间和资源，而技术的设计和配置只是多策略过程的一个组成部分。从这项研究中获得的知识和见解可能对其他在大规模司法管辖区实施类似数字健康工具有用。
