Rocha Kérilin Stancine Santos, Cerqueira-Santos Sabrina, Santos-Júnior Genival Araújo Dos, Cavalcante-Santos Lincoln Marques, Araújo-Neto Fernando de Castro, Prado Fernanda Oliveira, Brito Giselle de Carvalho, Lyra-Jr Divaldo Pereira de
Health Sciences Graduate Program. Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
Laboratory for Innovation in Health Care, Department of Pharmaceutical Sciences, Federal University of Espirito Santo, Vitória, Brazil.
Explor Res Clin Soc Pharm. 2024 Oct 22;16:100534. doi: 10.1016/j.rcsop.2024.100534. eCollection 2024 Dec.
The implementation of clinical pharmacy services (CPS) has grown worldwide. However, few studies have used models and/or frameworks to facilitate the implementation process, especially in a low and middle-income countries. In addition, there are limitations in the ways that implementation frameworks are used. Therefore, this discussion aimed to propose and describe an approach using the ReflACTION framework. ReflACTION emerged from several years of systematic observation and experience of the Laboratory of Teaching and Research in Social Pharmacy (LEPFS) in implementing CPS in different settings of Brazilian health system. These experiences led the research group to systematize the implementation of CPS based on three theorical references: Paulo Freire's theoretical references, the Maguerez Arc and the Apoteca framework. The ReflACTION framework proposes five steps that starts and ends in the setting, which are: observation of reality; gathering key-points; theorization; solution hypothesis; and application to reality. All steps were carried out considering the determinants of the implementation process. For the present study, we highlight the importance of the implementation team, the involvement of stakeholders as well as their dialogue and awareness. Thus, we describe the operationalization process for each step. The ReflACTION framework can be used to describe and guide the implementation process of CPS. We expect the proposed framework may add knowledge to implementation science and, ultimately, achieve desired patient outcomes.
临床药学服务（CPS）在全球范围内得到了广泛开展。然而，很少有研究使用模型和/或框架来促进实施过程，特别是在低收入和中等收入国家。此外，实施框架的使用方式存在局限性。因此，本讨论旨在提出并描述一种使用ReflACTION框架的方法。ReflACTION源于社会药学教学与研究实验室（LEPFS）在巴西卫生系统不同环境中实施CPS的数年系统观察和经验。这些经验促使研究小组基于三个理论参考对CPS的实施进行系统化：保罗·弗莱雷的理论参考、马格雷兹弧线和药剂师框架。ReflACTION框架提出了五个步骤，这些步骤始于并终于实际环境，即：观察现实；收集关键点；理论化；解决方案假设；以及应用于现实。所有步骤的实施都考虑了实施过程的决定因素。对于本研究，我们强调了实施团队的重要性、利益相关者的参与以及他们之间的对话和意识。因此，我们描述了每个步骤的操作过程。ReflACTION框架可用于描述和指导CPS的实施过程。我们期望所提出的框架可能会为实施科学增添知识，并最终实现预期的患者结果。
