Background
Studies have identified the positive impact of community pharmacist patient care services. Identifying the most effective implementation strategies and performing robust research are critical to sustaining evidence‐based patient care in this setting. This systematic review aimed to describe: (1) implementation strategies, and (2) dissemination and implementation (D&I) outcomes used to evaluate the implementation of patient care services in community pharmacies.
Methods
PubMed/MEDLINE, EMBASE, and International Pharmaceutical Abstracts were searched for articles that were: (1) written in English and published in 1985 or later, (2) described a peer‐reviewed empirical study or practice experience implementing a patient care service in a community pharmacy, and (3) described the strategies used to implement and/or evaluate the implementation of the service. Two investigators reviewed the abstract, and full‐text when necessary, of each article to assess eligibility. Data were extracted from each article by two investigators using a standardized form. Implementation strategies were categorized using the Expert Recommendations for Implementation Change (ERIC) study terminology. The D&I outcomes were classified using the Proctor and colleagues terminology. All data were summarized using descriptive statistics.
Results
Two hundred and thirty‐seven articles were included, 223 of which described at least one implementation strategy and 224 described at least one D&I outcome. “Train and educate stakeholders” and “engage consumer” were the most common and “provide interactive assistance” and “adapt and tailor to context” were the least commonly reported implementation strategies. Reach, acceptability, and adoption were the most common and fidelity and sustainability were the least commonly evaluated D&I outcomes. Most studies used quasi‐experimental or observational designs.
Conclusions
This systematic review used published manuscripts to identify the breadth and depth of implementation and evaluation strategies being utilized in various community pharmacies. Findings suggest opportunities for further research and innovation via collaboration between pharmacists and implementation practitioners and researchers.
Objectives: The authors employ a Whole Systems framework to explore implementation of new guidelines for back and neck pain in Oregon's Medicaid system. Whole Systems research is useful for understanding the relationship between complementary and integrative health care (CIH) and conventional health care systems in real-world clinical and practice settings. Design: Preliminary results are from an observational study designed to evaluate statewide implementation of CIH and other non-pharmacological treatments for neck and back pain among Oregon Medicaid patients. This natural experiment, even in early stages, provides insight into the challenges of integrating Whole Systems oriented therapies into Medicaid billing and treatment. Methods: Qualitative data are drawn from: (1) semi-structured interviews with representatives of each of the 16 coordinated care organizations (CCOs) responsible for administering the Oregon's Medicaid insurance through the Oregon Health Plan (OHP); and (2) open-ended survey responses from acupuncturists in all 16 CCO areas. Results: Implementation of the new policy guidelines poses logistical and epistemological challenges. Differences in worldview, inadequate reimbursement, and simple lack of awareness of CIH among medical providers are some of the factors that pose barriers to merging CIH therapies into conventional frameworks. Conclusions: In this article, we explore the potential for a Whole Systems perspective to better explain the complexity of integrating CIH and other non-pharmacological services into a state financed health care system. Oregon's expansion of services for back and neck pain presents an opportunity to explore challenges and successes in melding multiple approaches to health and pain management into a managed system such as the OHP.
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