Background To meet emergent healthcare needs, innovations need to be implemented into routine clinical practice. Community pharmacy is increasingly considered a setting through which innovations can be implemented to achieve positive service and clinical outcomes. Small-scale pilot programmes often need scaled up nation-wide to affect population level change. This systematic review aims to identify facilitators and barriers to the national implementation of community pharmacy innovations. Methods A systematic review exploring pharmacy staff perspectives of the barriers and facilitators to implementing innovations at a national level was conducted. The databases Medline, EMBASE, PsycINFO, CINAHL, and Open Grey were searched and supplemented with additional search mechanisms such as Zetoc alerts. Eligible studies underwent quality assessment, and a directed content analysis approach to data extraction was conducted and aligned to the Consolidated Framework for Implementation Research (CFIR) to facilitate narrative synthesis. Results Thirty-nine studies were included: 16 were qualitative, 21 applied a questionnaire design, and 2 were mixed methods. Overarching thematic areas spanning across the CFIR domains were pharmacy staff engagement (e.g. their positive and negative perceptions), operationalisation of innovations (e.g. insufficient resources and training), and external engagement (e.g. the perceptions of patients and other healthcare professionals, and their relationship with the community pharmacy). Study participants commonly suggested improvements in the training offered, in the engagement strategies adopted, and in the design and quality of innovations. Conclusions This study’s focus on national innovations resulted in high-level recommendations to facilitate the development of successful national implementation strategies. These include (1) more robust piloting of innovations, (2) improved engagement strategies to increase awareness and acceptance of innovations, (3) promoting whole-team involvement within pharmacies to overcome time constraints, and (4) sufficient pre-implementation evaluation to gauge acceptance and appropriateness of innovations within real-world settings. The findings highlight the international challenge of balancing the professional, clinical, and commercial obligations within community pharmacy practice. A preliminary theory of how salient factors influence national implementation in the community pharmacy setting has been developed, with further research necessary to understand how the influence of these factors may differ within varying contexts. Trial registration A protocol for this systematic review was developed and uploaded onto the PROSPERO international prospective register of systematic reviews database (Registration number: CRD42016038876 ). Electronic supplementary material The online v...

Background In Scotland, there has been significant investment in pharmacy teams in general medical practices over recent years, aligned to current government policy. Objectives To characterize the national pharmacy workforce including activities undertaken, perceived competence and confidence, as well as perception of integration of the intervention. Methods A cross-sectional survey of all pharmacists and pharmacy technicians in general practices. Survey items were demographics, activities undertaken and experiences. The NoMAD tool (Improving the Normalization of Complex Interventions) was included as a measure of perspectives of implementation. Post-piloting, a questionnaire link was sent to all pharmacists (n = 471) and pharmacy technicians (n = 112). A total NoMAD score was obtained by assigning 1 (strongly disagree) to 5 (strongly agree) to each item. Results Responses were received from 393 (83.4%) pharmacists and 101 (91.8%) pharmacy technicians. Three quarters of pharmacists (74.6%) and pharmacy technicians (73.3%) had been qualified for over 10 years. Two-thirds of pharmacists (68.4%) were independent prescribers, with three quarters (72.3%) currently prescribing. Respondents worked in a median of two practices and were providing a range of activities including medication/polypharmacy reviews, medicines reconciliation, prescribing efficiencies and training. Respondents reported high levels of competence and confidence (median 8, scale 0–10 highest). Median NoMAD total score (scale 20–100 highest, Cronbach’s alpha 0.89) was 80 for pharmacists and 75 for pharmacy technicians, P ≤ 0.001. Conclusions The general practice pharmacy workforce in Scotland is experienced, well-qualified and integrated within general practices, delivering a range of activities. These findings have implications for workforce planning and future education and training.

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Objectives Avoiding harm when patients interact with healthcare services is a global issue. Guidelines are often produced to improve the prescribing and monitoring of medication with a narrow therapeutic index. Adherence to guidelines may not occur in clinical practice. This paper aims to explore the barriers faced by clinical pharmacists and junior doctors when using complex guidelines to support the prescribing and therapeutic drug monitoring of gentamicin and vancomycin. Methods Twenty-three junior doctors and 27 clinical pharmacists took part in focus groups at four hospital sites in four Scottish health boards between March and July 2011. Focus groups were run separately at each hospital site for the two clinical groups. The data were organised using the framework approach, validated, and a thematic analysis was conducted. Results Five themes emerged to explain barriers to effective initial prescribing and therapeutic drug monitoring, which were divided into two types. Barriers could be a direct result of the content of the guidelines—specifically that clinicians required experience to use the guidelines effectively. Barriers also resulted from a failure in the context in which the guidelines function which was related to insufficient dissemination, communication issues within the hospital site, unmet educational needs and staffing issues. Conclusions Improved patient safety cannot be assumed due to the existence of gentamicin and vancomycin guidelines. The findings of this study highlight the complexities associated with their appropriate use. Future quality improvement strategies must consider where the guidelines will be implemented, and the context in which they will function

More than one of every two entries to alcohol misuse services between 2004 and 2008 resulted in an unplanned discharge. The trend of improvement over the examined 4-year period was not consistent for all regions. A comparison of this figure with available US and Welsh data is made. The importance of these data in assessing the cost-effectiveness of alcohol treatment services and implications for policy making is discussed.