Preparing for the spread of patient-reported outcome (PRO) data collection from primary care to community pharmacy: a mixed-methods study

Abstract

Background Medication non-adherence is a significant public health problem. Patient-reported outcomes (PROs) offer a rich data source to facilitate resolution of medication non-adherence. PatientToc™ is an electronic PRO data collection software originally implemented at primary care practices in California, United States (US). Currently, the use of standardized PRO data collection systems in US community pharmacies is limited. Thus, we are conducting a two-phase evaluation of the spread and scale of PatientToc™ to US Midwestern community pharmacies. This report focuses on the first phase of the evaluation. The objective of this phase was to prepare for implementation of PatientToc™ in community pharmacies by conducting a pre-implementation developmental formative evaluation to (1) identify potential barriers, facilitators, and actionable recommendations to PatientToc™ implementation and (2) create a draft implementation toolkit. Methods Data collection consisted of demographics, observations, audio-recorded contextual inquiries, and semi-structured interviews with staff (e.g., primary care providers, pharmacists, pharmacy technicians) and patients during 1-day site visits to a purposive sample of (1) primary care practices currently using PatientToc™ and (2) community pharmacies in Indiana, Wisconsin, and Minnesota interested in the future use of PatientToc™. Post-visit site observation debriefs were also audio-recorded. Verbatim transcripts of all recordings were coded using deductive/inductive approaches and intra-/inter-site summaries were produced identifying potential barriers, facilitators, and actionable recommendations mapped to the Consolidated Framework for Implementation Research constructs. A stakeholder advisory panel engaged in an Evidence-Based Quality Improvement (EBQI) implementation process. This included “member checking” and prioritizing findings, and feedback on the adapted PatientToc™ application, implementation strategies, and accompanying toolkit for community pharmacy implementation. Results Two primary care practices, nine pharmacies, and 89 individuals participated. Eight major themes (four barriers and four facilitators) and 14 recommendations were identified. Throughout the four EBQI sessions, the panel (1) confirmed findings; (2) designated high priority recommendations: (a) explain PatientToc™ and its benefits clearly and simply to patients, (b) ensure patients can complete questionnaires within 10 min, and (c) provide hands-on training/resources for pharmacy teams; and (3) provided feedback on the adapted PatientToc™ application and finalized toolkit items for initial community pharmacy implementation. Conclusions Adoption of electronically captured PROs in community pharmacies is warranted. The implementation strategies systematically developed in this study can serve as a model for implementation of technology-driven health information patient care services, in the understudied context of community pharmacies.

Mapping Theories, Models, and Frameworks to Evaluate Digital Health Interventions: Scoping Review

“…DHIs targeting HCPs included (but are not limited to) mobile apps targeting patients’ smoking cessation [ 45 ] and medication adherence counseling [ 46 , 47 ], telemedicine and telehealth [ 48 , 49 ], cancer prevention decision support tools [ 50 ], e-consultation between primary care providers and specialty care expertise [ 51 , 52 ], and e-learning for dementia caregiver education [ 53 ]. Two studies targeted health system managers and an information system for case-based surveillance [ 54 ] and a patient-reported outcome data collection system [ 55 ]. Two studies focused on data services including big data analytics [ 56 ], the former being reported in combination with clients, and an electronic patient falls reporting system [ 57 ].…”

Evidence-Based Quality Improvement (EBQI) in the pre-implementation phase: key steps and activities

“…Most (7/8) cases included all these steps; three included an additional step of making research design decisions (e.g., choosing the control condition; selecting/refining measures). For the third step of selecting EBI adaptations and/or implementation strategies, all cases selected implementation strategies, while 3 also selected adaptations of the EBI ( 27 , 29 , 34 ).…”

“…In fact, EBQI may be a “meta-strategy” during the active implementation phase through which many other strategies can be decided upon and deployed (e.g., working groups, facilitation calls, champion engagement). We believe operationalizing EBQI as an implementation strategy is most fitting when the purpose is “to enhance the adoption, implementation, and sustainability of a clinical program or practice” ( 37 ) or for “creating buy-in among stakeholders.” ( 34 ) The Department of Veterans Affairs (VA) Quality Enhancement Research Initiative (QUERI) implementation road map ( 38 ) conceives of EBQI in this way and illustrates how EBQI operates during both active implementation and sustainment phases. Continuation of EBQI engagement across implementation phases allows continuation of partnerships formed in pre-implementation.…”