Project description:BackgroundStructured workplace training supports pharmacists in achieving individual career goals as well as health services to meet workforce development goals. Hospital pharmacy residency programs offer structured training pathways for early career pharmacists. A residency program was introduced in Australia, modelled on formal programs already established in other countries.ObjectiveThis qualitative study explored key stakeholders' expectations and early experiences with the implementation of a pharmacy residency program using an analytical framework derived from implementation science.MethodsThree focus groups and seven semi-structured interviews were conducted over a 24-months period with pharmacy managers, senior pharmacists and resident and non-resident pharmacists from different Australian State and hospital settings. They were audio recorded and transcribed verbatim. Transcripts were analysed via thematic analysis using Diffusion of Innovation Theory as a categorising framework.ResultsThirty stakeholders participated in focus groups and interviews. Three of the five main factors that influenced the adoption of an innovation according to Diffusion of Innovation Theory were identified as prominent, two as weaker themes. The relative or perceived advantage of adopting or participating in a residency program was identified as a major theme. Pharmacy managers and resident pharmacists regarded individual and workforce advancement as creating a potential advantage for them. The complexity of the program's implementation, with concerns about its resourcing requirements and sustainability, influenced uptake. The compatibility of the program with already existing training pathways was explored, with the residency sharing similar objectives with current pharmacy education and workforce development goals. Observability and trialability played lesser roles in facilitating program uptake.ConclusionThe implementation and diffusion of the pharmacy residency program can be interpreted by referring to key principles of Diffusion of Innovation Theory. Findings from this study and consideration of theory can inform the diffusion and ongoing maintenance of pharmacy workplace training and education programs.

Project description:BackgroundThe National Immunization Program Information System (SIPNI - Sistema de Informação do Programa Nacional de Imunização) in Brazil is a technological innovation management tool that enhances the performance of managers and health professionals in the evaluation and monitoring of immunization activities. In the country, the decentralization of the System is at an advanced stage, but it still faces challenges regarding its operation and use, impacting on its results. This study aims to evaluate the deployment of SIPNI in the state of Minas Gerais, in 2017.MethodCross-section study performed in Primary Healthcare vaccination rooms in 54 municipalities in the Brazilian state of Minas Gerais, in 2017. A multidimensional questionnaire was used with nursing professionals who work in vaccination rooms, containing questions about the structure (presence of an internet-connected computer, instruction manual, software version, IT professional for technical support, trained healthcare professional, use of communication channels to obtain system information) and the process (activities performed by the staff to operate the immunization information system) of their work. Those questions refer to the components of the information system: system management, immunized-patient records, and Movement of Immunobiological. Implementation Degree (ID) was defined by a score system with different weights for each criterion, according to the importance level observed in it, with a rating of: adequate, partially adequate, inadequate and critically inadequate. For data analysis, median was used as the summary measure, and Pearson's Chi-Squared Test was used for proportion comparison.ResultsMunicipal SIPNI is not adequately implemented and that results mainly from the actions performed in health service units, indicating problems in the use of technology by professionals working in vaccination rooms. The structure was better evaluated than the process, presenting IDs of 70.9 and 59.5%, respectively. Insufficient internet access, inadequate use of communication channels, and lack of professional qualification were some of the identified structural issues. "Movement of Immunobiological" was the best-ranked component (ID = 68.5%), followed by "immunized patient records" (ID = 59.3%) and "SIPNI management" (ID = 50.7%). Partial performance of SIPNI is independent of population size in the municipality and of FSH coverage.ConclusionsSIPNI is still an underutilized technological innovation. There are challenges that must be overcome, such as implementation of the final web version, internet connectivity, and capabilities aimed at the use of information generated by technology. Nevertheless, perspectives regarding SIPNI are positive, with functionalities to optimize activities in vaccination rooms.

Project description:BackgroundDespite numerous translations of diabetes prevention programs, implementation evaluations are rarely conducted. The purpose of this study was to examine the implementation process and multilevel contextual factors as an evidence-based diabetes prevention program was implemented into two local community organization sites to inform future scale-up. To build the science of implementation, context and strategies must be identified and explored to understand their impact.MethodsThe program was a brief-counseling diet and exercise modification program for individuals at risk of developing type 2 diabetes. A 1-year collaborative planning process with a local not-for-profit community organization co-developed an implementation plan to translate the program. A pragmatic epistemology guided this research. Semi-structured interviews were conducted with staff who delivered the program (n = 8), and a focus group was completed with implementation support staff (n = 5) at both community sites. Interviews were transcribed verbatim and thematically analyzed using a template approach. The consolidated framework for implementation research (CFIR) is a well-researched multilevel implementation determinant framework and was used to guide the analysis of this study. Within the template approach, salient themes were first inductively identified, then identified themes were deductively linked to CFIR constructs.ResultsImplementation strategies used were appropriate, well-received, and promoted effective implementation. The implementation plan had an impact on multiple levels as several CFIR constructs were identified from all five domains of the framework: (a) process, (b) intervention characteristics, (c) outer setting, (d) inner setting, and (e) individual characteristics. Specifically, results revealed the collaborative 1-year planning process, program components and structure, level of support, and synergy between program and context were important factors in the implementation.ConclusionThis study offers insights into the process of implementing a community-based diabetes prevention program in two local sites. Successful implementation benefited from a fully engaged, partnered approach to planning, and subsequently executing, an implementation effort. The CFIR was a useful and thorough framework to evaluate and identify multilevel contextual factors impacting implementation. Results can be used to inform future implementation and scale-up efforts.

Project description:Background: Few studies of hospital-based implementation assess sustainability or collect formal implementation outcomes, in part because the emphasis is often on initial adoption and rapid cycles of improvement. The purpose of this process evaluation was to assess the implementation of a pharmacy-led, hospital-wide program and contribute to the literature by collecting formal implementation outcomes, including sustainability. Methods: This was a qualitative process evaluation of a program that delivers discharge medications and related education to hospitalized patients' bedside prior to discharge. Semi-structured interviews were conducted with the program's key stakeholders to assess the program's implementation barriers and facilitators as well as its potential for sustainability. An interview guide was created based on the RE-AIM constructs of Reach, Adoption, Implementation, and Maintenance. Effectiveness was not assessed due to an ongoing effectiveness evaluation by another team. Each interview was coded by two independent coders and any discrepancy was adjudicated by a third, independent coder. Results: Twelve stakeholders were approached and all agreed to be interviewed. Related to providers' decisions to adopt the program, key themes emerged around the different priorities of nurses and physicians, which has implications for how program leadership promoted the program to these different stakeholder groups. Key implementation barriers included the nature of hospital provider rotations and turnover, which led to confusion on who could use the program and to whom providers should direct program-related questions. Key implementation facilitators included the enthusiasm of program staff and identified champions on the units. Themes related to maintenance or sustainability included the need to continually generate buy-in and educate providers about the program and allowing program staff and leadership to remain nimble and adapt their operations to meet evolving needs. Conclusions: The results suggest that in an environment in which rapidly achieving improvement is often the focus more than maintaining that improvement, strategies to achieve successful implementation may not be sufficient to achieve successful sustainment. New strategies are likely needed to address the unique barriers to sustaining a program once initial adoption and implementation is complete.

Project description:BackgroundA hospital pharmacy foundation residency training program has been introduced in Australia, modelled on residency programs established in other countries. The program aims to support the professional development of early-career hospital pharmacists, in both clinical and non-clinical roles. Pharmacy educators are usually tasked with the implementation and maintenance of this program. This qualitative, longitudinal study aimed to investigate hospital pharmacy educators' expectations, perceptions and experiences with implementing and developing their residency program.MethodsQualitative data were collected at two timepoints, approximately 24 months apart, using either focus groups or interviews with pharmacy educators who were directly involved in the implementation of the residency program at their respective hospitals. During the early phases of implementation, and approximately 24 months later, participants were asked about their experiences and expectations of the residency program as well as any changes that had occurred within the residency program over time.ResultsFour focus groups and three semi-structured interviews were held with pharmacy educators and senior pharmacists from different hospital settings. These were audio recorded and transcribed verbatim. Transcripts were inductively analysed via thematic analysis. Fifteen hospital pharmacy educators and senior hospital pharmacists participated in the initial focus groups and interviews, and seven educators were retained for follow-up. Four main themes were established from the discussions: participants had great expectations of a positive impact of the residency on their workplace and residents' professional development; substantial effort, support and resources were needed to implement and maintain a residency program; self-motivation and engagement is needed by residents to succeed and experience timely completion and career acceleration; and lastly a balance between standardisation, consistency and flexibility in delivering the residency needs to be found. The role of educators changed with the implementation of a residency, with the addition of more managerial and supervisory aspects.ConclusionThe Australian hospital pharmacy foundation residency program is a complex workplace training program with multiple factors and prerequisites influencing its implementation, development and outcomes. Pharmacy educators are central to the successful implementation and ongoing sustainability of a residency program. They may benefit from formal training and qualifications to support their role.

Project description:OBJECTIVES:(1) To develop an adaptation framework for MTM delivery for pharmacists (the MTM Adaptability Framework), (2) to examine the impact of an educational intervention informed by the MTM Adaptability Framework on MTM completion rates over a 2-year period, and (3) to explore pharmacists' perceptions regarding knowledge and beliefs about MTM and MTM implementation self-efficacy pre- and post-intervention. METHODS:This study is a prospective, mixed-methods research study including a quasi-experimental, one-group pretest-posttest quantitative study with a sequential explanatory qualitative study arm featuring semi-structured key informant interviews. US supermarket pharmacy chain setting included 93 community pharmacy sites located in Tennessee, Kentucky, and Alabama. MTM completion rates are reported as percentage of completed comprehensive medication reviews (CMRs) and targeted medication reviews (TMRs) and pharmacist perceptions. RESULTS:An 11.4% absolute increase in MTM completion rates was seen after the educational intervention targeting adaptation of MTM in the community pharmacy setting. This was found to be significant (46.92% vs. 58.3%; p < 0.001). Responses to the semi-structured interviews were mapped against CFIR and included themes: "knowledge and beliefs about MTM (pre-intervention)," "self-efficacy for MTM implementation (pre-intervention)," "knowledge and beliefs about MTM (post-intervention)," and "self-efficacy for MTM implementation (post-intervention)." Data convergence was found across these methodologies and suggested that targeting adaptability of MTM delivery increases MTM completion rates (quantitative data) and positively changes perceptions of MTM feasibility and self-efficacy (interviews). CONCLUSION:The use of an educational intervention about adaptation of MTM to influence adaptation of MTM to a chain community pharmacy setting part of an implementation strategy improved MTM completion rates significantly. Future research should investigate combined implementation strategies and their impact on MTM implementation success.

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Qualitative Investigation of Community Pharmacy Immunization Enhancement Program Implementation

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