Barriers to and facilitators of the implementation of pharmacist services in primary care clinics: a scoping review protocol.
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ABSTRACT: Introduction
Inappropriate medication use is a leading cause of avoidable harm in health systems and is particularly severe in primary care settings. Evidence has shown that the integration of pharmacists into primary care clinics has favourable satisfaction and effectiveness in health outcomes. However, barriers to and facilitators of pharmacist services in these settings have not been comprehensively reviewed. Therefore, this scoping review aims to map and examine the literature available on the barriers to and facilitators of the implementation of pharmacist services in primary care clinics to guide future implementation research.Methods and analysis
This scoping review will be undertaken following the six-stage framework developed by Arksey and O'Malley and be guided by recommendations by Levac et al. Eight electronic databases (PubMed, Embase, Scopus, Web of Science, CINAHL, PsycINFO, CNKI and Wanfang) will be searched. Reference lists and related citations, and grey literature from websites will be searched manually. Available information that has been reported in Chinese or English up to 31 August 2021 will be included. Studies will be selected and screened by two reviewers independently. Findings from the included studies will be extracted by two independent reviewers and supervised by a third reviewer. A content analysis of the findings will be performed using MAXQDA 2020.Ethics and dissemination
Ethical approval will not be required for this scoping review, as all data and information will be obtained from publicly available literature. The findings of this scoping review will be shared with healthcare managers in primary care institutions and health authorities as well as disseminated via publication in a peer-reviewed journal.
SUBMITTER: Li H
PROVIDER: S-EPMC8753389 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:IntroductionElectronic consultations (eConsult), asynchronous exchanges of patient health information at a distance, are increasingly used as an option to facilitate patient care and collaboration between primary care providers and specialists. Although eConsult has demonstrated success in increasing efficiency in the referral process and enhancing access to care, little is known about the factors influencing its wider adoption and implementation by end users. In this paper, we describe a protocol to conduct a scoping review of the literature on the barriers and facilitators to a wider adoption and implementation of eConsult service.Methods and analysisThis scoping review will be based on the framework pioneered by Arksey and O'Malley and later developed by Levac et al. We will use the guidance for scoping reviews developed by the Joanna Briggs Institute to report our findings. In addition to several electronic databases (Medline, Embase, Cochrane Library, CINAHL, EBSCOhost and PsycINFO) studies will be identified by including relevant grey literature. Two reviewers will independently screen titles and full texts for inclusion. Studies reporting on barriers and/or facilitators in settings similar to eConsult will be included. Data on study characteristics and key barriers and facilitators will be extracted. Data will be analysed thematically and classified using the Quadruple Aim framework.Ethics and disseminationApproval by research ethics board is not required since the review will only include published and publicly accessible data. Review findings will be used to inform future studies and the development of practice tools to support the wider adoption and success of eConsult implementation. We plan to publish our findings in a peer-reviewed journal and develop a useful and accessible summary of the results.
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Project description:IntroductionGuideline-adherent physiotherapy can improve patient outcomes and reduce costs in the healthcare system. However, although there are numerous guidelines for physiotherapy practice, services are not consistently based on clinical practice guidelines. While various systematic and scoping reviews have highlighted barriers, facilitators and implementation strategies for guideline-adherent practice in other health professions, this scoping review aims to explore the barriers and facilitators for guideline-adherent physiotherapy and summarises the strategies used to implement such practice.Methods and analysisThis scoping review will be based on Arksey and O'Malley's scoping review methodology and the methodological guidance for conducting scoping reviews published by Joanna Briggs Institute. Relevant publications will be first searched from the beginning of June 2023 on the MEDLINE and CINAHL databases before we expand the search to other databases such as EMBASE, the Cochrane Library and PEDro at the end of June 2023. Two reviewers will independently screen the titles and abstracts of all retrieved citations for inclusion against the eligibility criteria before conducting an independent full-text screening. The criteria will be tested on a sample of abstracts before beginning the abstract review to ensure that they are robust enough to capture any articles that may relate. The extracted data will finally be collated and charted to summarise key findings regarding our research question.Ethics and disseminationThis scoping review will provide an extensive overview of the barriers, facilitators and implementation strategies for guideline-adherent physiotherapy. As scoping reviews are a form of secondary data analysis, ethical review is not required. Results will be disseminated through a peer-reviewed publication and stakeholder meetings.Trial registration numberThis scoping review has been registered on 3 April 2023 on the Open Science Framework under https://doi.org/10.17605/OSF.IO/SEUW6.
| S-EPMC10351290 | biostudies-literature
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Project description:BACKGROUND:Alcohol and drug use are leading causes of morbidity and mortality that frequently go unidentified in medical settings. As part of a multi-phase study to implement electronic health record-integrated substance use screening in primary care clinics, we interviewed key clinical stakeholders to identify current substance use screening practices, barriers to screening, and recommendations for its implementation. METHODS:Focus groups and individual interviews were conducted with 67 stakeholders, including patients, primary care providers (faculty and resident physicians), nurses, and medical assistants, in two urban academic health systems. Themes were identified using an inductive approach, revised through an iterative process, and mapped to the Knowledge to Action (KTA) framework, which guides the implementation of new clinical practices (Graham et al. in J Contin Educ Health Prof 26(1):13-24, 2006). RESULTS:Factors affecting implementation based on KTA elements were identified from participant narratives. Identifying the problem: Participants consistently agreed that having knowledge of a patient's substance use is important because of its impacts on health and medical care, that substance use is not properly identified in medical settings currently, and that universal screening is the best approach. Assessing barriers: Patients expressed concerns about consequences of disclosing substance use, confidentiality, and the individual's own reluctance to acknowledge a substance use problem. Barriers identified by providers included individual-level factors such as lack of clinical knowledge and training, as well as systems-level factors including time pressure, resources, lack of space, and difficulty accessing addiction treatment. Adapting to the local context: Most patients and providers stated that the primary care provider should play a key role in substance use screening and interventions. Opinions diverged regarding the optimal approach to delivering screening, although most preferred a patient self-administered approach. Many providers reported that taking effective action once unhealthy substance use is identified is crucial. CONCLUSIONS:Participants expressed support for substance use screening as a valuable part of medical care, and identified individual-level as well as systems-level barriers to its implementation. These findings suggest that screening programs should clearly communicate the goals of screening to patients and proactively counteract stigma, address staff concerns regarding time and workflow, and provide education as well as treatment resources to primary care providers.
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Project description:PurposeThis scoping review identifies and characterises reported barriers and facilitators to providing integrated cancer care reported in the international literature, and develops recommendations for clinical practice.MethodsThis scoping review included literature published between 2009 and 2022 and describes the delivery of integrated cancer care between primary and secondary care sectors. Searches were conducted of an online database Ovid Medline and grey literature.ResultsThe review included thirty-two papers. Barriers and facilitators to integrated cancer care were identified in three core areas: (1) at an individual user level around patient-healthcare professional interactions, (2) at an organisational level, and (3) at a healthcare system level. The review findings identified a need for further training for primary care professionals on cancer care, clarity in the delineation of primary care and oncologist roles (i.e. who does what), effective communication and engagement between primary and secondary care, and the provision of protocols and guidelines for follow-up care in cancer.ConclusionsInformation sharing and communication between primary and secondary care must improve to meet the increasing demand for support for people living with and beyond cancer. Delivering integrated pathways between primary and secondary care will yield improvements in patient outcomes and health economic costs.
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Project description:IntroductionInjury accounts for 10% of the global burden of disease. While the literature is scarce, research investigating injury among Indigenous populations has found incidence and prevalence rates are higher, compared with non-Indigenous populations. New Zealand is no exception; Māori have higher rates of injury and disability compared with non-Māori. Given the burden of injury for Māori, this scoping review aims to identify, understand and map available literature related to the barriers and facilitators to accessing injury-related healthcare for Māori in New Zealand.Methods and analysisA scoping review will be conducted to identify the relevant literature and provide an opportunity to highlight key concepts and research gaps in the literature. This work will be guided by the scoping review framework developed by Arksey and O'Malley and will be underpinned by Kaupapa Māori research principles. The overall project is also be guided by a Māori advisory group. Database searches, for example, MEDLINE (Ovid), Scopus and Embase, will be used to identify empirical literature, and Google, New Zealand government websites and relevant non-government organisations will be used to identify relevant grey literature.Ethics and disseminationTo the best of our knowledge, this scoping review is the first to systematically examine the currently available literature relating to the barriers and facilitators of accessing injury-related healthcare for Māori in New Zealand. Ethical approval was not required for this scoping review. Dissemination will include publication of the scoping review findings in a peer-reviewed journal, as well as presentations at conferences, to the project's advisory group, and staff working in the field of Māori disability and rehabilitation.
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| S-EPMC5623507 | biostudies-literature
Project description:IntroductionSocial isolation is a significant issue in aged care settings (eg, long-term care (LTC) and hospital) and is associated with adverse outcomes such as reduced well-being and loneliness. Loneliness is linked with depression, anxiety, cognitive decline, weakened immune system, poor physical health, poor quality of life and mortality. The use of robotic assistance may help mitigate social isolation and loneliness. Although telepresence robots have been used in healthcare settings, a comprehensive review of studies focusing on their use in aged care for reducing social isolation requires further investigation. This scoping review will focus on the use of telepresence robots to support social connection of older people in care settings.Methods and analysisThis scoping review will follow Joanna Briggs Institute scoping review methodology. The review team consists of patient partners and family partners, a nurse researcher and a group of students. In the scoping review, we will search the following databases: MEDLINE (Ovid), CINAHL, PsycINFO (EBSCO), Web of Science and ProQuest Dissertations & Theses Global. Google and Google Scholar will be used to search for additional literature. A handsearch will be conducted using the reference lists of included studies to identify additional relevant articles. The scoping review will consider studies of using a telepresence robotic technology with older adults in care settings (ie, LTC and hospital), published in English.Ethics and disseminationSince the methodology of the study consists of collecting data from publicly available articles, it does not require ethics approval. By examining the current state of using telepresence to support older people in care settings, this scoping review can offer useful insight into users' needs (eg, patients' and care providers' needs) and inform future research and practice. We will share the scoping review results through conference presentations and an open access publication in a peer-reviewed journal.
| S-EPMC8451287 | biostudies-literature
Project description:BackgroundThe field of eHealth has a history of more than 20 years. During that time, many different eHealth services were developed. However, factors influencing the adoption of such services were seldom the main focus of analyses. For this reason, organizations adopting and implementing eHealth services seem not to be fully aware of the barriers and facilitators influencing the integration of eHealth services into routine care.ObjectiveThe objective of this work is to provide (1) a comprehensive list of relevant barriers to be considered and (2) a list of facilitators or success factors to help in planning and implementing successful eHealth services.MethodsFor this study, a twofold approach was applied. First, we gathered experts' current opinions on facilitators and barriers in implementing eHealth services via expert discussions at two health informatics conferences held in Europe. Second, we conducted a systematic literature analysis concerning the barriers and facilitators for the implementation of eHealth services. Finally, we merged the results of the expert discussions with those of the systematic literature analysis.ResultsBoth expert discussions (23 and 10 experts, respectively) identified 15 barriers and 31 facilitators, whereas 76 barriers and 268 facilitators were found in 38 of the initial 56 articles published from 12 different countries. For the analyzed publications, the count of distinct barriers reported ranged from 0 to 40 (mean 10.24, SD 8.87, median 8). Likewise, between 0 and 48 facilitators were mentioned in the literature (mean 9.18, SD 9.33, median 6). The combination of both sources resulted in 77 barriers and 292 facilitators for the adoption and implementation of eHealth services.ConclusionsThis work contributes a comprehensive list of barriers and facilitators for the implementation and adoption of eHealth services. Addressing barriers early, and leveraging facilitators during the implementation, can help create eHealth services that better meet the needs of users and provide higher benefits for patients and caregivers.
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