PDF(Pubmed)
Abstract：
Hospital to community pharmacy transfer of care medicines-related interventions for inpatients discharged home aim to improve continuity of care and patient outcomes. One such intervention has been provided for seven years within a region in England. This study reports upon the implementation process and fidelity of this intervention.
The process evaluation guidance issued by the Medical Research Council has informed this study. A logic model to describe the intervention and causal assumptions was developed from preliminary semi-structured interviews with project team members. Further semi-structured interviews were undertaken with intervention providers from hospital and community pharmacy, and with patient and public representatives. These aimed to investigate intervention implementation process and fidelity. The Consolidated Framework for Implementation Research and the Consolidated Framework for Intervention Fidelity informed interview topic guides and underpinned the thematic framework analysis using a combined inductive and deductive approach.
Themes provided information about intervention fidelity and implementation that were mapped across the sub processes of implementation: planning, execution, reflection and evaluation, and engagement. Interviewees described factors such as lack of training, awareness, clarity on the service specification, governance and monitoring and information and feedback which caused significant issues with the process of intervention implementation and suboptimal intervention fidelity.
This provides in-depth insight into the implementation process and fidelity of a ToC intervention, and the extant barriers and facilitators. The findings offer learning to inform the design and implementation of similar interventions, contribute to the evidence base about barriers and facilitators to such interventions and provides in-depth description of the implementation and mechanisms of impact which have the potential to influence clinical and economic outcome evaluation.
The process evaluation guidance issued by the Medical Research Council has informed this study. A logic model to describe the intervention and causal assumptions was developed from preliminary semi-structured interviews with project team members. Further semi-structured interviews were undertaken with intervention providers from hospital and community pharmacy, and with patient and public representatives. These aimed to investigate intervention implementation process and fidelity. The Consolidated Framework for Implementation Research and the Consolidated Framework for Intervention Fidelity informed interview topic guides and underpinned the thematic framework analysis using a combined inductive and deductive approach.
Themes provided information about intervention fidelity and implementation that were mapped across the sub processes of implementation: planning, execution, reflection and evaluation, and engagement. Interviewees described factors such as lack of training, awareness, clarity on the service specification, governance and monitoring and information and feedback which caused significant issues with the process of intervention implementation and suboptimal intervention fidelity.
This provides in-depth insight into the implementation process and fidelity of a ToC intervention, and the extant barriers and facilitators. The findings offer learning to inform the design and implementation of similar interventions, contribute to the evidence base about barriers and facilitators to such interventions and provides in-depth description of the implementation and mechanisms of impact which have the potential to influence clinical and economic outcome evaluation.
摘要：
医院到社区药房对出院患者的护理药物相关干预措施的转移旨在改善护理的连续性和患者的预后。在英格兰的一个地区已经提供了七年的这种干预。本研究报告了该干预措施的实施过程和保真度。
医学研究委员会发布的过程评估指南已经通知了这项研究。通过与项目团队成员的初步半结构化访谈，开发了描述干预和因果假设的逻辑模型。对来自医院和社区药房的干预提供者进行了进一步的半结构化访谈，以及患者和公众代表。这些旨在调查干预实施过程和保真度。实施研究综合框架和干预保真度综合框架为访谈主题指南提供了信息，并使用归纳和演绎相结合的方法支持了主题框架分析。
主题提供了有关干预保真度和实施的信息，这些信息映射到实施的子流程中：规划、执行，反思和评价，和订婚。受访者描述了缺乏培训等因素，意识,服务规范的清晰度，治理和监测以及信息和反馈，这在干预实施和次优干预保真度的过程中引起了重大问题。
这为ToC干预的实施过程和保真度提供了深入的见解，以及现存的障碍和促进者。这些发现为类似干预措施的设计和实施提供了学习信息，为此类干预措施的障碍和促进者提供证据基础，并对有可能影响临床和经济结果评估的实施和影响机制进行深入描述。
医学研究委员会发布的过程评估指南已经通知了这项研究。通过与项目团队成员的初步半结构化访谈，开发了描述干预和因果假设的逻辑模型。对来自医院和社区药房的干预提供者进行了进一步的半结构化访谈，以及患者和公众代表。这些旨在调查干预实施过程和保真度。实施研究综合框架和干预保真度综合框架为访谈主题指南提供了信息，并使用归纳和演绎相结合的方法支持了主题框架分析。
主题提供了有关干预保真度和实施的信息，这些信息映射到实施的子流程中：规划、执行，反思和评价，和订婚。受访者描述了缺乏培训等因素，意识,服务规范的清晰度，治理和监测以及信息和反馈，这在干预实施和次优干预保真度的过程中引起了重大问题。
这为ToC干预的实施过程和保真度提供了深入的见解，以及现存的障碍和促进者。这些发现为类似干预措施的设计和实施提供了学习信息，为此类干预措施的障碍和促进者提供证据基础，并对有可能影响临床和经济结果评估的实施和影响机制进行深入描述。
