PDF(Pubmed)
Abstract：
BACKGROUND: Since 2022, patients with five or more medicines are eligible for a medication review (MR) in a community pharmacy remunerated by the German health system. However, implementation has been slow, with few pharmacies providing MRs. Stakeholders\' input is necessary to detail how implementation strategies can be executed effectively on a national level. Prior research identified \"external facilitation\" and \"altering incentives\" as crucial strategies to achieve implementation outcomes.
OBJECTIVE: To gather stakeholders\' recommendations for, and obtain consensus on, mechanisms of change that allow implementation strategies to work in practice.
METHODS: The consensus method used was the nominal group technique (NGT) with NGT-discussions held separately with pharmacy owners and pharmacy chambers employees. Votes were summed and the relative importance (rI) calculated, defined as (score achieved for a mechanism)/(maximum possible score) × 100. Content analysis provided context for the highest ranked mechanisms and allowed linking to implementation outcomes.
RESULTS: Four NGT-discussions were held in 2023 (n = 2 owners; n = 2 chamber employees) with a total of 17 participants. The overall highest ranked mechanisms were fit-for-purpose software (rI = 154.7) detailed process support (rI = 104.9) and an expert support line (rI = 77.7). These together with financial viability (rI = 40.0) were prioritised by both participant groups. Three mechanisms were favoured for both implementation strategies, namely software, process support and materials (rI = 34.3).
CONCLUSIONS: This study identified stakeholders\' priorities for mechanisms of change to implement MRs in community pharmacies. Focusing efforts on the prioritised mechanisms is likely to significantly advance a national implementation plan for countries which are at an early implementation stage.
OBJECTIVE: To gather stakeholders\' recommendations for, and obtain consensus on, mechanisms of change that allow implementation strategies to work in practice.
METHODS: The consensus method used was the nominal group technique (NGT) with NGT-discussions held separately with pharmacy owners and pharmacy chambers employees. Votes were summed and the relative importance (rI) calculated, defined as (score achieved for a mechanism)/(maximum possible score) × 100. Content analysis provided context for the highest ranked mechanisms and allowed linking to implementation outcomes.
RESULTS: Four NGT-discussions were held in 2023 (n = 2 owners; n = 2 chamber employees) with a total of 17 participants. The overall highest ranked mechanisms were fit-for-purpose software (rI = 154.7) detailed process support (rI = 104.9) and an expert support line (rI = 77.7). These together with financial viability (rI = 40.0) were prioritised by both participant groups. Three mechanisms were favoured for both implementation strategies, namely software, process support and materials (rI = 34.3).
CONCLUSIONS: This study identified stakeholders\' priorities for mechanisms of change to implement MRs in community pharmacies. Focusing efforts on the prioritised mechanisms is likely to significantly advance a national implementation plan for countries which are at an early implementation stage.
摘要：
背景：自2022年以来，使用五种或更多药物的患者有资格在由德国卫生系统付费的社区药房进行药物审查（MR）。然而,实施缓慢，很少有药店提供MR。利益相关者的投入对于详细说明如何在国家一级有效执行实施战略是必要的。先前的研究将“外部促进”和“改变激励措施”确定为实现实施成果的关键策略。
目标：收集利益相关者的建议，达成共识,允许实施策略在实践中发挥作用的变革机制。
方法：使用的共识方法是名义小组技术（NGT），与药房所有者和药房员工分别进行NGT讨论。对选票进行求和，并计算相对重要性(rI)，定义为（机制获得的分数）/（最大可能分数）×100。内容分析为排名最高的机制提供了背景，并允许与实施成果联系起来。
结果：2023年举行了四次NGT讨论（n=2个所有者；n=2个商会雇员），共有17名参与者。总体排名最高的机制是适合用途的软件（rI=154.7）详细过程支持（rI=104.9）和专家支持线（rI=77.7）。这些与财务可行性(rI=40.0)一起被两个参与者组优先考虑。两种执行战略都倾向于三种机制，即软件,工艺支持和材料(RI=34.3)。
结论：本研究确定了利益相关者在社区药房实施MRs的改变机制的优先事项。将努力集中在优先机制上可能会大大推进处于早期实施阶段的国家的国家实施计划。
目标：收集利益相关者的建议，达成共识,允许实施策略在实践中发挥作用的变革机制。
方法：使用的共识方法是名义小组技术（NGT），与药房所有者和药房员工分别进行NGT讨论。对选票进行求和，并计算相对重要性(rI)，定义为（机制获得的分数）/（最大可能分数）×100。内容分析为排名最高的机制提供了背景，并允许与实施成果联系起来。
结果：2023年举行了四次NGT讨论（n=2个所有者；n=2个商会雇员），共有17名参与者。总体排名最高的机制是适合用途的软件（rI=154.7）详细过程支持（rI=104.9）和专家支持线（rI=77.7）。这些与财务可行性(rI=40.0)一起被两个参与者组优先考虑。两种执行战略都倾向于三种机制，即软件,工艺支持和材料(RI=34.3)。
结论：本研究确定了利益相关者在社区药房实施MRs的改变机制的优先事项。将努力集中在优先机制上可能会大大推进处于早期实施阶段的国家的国家实施计划。
