Background

Sub-optimal medication use results in significant avoidable morbidity, mortality, and costs. Programs, such as comprehensive medication management (CMM), can help to optimize medication use, improve outcomes, and reduce costs. However, implementing programs like CMM can be challenging and differences in how CMM has been implemented may be responsible for observed heterogeneity in the outcomes associated with CMM.

Objective(s)

Describe the implementation strategies utilized in implementing CMM telephonically within a team-based at-home care program and evaluate the implementation process.

Methods

The implementation of CMM was facilitated using various implementation strategies including: develop educational material and conduct training, change record system, audit and feedback, learning collaborative, quality monitoring, readiness assessment, and implementation team formation. The impact of these strategies as well as pharmacist and team member perspectives on the implementation of CMM were examined using mixed methods and guided by Proctor's conceptual model for implementation.

Results

The pharmacists felt that most of the implementation strategies used to facilitate consistent delivery of CMM were useful, but were unable to successfully implement all of them. Despite this, significant increases in fidelity to steps of the patient care process was achieved. The pharmacists felt that CMM was acceptable, appropriate for patient population, and feasible, but barriers (e.g., the telephonic and remote nature of the practice, the evolving nature of the program, and the difficulty in coordinating care between the patients primary care team and the care team affiliated with the program) affected the feasibility and organizational fit of CMM within this team-based, at-home care program. General pharmacy services, however, were seen as acceptable, appropriate, and feasible.

Conclusion

Deliberately designing and utilizing a variety of implementation strategies can facilitate the implementation of CMM and significantly increase fidelity to the patient care process. To improve feasibility and organizational fit of CMM, additional barriers and challenges need to be addressed.

中文翻译：

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在基于团队的家庭护理计划中对药房服务实施的混合方法评估

背景

次优的药物使用导致显着的可避免的发病率、死亡率和成本。综合药物管理 (CMM) 等计划有助于优化药物使用、改善结果并降低成本。然而，实施像 CMM 这样的计划可能具有挑战性，并且 CMM 实施方式的差异可能是导致观察到的与 CMM 相关的结果的异质性的原因。

目标

描述在基于团队的家庭护理计划中通过电话实施 CMM 所使用的实施策略并评估实施过程。

方法

使用各种实施策略促进了 CMM 的实施，包括：开发教育材料和进行培训、变更记录系统、审计和反馈、学习协作、质量监控、准备情况评估和实施团队组建。这些策略以及药剂师和团队成员的观点对 CMM 实施的影响使用混合方法进行了检查，并以 Proctor 的实施概念模型为指导。

结果

药剂师认为，大多数用于促进 CMM 持续给药的实施策略是有用的，但无法成功实施所有策略。尽管如此，还是实现了对患者护理过程步骤的忠实度的显着提高。药剂师认为 CMM 是可以接受的，适用于患者群体，并且可行，但存在障碍（例如，实践的电话和远程性质、计划的发展性质以及患者初级保健团队和隶属于该计划的护理团队）影响了 CMM 在这个以团队为基础的家庭护理计划中的可行性和组织适应性。然而，一般药房服务被认为是可以接受的、适当的和可行的。

结论

有意识地设计和利用各种实施策略可以促进 CMM 的实施，并显着提高对患者护理过程的保真度。为了提高 CMM 的可行性和组织适应性，需要解决额外的障碍和挑战。