Background

Though medication reviews have shown positive patient outcomes, they are still not widely implemented in community pharmacies. Published reviews on their implementation often include several other pharmacy services, making them non-specific. Using the Consolidated Framework for Implementation Research (CFIR) to focus solely on the experiences of different stakeholders with the implementation of medication reviews will help to better understand relevant facilitators and barriers.

Objectives

To critically appraise, synthesise and present the available evidence on experiences of key stakeholders with the implementation of medication reviews and to identify barriers and facilitators to its implementation in community pharmacies.

Methods

A systematic literature search was conducted in four databases for studies published in English, Spanish or German. Key search terms included: implementation, pharmac*, medication review, facilitator, barrier. Study selection, quality assessment and data extraction were performed by two independent reviewers. Findings were mapped directly against the constructs of the CFIR.

Results

Out of 924 retrieved records 24 articles from 9 countries met the inclusion criteria. Key facilitators identified included pharmacists' openness to practice change and a high degree of patient satisfaction post medication review. Attracting patients to the service was stated as challenging due to an unawareness of the scope and potential benefit of a medication review. The dominant barrier was inadequate remuneration, as it impacted all additional resourcing and ultimately the viability of the service. Further barriers included difficult professional relationships with doctors and little mandate from health authorities. Most reports were from the employed pharmacists’ perspective and concerned the inner setting, other perspectives were under-reported.

Conclusions

Results of this systematic review illustrate different stakeholders' experiences and add to the understanding of challenges in the implementation process. Nevertheless, findings also highlight how scarce reporting of external stakeholders’ views is and that filling this gap can unveil hidden barriers and facilitators.

Registration

PROSPERO register (CRD 42019122836)

中文翻译：

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主要利益相关者在社区药房实施药物审查的经验：使用实施研究综合框架 (CFIR) 的系统评价

背景

尽管药物审查显示出积极的患者结果，但它们仍未在社区药房广泛实施。已发表的关于其实施的评论通常包括其他几种药房服务，因此它们并不具体。使用实施研究综合框架 (CFIR) 仅关注不同利益相关者在实施药物审查方面的经验，将有助于更好地了解相关的促进因素和障碍。

目标

批判性地评估、综合和展示关键利益相关者在实施药物审查方面的经验的现有证据，并确定在社区药房实施的障碍和促进因素。

方法

在四个数据库中对以英语、西班牙语或德语发表的研究进行了系统的文献检索。关键搜索词包括：实施、药学*、药物审查、促进者、障碍。研究选择、质量评估和数据提取由两名独立评审员进行。调查结果直接与 CFIR 的结构相对应。

结果

在 924 条检索记录中，来自 9 个国家的 24 篇文章符合纳入标准。确定的关键促进因素包括药剂师对实践变革的开放态度以及药物审查后患者的高度满意度。由于不了解药物审查的范围和潜在益处，吸引患者参与这项服务具有挑战性。主要障碍是报酬不足，因为它影响了所有额外的资源，并最终影响了服务的可行性。进一步的障碍包括与医生的困难专业关系以及卫生当局的很少授权。大部分报道来自在职药剂师的视角，涉及内部环境，其他视角被低估。

结论

该系统审查的结果说明了不同利益相关者的经验，并增加了对实施过程中挑战的理解。然而，调查结果也强调了外部利益相关者观点的报告是多么稀少，填补这一空白可以揭示隐藏的障碍和促进因素。

登记

PROSPERO 寄存器 (CRD 42019122836)