Table 1
Semi-structured interview questions.
Questions to pharmacists (MRC-UK themes)
|
How are the results of the consultation recorded? (Description of Interventional Model)
|
| What barriers have you experienced that reduced your effectiveness in integrating with the practice? (Circumstances affecting implementation) What facilitators have you observed that have assisted your integration into the practice? (Circumstances affecting implementation). |
Questions to general practitioners
|
Table 2
Quantitative data fields used to inform the process evaluation.
| Variable* | Process Evaluation Theme(s) | Description |
|---|---|---|
| Number of current medicines (prescription and non- prescription) | Interventional Model | These variables were used to provide information on patient demographics to allow evaluation of the selection and recruitment process and to establish if the recruited patients reflected the project target population. |
| Number of current comorbidities | Interventional Model | |
| Age | Interventional Model | |
| Number of medication cessation recommendations | Interventional Model | These variables informed the researchers of the activities conducted during the patient consultation and provided insight into the impact of the intervention. |
| Number of addition of new medication recommendations | Interventional Model | |
| Number of recommendations for dose reduction | Interventional Model | |
| Number of suspected ADR identified | Interventional Model | |
| Number of suspected drug interactions detected | Interventional Model | |
| Number of recommendations for dose increase | Interventional Model | |
| Number of recommendations actioned by GP | Circumstances affecting implementation Situational Context | This variable provided insight into the effectiveness of the intervention and the level of collaboration between different practitioners. It was also used to demonstrate the differences in acceptance of the intervention at different sites to inform the situational context. |
| Number of recommendations by pharmacist | Circumstances affecting implementation Situational Context | This variable provided information on the ability of the pharmacist to implement the intervention. Differences in this variable were used to demonstrate the differences between pharmacist practitioners in conducting the intervention. |
| Practice ID | Situational Context | This variable allowed the researchers to consider the data from different practice sites to inform the situational context. |
| Pharmacist ID | Situational Context | This variable allowed the researchers to identify different pharmacist practitioners to inform the situational context. |
[i] * This table describes selected variables that were used to inform the process evaluation and is not a comprehensive list of the variables collected.
Table 3
Consultation data March–June 2016 (n = 299 consultations).
| Demographics | Average patient age (years) | 69.5 ± 12.1 |
| Average number of patient co-morbidities | 7.1 ± 2.4 | |
| Average number of medications per patient (prescription and non-prescription) | 9.6 ± 4.0 | |
| Pharmacist recommendations | Total number | 807 |
| Number recorded as accepted | 329* | |
| Medication dose reduction | 147 | |
| Medication Cessation | 173 | |
| Medication dose increase | 47 | |
| New medication added | 85 | |
| Suspected adverse drug reaction | 85 | |
| Potential drug interaction | 78 | |
| Other recommendations | 192 | |
| Other actions | Detection and resolution of discrepancies in patient record | 349 |
[i] * Pharmacist 2 did not record the number of recommendations accepted.
Figure 1
Intervention Model Design/Mechanisms of Impact.
Table 4
TICD implementation factors.
| TICD Domain | Barrier | Facilitator |
|---|---|---|
| Guideline factors | Lack of guidelines, training and resources. Uncertain project timelines. Data collection spreadsheet design. | |
| Individual health professional factors | Individual general practitioners resistant to service. Individual pharmacist characteristics- lack of confidence and/or competence. Pharmacist perceived as a threat to the general practitioner’s professional territory. | General practitioners willing to collaborate. Positive professional relationship between pharmacist and general practitioner. Warm handover. Pharmacist proactive and clinically competent. Good communication between pharmacist and general practitioner. |
| Patient Factors | Patient resistance to service. | Improvement in patient outcomes due to ongoing follow up and review. Improved communication due to real time synchronous discussion. Doctor recommendation and introduction of the pharmacist reduced patient resistance |
| Professional Interactions | Lack of an established relationship between pharmacist and general practitioner and/or practice staff. Lack of general practitioner co-operation. Uncertainty regarding the role of the practice pharmacist. Resistance from community pharmacy. Pharmacist unable to establish rapport with other team members. | Team support. |
| Incentives and resources | Costs relating to the intervention. Lack of pharmacist remuneration and government funding for the service. Limited availability of the clinical pharmacist. | Allocation of sufficient funding. Increased pharmacist contact hours. |
Table 5
Quantitative data informing the Situational context.
| Pharmacist | Number of recommendations made per patient consultation (mean ± standard deviation) | Recommendations accepted by general practitioner n (%) |
|---|---|---|
| 1 | 2.6 ± 2.0 | 97 (94) |
| 2 | 2.2 ± 1.8 | Not evaluable* |
| 3 | 3.6 ± 1.4 | 39 (91) |
| 4 | 4.3 ± 1.4 | 121 (72) |
| 5 | 3.7 ± 1.6 | 72 (92) |
[i] * Pharmacist 2 did not consistently record the number of recommendations accepted by the GP.