The role of network ties to support implementation of a community pharmacy enhanced services network

BackgroundLimited evidence exists on how to integrate community pharmacists into team-based care models, as the inclusion of community pharmacy services into alternative payment models is relatively new. To be successful in team-based care models, community pharmacies need to successfully build relationship with diverse stakeholders including providers, care managers, and patients.ObjectivesThe aims of this study are to: (1) identify the role of network ties to support implementation of a community pharmacy enhanced services network, (2) describe how these network ties are formed and maintained, and (3) compare the role of network ties among high- and low-performing community pharmacies participating in an enhanced services network.MethodsUsing a semi-structured interview guide, we interviewed 40 community pharmacy representatives responsible for implementation of a community pharmacy enhanced services program. We analyzed for themes using social network theory to compare network ties among 24 high- and 16 low-performing community pharmacies.ResultsThe study found that high-performing pharmacies had a greater diversity of network ties (e.g., relationships with healthcare providers, care managers, and public health agencies). High-performing pharmacies were able to use those ties to support implementation of NC-CPESN. High- and low-performing pharmacies used similar strategies for establishing ties with patients, such as motivational interviewing and assigning staff members to be responsible for engaging high-risk patients. High-performing pharmacies used additional strategies such as assessing patient preferences to support patient engagement, increasing patient receptivity towards enhanced services.ConclusionsCommunity pharmacies may vary in their ability to develop relationships with other healthcare providers, care management and public agencies, and patients. As enhanced services interventions that require care coordination are scaled up and spread, additional research is needed to test implementation strategies that support community pharmacies with developing and maintaining relationships across a diverse group of stakeholders (e.g., healthcare providers, care managers, public health agencies, patients).     

The complexity of implementation factors in professional pharmacy services

Implementation of professional pharmacy services is a complex process, in which multi-level factors interact and influence implementation process and outcomes at various levels or domains. In this paper the terms that have been used to describe the factors that influence implementation of evidence-based services and their domains are presented. The complex ‘cause-and-effect’ interactions by which implementation factors appear to interact throughout the implementation process are also discussed. Identifying and understanding these complex and causal relationships between different implementation factors, represents a key process in the implementation of any service, in order to assist in the development of tailored implementation strategies. Future research should be directed to gain an understanding of the nature of individual implementation factors, their cause-and-effect interactions, and their relationships. Implementation strategies are less likely to succeed unless these are identified and targeted to the causes identified when designing and planning an implementation strategy.     

Addicted to discovery: Does the quest for new knowledge hinder practice improvement?

Despite the billions of dollars spent on health-focused research and the hundreds of billions spent on delivering health services each year, relatively little money and effort are directed toward investigating how best to connect the two. This results in missed opportunities to assure that research findings inform and improve quality across healthcare in general and for addiction prevention and treatment in particular. There is an asymmetrical focus that favors the identification of new interventions and neglects the implementation of science-based knowledge in actual practice. The consequences of that neglect are severe: significantly diminished progress in research on how to implement treatments that could improve the lives of persons with addiction problems, their families, and the rest of society. While the advancement of knowledge regarding effective implementation is lagging, it is clear that existing systemic incentives in the conduct of science inhibit rather than facilitate widespread adoption of evidence-based practices. This commentary proposes three interrelated strategies for improving the implementation process. First, develop scientific tools to understand implementation better, by expanding investigations on the science of implementation and broadening approaches to the design and execution of research. Second, nurture and support a collaborative implementation workforce comprised of scientists and on-the-ground practitioners, with an explicit focus on enhancing appropriate incentives for both. Third, pay closer attention to crafting research that seeks answers that are most relevant to clinicians' actual needs, primarily by ensuring that the anticipated users of the evidence-based practice are full partners in developing the questions right from the start.     

Measuring implementation of medication optimization services: Development and validation of an implementation outcomes questionnaire

BackgroundImplementation outcomes serve as progress and success indicators of the implementation process. They are also key antecedents to achieving the more traditional clinical outcomes typically associated with a service. Despite their importance, there are few implementation outcomes measures with appropriate psychometric properties, none of which have yet been adapted for medication optimization services.ObjectivesThis study aims to develop and validate the Implementation Outcomes Questionnaire (IOQ) to assess implementation of medication optimization services, starting with Comprehensive Medication Management (CMM). The resulting IOQ is a 40-item self-report instrument for six implementation outcomes, including adoption, acceptability, feasibility, appropriateness, penetration, and sustainability.MethodsA three-phase approach was used to develop and validate the IOQ. Development of the instrument, Phase I, was informed by a targeted search of existing implementation outcomes measures in other fields, a review of suitableoptions options by an expert panel, and item adaptation. To assess content validity, Phase II, an internal vetting process was conducted using an adapted version of Rubio and colleagues’ methodology. Evidence of reliability and construct validity, Phase III, was obtained through a pilot test with 167 pharmacists within 78 different care settings.ResultsOverall, the results supported the reliability and validity (both content and construct) of the IOQ, with further psychometric testing needed for adoption. The items' relevance, clarity, and alignment with each implementation concept were high, except for Penetration. As a result, the Penetration items were refined for further use. Best-fit models were identified for each outcome based on the MCFA analyses, thereby providing insights into the factor structures and interpretation for each measure. Cronbach’ alphas indicated good internal consistency.ConclusionsThis questionnaire is the first of its kind tailored to medication optimization services, starting with CMM. Access to this survey should facilitate measurement of implementation outcomes, thereby increasing the likelihood of achieving the desired clinical outcomes.     

《处方管理办法》施行中亟待解决的几个具体问题

目的:为解决《处方管理办法》(以下简称《办法》)在施行中存在的具体问题提供建设性建议。方法:依据国家有关法律、法规,以及处方管理工作的现状和基本国情,研究问题、分析原因、探讨对策。结果与结论:《办法》在个别地方尚存在逻辑不严密,欠规范、合理、严谨,缺乏可操作性等问题。建议针对《办法》施行后出现的新情况,适时制定与其具有同等效力的规章解释或适当进行规章修订,尽快使其个别相应内容的逻辑严密,用语准确,条文内容规范、合理、严谨、具体,具有可操作性。     

Impact of research network participation on the adoption of buprenorphine for substance abuse treatment

There is a growing body of research supporting the use of buprenorphine and other medication assisted treatments (MATs) for the rapidly accelerating opioid epidemic in the United States. Despite numerous advantages of buprenorphine (accessible in primary care, no daily dosing required, minimal stigma), implementation has been slow. As the field progresses, there is a need to understand the impact of participation in practitioner–scientist research networks on acceptance and uptake of buprenorphine. This paper examines the impact of research network participation on counselor attitudes toward buprenorphine addressing both counselor-level characteristics and program-level variables using hierarchical linear modeling (HLM) to account for nesting of counselors within treatment programs. Using data from the National Treatment Center Study, this project compares privately funded treatment programs (N = 345) versus programs affiliated with the National Institute on Drug Abuse Clinical Trials Network (CTN) (N = 198). Models included 922 counselors in 172 CTN programs and 1203 counselors in 251 private programs. Results of two-level HLM logistic (Bernoulli) models revealed that counselors with higher levels of education, larger caseloads, more buprenorphine-specific training, and less preference for 12-step treatment models were more likely to perceive buprenorphine as acceptable and effective. Furthermore, buprenorphine was 50% more likely to be perceived as effective among counselors working in CTN-affiliated programs as compared to private programs. This study suggests that research network affiliation positively impacts counselors' acceptance and perceptions of buprenorphine. Thus, research network participation can be utilized as a means to promote positive attitudes toward the implementation of innovations including medication assisted treatment.     

药物临床试验实施阶段存在问题的问卷调查

目的：了解和探讨我国药物临床试验实施阶段存在的主要问题及对策。方法：采取目的抽样方法，以药物临床试验基地为研究现场，以参与过药物临床试验的医务人员为研究对象，采用自填式问卷调查获取相关问题的答案，应用Epidata 3．0录入数据，用SAS8.0软件进行统计分析。结果：148名研究对象中142名参加过药物临床试验的实施，实施中存在的主要问题是向研究对象收取试验用药费用、存在服药的依从性问题、有病例失访或中途退出时增补新病例、试验结果数据较少重复测定、GCP培训力度不够、实施前相关培训效果较低等。结论：培养科学的研究态度、加强培训力度、严格遵守GCP规范、加强质量监督与管理是提高我国药物临床试验实施质量的重要手段与途径。     

Disseminating contingency management: Impacts of staff training and implementation at an opiate treatment program

Guided by a comprehensive implementation model, this study examined training/implementation processes for a tailored contingency management (CM) intervention instituted at a Clinical Trials Network-affiliate opioid treatment program (OTP). Staff-level training outcomes (intervention delivery skill, knowledge, and adoption readiness) were assessed before and after a 16-hour training, and again following a 90-day trial implementation period. Management-level implementation outcomes (intervention cost, feasibility, and sustainability) were assessed at study conclusion in a qualitative interview with OTP management. Intervention effectiveness was also assessed via independent chart review of trial CM implementation vs. a historical control period. Results included: 1) robust, durable increases in delivery skill, knowledge, and adoption readiness among trained staff; 2) positive managerial perspectives of intervention cost, feasibility, and sustainability; and 3) significant clinical impacts on targeted patient indices. Collective results offer support for the study's collaborative intervention design and the applied, skills-based focus of staff training processes. Implications for CM dissemination are discussed.     

优化护理服务流程中全面实施健康体检管理相关思考

目的针对健康体检管理实施服务流程优化分析,旨在完善护理模式,提升健康体检效率。方法进行健康体检活动的研究对象共120例,将其随机分为对照组及观察组,每组60例,对照组采用传统服务模式,观察组采用护理流程优化模式,对比两组体检对象对护理效果的满意程度。结果观察组对护理满意程度（100.00%）明显优于对照组（73.33%）,体检时间更短且评价更优。结论在健康体检中实施优化护理流程服务能够有效提升体检效率,适合在各院体检活动中推广使用。     

浅谈药品标准执行中存在的问题及建议

通过阐述药品检验工作中执行标准的现状,分析其存在的问题,并提出一些建议及对策.希望尽快规范、统一药品标准,提高和完善我国的药品标准管理水平.     

药品批发企业“两票制”执行情况分析

分析“两票制”对药品流通行业的影响及药品批发企业执行“两票制”过程中的问题与困难，为企业顺利应对政策要求、长期健康发展提供参考。调研江苏省药品批发企业“两票制”执行情况，针对企业遇到的困难和问题，分析对应的解决办法。“两票制”对于药品批发企业既是挑战也是机遇，企业要进一步发展壮大，必须积极应对政策调整所带来的问题和困难，提高自身管理水平，调整经营思路。要使“两票制”政策落实到位，充分发挥效力，促进行业长期健康发展，并从立法、市场、监管等多个层面共同发力。     

药学保健在传染病防治中的实施策略探讨

药学保健是医院药学发展的更高层次，国内外相关研究和实践也取得了一定成效。在院内传染病防治中开展药学保健，结合传染病防治特点，分析药学保健的服务方式，探讨药学保健的可行性实施策略，规范药物的合理使用，减少不良反应，提高疗效，对提升传染病综合防治能力有积极意义。药学保健可为及时控制和消除传染病提供有力的保障，同时符合新医改和医院“三好一满意”服务的需要。     

Using network analysis to explore factors moderating the implementation of a medication review service in community pharmacy

BackgroundImplementation factors are hypothesised to moderate the implementation of innovations. Although individual barriers and facilitators have been identified for the implementation of different evidence-based services in pharmacy, relationships between implementation factors are usually not considered.ObjectivesTo examine how a network of implementation factors and the position of each factor within this network structure influences the implementation of a medication review service in community pharmacy.MethodsA mixed methods approach was used. Medication review with follow-up service was the innovation to be implemented over 12 months in community pharmacies. A network analysis to model relationships between implementation factors was undertaken. Two networks were created.ResultsImplementation factors hindering the service implementation with the highest centrality measures were time, motivation, recruitment, individual identification with the organization and personal characteristics of the pharmacists. Three hundred and sixty-nine different interrelationships between implementation factors were identified. Important causal relationships between implementation factors included: workflow-time; characteristics of the pharmacy-time; personal characteristics of the pharmacists-motivation.Implementation factors facilitating the implementation of the service with highest centrality scores were motivation, individual identification with the organization, beliefs, adaptability, recruitment, external support and leadership. Four hundred and fifty-six different interrelationships were identified. The important causal relationships included: motivation-external support; structure-characteristics of the pharmacy; demographics-location of the pharmacy.ConclusionNetwork analysis has proven to be a useful technique to explore networks of factors moderating the implementation of a pharmacy service. Relationships were complex with most implementation factors being interrelated. Motivation and individual identification with the organisation seemed critical factors in both hindering and facilitating the service implementation. The results can inform the design of implementation programs and tailored strategies to promote faster implementation of innovations in pharmacy.     

新版GMP对制药企业的影响和对策分析

通过调查制药企业的GMP实施情况，研究相关文献，总结GMP实施过程中存在问题，探索符合中国制药企业自身发展需要的GMP模式，并提出相应的改进措施，促进制药企业发展。     

重庆市药品经营企业新版GSP实施情况调查

目的:了解重庆市药品经营企业对新版《药品经营质量管理规范》(简称"新版GSP")的实施情况,为推进新版GSP的实施提供参考。方法:采取随机分层抽样的方法,对重庆市114家药品批发企业和270家零售药店的工作人员就被访者的基本信息,新版GSP的实施进展、实施难度、应对措施以及药品经营企业人员对新版GSP的实施意见与建议等进行问卷调查。结果与结论:有85.0%的药品批发企业和85.2%的零售药店仍处于GSP改造初期。其实施难度在药品批发企业中主要体现在冷链全程控制、库房面积、设备验证等10个方面,在零售药店中主要体现在执业药师配备、人工成本等6个方面。为了尽快推进新版GSP的贯彻实施,建议尽快调整和完善相关政策,如将医院纳入到GSP管理中来、按照企业大小及配送区域大小来规定仓库面积、引导验证机构和第三方物流的发展;另外,药品经营企业自身也要积极寻求应对措施,如调整经营范围、转变经营方式、与其他公司进行整体合并或业务合并等,以降低自身风险。     

The identification of barriers preventing the successful implementation of a surgical prophylaxis protocol

Aim: The aim of this study was to introduce a protocol for the use of antimicrobials in surgical prophylaxis for the described procedures in Antrim Area Hospital. Method: Historical data of antimicrobial use were obtained from retrospective analysis of patients" charts, for those patients identified as having one of the following clean / contaminated surgical procedures over the previous six months; cholecystectomy or abdominal hysterectomy. These data were analysed, and a protocol was introduced providing guidelines for the choice of antimicrobial agent, its administration time, route, dose, duration and frequency of treatment. Main outcome measure: The main outcome measure was the success of the uptake of the protocol following its implementation. Results: There was a total of 285 patients identified, 105 prior to and 180 post implementation. Overall, 68% of patients received some form of prophylaxis in the first cycle, and 72% in the second. Conclusion: Although the introduction of the protocol led to slight improvements in compliance with standard prescribing procedures, with an increase in singledose prophylaxis, and a reduction in prolonged prophylactic treatment, the improvements did not reach expectations. This paper attempts to identify the possible barriers to protocol implementation.     

影响我国制药企业成功实施ERP的因素分析及策略

目的:为我国制药企业成功实施企业资源计划(ERP)提供参考。方法:取我国在2006年前实施及未实施ERP的上市制药企业各35家,结合有关财务数据和案例,分析我国制药企业实施ERP的效果及其影响因素,进而提出实施策略。结果与结论:我国制药企业在实施ERP后营运能力有显著提高,但成长能力、盈利能力和偿债能力没有显著变化。当前主要存在软件选型不当、目标需求定位不清、企业管理人员支持力度低、业务流程重组不善等影响因素。我国制药企业要成功实施ERP必须首先克服这些不利影响因素。     

我院门诊药房绩效考核的具体方案与实施

目的:为提高门诊药房调剂人员的工作积极性和工作质量提供参考。方法:制定科学的绩效考核方案,根据调剂人员的工作量及工作能力、岗位责任、工作态度、同事评价、考试、奖惩情况几方面标准综合评分,按所得分值排名后计算奖金金额:工作量及工作能力占50分,岗位责任占15分,工作态度占15分,同事评价占5分,考试占15分,奖惩情况未计入100分里面,于所得总分后加减。结果:实施该绩效考核方案后每月对每个调剂人员的工作量与工作质量等有了量化考核,激励了调剂人员的工作积极性,降低了出错率,提升了工作质量,改善了服务态度,强化了劳动纪律。结论:该绩效考核方案一定程度上提高了门诊药房的管理水平。     

对实施药品风险管理的思考

目的:探讨以药品生产企业为实施主体的风险管理具体策略。方法:从药品风险管理理论的内涵、制度概念剖析入手,结合药品风险评价的核心原则,重点采用系统分析方法进行论述性阐述。结果与结论:药品风险管理看似缘起于风险,但对具体品种进行评价时,脱离不开其疗效和效益。它是一个系统工程,涉及药品监管的各个方面。它作为一种制度形式,虽然已有国外趋于成型的经验,但在我国尚需进一步完善。