Factors influencing the implementation of clinical pharmacy services for hospitalized patients: A mixed-methods systematic review |
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| Affiliation: | 1. Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, SE, Brazil;2. Nursing Department, Federal University of Sergipe, Campus Prof. Antônio Garcia Filho, Lagarto, SE, Brazil;1. RCSI School of Pharmacy, 1st Floor Ardilaun House Block B, 111 St Stephen''s Green, Dublin 2, Ireland;2. RCSI Health Professions Education Centre, 123 St Stephen''s Green, Dublin 2, Ireland;3. Department of Pharmacy, 18 Science Drive 4, National University of Singapore, 117559, Singapore;1. Pharmacie Pitié-Salpêtrière, 47, boulevard de l’hôpital, 75013 Paris, France;2. Pharmacie St-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France;3. Pharmacie Bretonneau, 2, boulevard Tonnelle, 37044 Tours, France;4. Pharmacie Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny 94100 Créteil, France;5. Université Aix-Marseille II, UMR 911–CRO2 faculté de médecine, 27, boulevard Jean-Moulin 13385 Marseille, France;6. Pharmacie, CHU Caen, avenue de la Côte-de-Nacre, 14033 Caen, France;7. Pharmacie Cochin, 27, rue du Faubourg-St-Jacques, 75014 Paris, France;8. Pharmacie IGR, 114, rue Édouard-Vaillant, 94805 Villejuif, France;9. Faculté de pharmacie, université Paris Descartes, 4, rue de l’Observatoire, 75006, Paris, France;10. Pharmacie, CRLC Henri-Becquerel, rue d’Amiens, 76038 Rouen, France;11. Pharmacie, CRLC Val-d’Aurelle-Parc Euromédecine 208, rue des Apothicaires, 34298 Montpellier, France;12. Pharmacie, centre Léon-Bérard, 28, rue Laennec, 69373 Lyon, France;13. Pharmacie, CHU Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France;1. Geriatric Research, Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, Madison, WI, USA;2. University of Wisconsin–Madison, School of Pharmacy, Sonderegger Research Center, Madison, WI, USA;3. University of Wisconsin–Madison, Department of Medicine, Division of Geriatrics, Madison, WI, USA;4. University of Wisconsin–Madison, School of Nursing, USA;1. Kingston University, Kingston upon Thames, London, UK;2. Health Education England, London, UK;3. Iheed, Dublin, Ireland;4. NHS Lambeth Clinical Commissioning Group, UK;1. Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, SE, Brazil;2. Laboratory of Pharmaceutical Care (LECFAR), Department of Pharmacy, Federal University of Sergipe, Campus Prof. Antônio Garcia Filho, Lagarto, SE, Brazil |
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| Abstract: | BackgroundDespite the evidence of benefits, clinical pharmacy services (CPS) are not uniformly implemented across healthcare institutions. Understanding the influencing factors and identifying the domains in which they act is the first step to a successful implementation.ObjectiveTo identify the factors that affect the implementation of CPS for inpatients and to categorize them.MethodsCochrane Library, Embase, CINAHL, IPA, Medline/PubMed, and Lilacs databases were researched up until January 2018. The search strategy was developed using text words or MESH terms related to the following four domains: “clinical pharmacy,” “influencing factors,” “implementation,” and “hospital.” Two reviewers selected original research articles that reported the factors influencing the implementation of CPS in hospitals, extracted data, and assessed the quality of the studies. After framework synthesis and categorization of the factors, a diagrammatic approach was used to present the results.ResultsFifty-three factors were identified in the 21 studies that were included in this review. The most cited influencing factors were uniformly distributed across the following four domains: Attitudinal, POlitical, TEChnical and Administrative (APOTECA domains). However, in terms of level (pharmacist, healthcare team, patient, institution, and national organization), the “pharmacist” group had the highest concentration of factors. “Clinical skills and knowledge” was the most frequently cited implementation factor, followed by “time to implement CPS.”ConclusionOur findings showed the multifactorial nature of CPS implementation process. We suggest that factors from all four APOTECA domains need to be fully considered and strategies need to be addressed for all five groups of interest to successfully implement CPS in hospitals. Future studies on the influence of implementation stages, interrelationships of implementing factors, and strategies to overcome barriers could accelerate the successful adoption of these services.RegistrationPROSPERO register CRD42016050140. |
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| Keywords: | Clinical pharmacy Pharmacists Implementation research Barriers Facilitators Hospital |
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