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Pharmacist and data-driven quality improvement in primary care (P-DQIP): a qualitative study of anticipated implementation factors informed by the theoretical domains framework.

Tang, Jason; Toma, Madalina; Gray, Nicola M.; Delvaux, Joke; Guthrie, Bruce; Grant, Aileen; Duncan, Eilidh; Dreischulte, Tobias

Authors

Jason Tang

Madalina Toma

Nicola M. Gray

Joke Delvaux

Bruce Guthrie

Aileen Grant

Eilidh Duncan

Tobias Dreischulte



Abstract

Objectives: The quality and safety of drug therapy in primary care are global concerns. The Pharmacist and Data driven Quality Improvement in Primary care (P-DQIP) intervention aims to improve prescribing safety via an informatics tool which facilitates proactive management of drug therapy risks (DTRs) by health-board employed pharmacists with established roles in general practices. Study objectives were (1) to identify and prioritise factors that could influence P-DQIP implementation from the perspective of practice pharmacists, and (2) to identify potentially effective, acceptable and feasible strategies to support P-DQIP implementation. Design: Semi-structured face-to-face interviews using a Theoretical Domains Framework (TDF) informed topic guide. The framework method was used for data analysis. Identified implementation factors were prioritised for intervention based on research team consensus. Candidate intervention functions, behaviour change techniques (BCTs) and policies targeting these were identified from the Behaviour Change Wheel. The final intervention content and modes of delivery were agreed with local senior pharmacists. Setting: General practices from three Health and Social Care Partnerships (HSCPs) in NHS Tayside. Participants: 14 NHS employed practice pharmacists. Results: Identified implementation factors were linked to thirteen theoretical domains (all except intentions) and six (skill, memory/attention/decision-making, behavioural regulation, reinforcement, environmental context/resources, social influences) were prioritised. Three intervention functions (training, enablement, and environmental restructuring) were relevant and were served by two policy categories (guidelines, communication/marketing) and eight BCTs (Instructions on how to perform a behaviour, problem solving, action planning, prompt/cues, goal setting, self-monitoring, feedback, restructuring the social environment). Intervention components encompass an informatics tool, written educational material, a workshop for pharmacists, promotional activities, and small financial incentives. Conclusions: This study explored pharmacists’ perceptions of implementation factors which could influence management of DTRs in general practices to inform implementation of P-DQIP, which will initially be implemented in one Scottish health board with parallel evaluation of effectiveness and implementation.

Journal Article Type Article
Journal BMJ Open
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Institution Citation TANG, J., TOMA, M., GRAY, N.M., DELVAUX, J., GUTHRIE, B., GRANT, A., DUNCAN, E. and DREISCHULTE, T. [2020]. Pharmacist and data-driven quality improvement in primary care (P-DQIP): a qualitative study of anticipated implementation factors informed by the theoretical domains framework. BMJ open [online], (accepted).
Keywords Quality improvement; Behaviour change wheel; Theoretical domains framework; Behaviour change techniques; Polypharmacy review; Prescribing safety

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