gms | German Medical Science

Background: Community pharmacies offer increasingly so-called professional pharmacy services including screening services, adherence programs, and medication management. Their success is frequently impaired by implementation factors. Most commonly, resource-related factors as lack of time, staff, and remuneration are reported [1]. However, occurrence and composition of specific factors vary from service to service which makes it difficult to solve potential problems beforehand. Thereby factors might relate to different service characteristics, one of them being service complexity. The objective of this study was to explore the relationship between implementation factors and service complexity.

Materials and methods: A systematic review of implementation factors, i.e. barriers and facilitators, of professional pharmacy services was conducted according to the PRISMA guideline. PubMed, CINAHL and PsycINFO were searched. The Consolidated Framework for Implementation Research was applied [2] and complexity characteristics of each service were assessed according to the following characteristics: (i) number of involved healthcare professions, (ii) number of service components such as recruiting of patients, screening intervention and follow-up, (iii) frequency of the service (single vs. repeated intervention), (iv) length of single patient encounter, and (v) workflow distortion (i.e. book appointment for intervention). Based on a binary scoring system for characteristics (i)–(v), studies were divided in low (1–2) and high (3–5) complexity interventions. Quality and quantity of reported implementation factors were compared between studies with generally low and high complexity.

Results: Out of 664 retrieved search results 15 studies were included. Major complexity parameters were involvement of general practitioners, duration of a single patient encounter within the service of >10 min and 3 or more components per intervention. Complex interventions were associated with 13.3±4.5 (mean±SD) implementation factors per intervention compared to 8.5±4.1 implementation factors in less complex interventions. Quantity of implementation factors differed between the domains as inner and outer setting were associated with 3.7±3.2 and 3.2±2.5 factors and study characteristics and process with 1.2±1.2 and 0.4±0.9 factors, respectively.

Conclusion: Results of this review show that with an increasing level of complexity of an intervention more implementation factors arise. While for some factors a clear association with a specific complexity parameter could be revealed, other factors are not clearly attributable and need further investigation.