Implementation of Professional Services Flashcards
What are large scale trials of complex services focussed on disease state management?
- diabetes –> meds check and pharmacy trial program +ve
- asthma –> asthma management service, asthma care program, trial program asthma and rhinitis control
What are some smaller scale individual pharmacy services or pharmacy-based health program?
What makes an innovative pharmacy?
What makes an innovative pharmacy owner or manager?
What are the FOUR stages of implementation?
- Exploration stage (appraising)
- Preparation stage
- Testing stage
- Operation stage
What is the exploration stage? What does early planning stages ensure?
who, what, why, where, when, how –> conceptual design of the service
ensures
- developed collaboratively
- address health problem or need
- grounded in theory and evidence
- tested in the pharmacy setting
- considers the circumstances that can reinforce, hinder or interact with that service
For exploration stage:
A) What is done in research (1a)?
B) What is done in theoretical framework (1b)?
C) What is done in vision (1c)?
D) What is done in business goals (1d)?
E) What is done in people and money (1e)?
F) What is done in evaluation measures (1f)?
A)
- Gaps between current systems and needs
- ideas an innovations from conferences or trade shows and other specialists
- context and complex systems in which service will be implemented –> individual (beliefs, attitudes, self-efficacy), interpersonal (pharmacy staff, clients/patients), local setting/community (demographics, needs, culture to accomodate a new service)
- what needs to change and why (SWOT analysis)
> strengths
> weaknesses
> opportunities
> threats
B)
- COM-B model –> capability, motivation, oppurtunity –> behaviour = for smoking cessation/weight management
- Stanges of change model (see attached image)
- Fogg behvaiour model (things hard to do will have a high motivation for)
C)
- broad aim
> improve the helath of women approaching or experiencing menopause –> an outcome-centred apporach
> stake holder consultation
- scope of the proposed service
> how extensive?
> how integrated?
D)
- During the first month of our service, each pharmacist will inform 10 female patients per week of our service –> behavioural goal
- 80% of our participants with high cholesterol at commencement of our service will have normal cholesterol within six months –> health goal
E)
- Personnel requirements for the service
- Workflow redesign to free up key staff
- Remuneration for the service
- Investment required
F)
- Formative evaluation –> early with staff and client feedback
- Process evaluation –> resources, staffing, space, promotion, number of clients = quality control
- Impact evaluation = clinical outcomes such as:
> weight loss, BP (clinical measures)
> GP referrals, change in meds usage (surrogate measures)
- Economic outcomes (investment vs return)
- Humanistic outcomes (satisfaction, qaulity of life)
What is involved in the preparation stage?
Explain what uptake or trial/pilot and program evaluation means in the testing stage
What is involed in the operation stage?
- Sustained implementation i.e. intergration and continuation of service delivery
- Maintenance of service setting
- Aiming for persistence of service outcomes
- Ongoing evaluation (review./audit)
Wrap up the four stages…..
What can get in the way of implementing professional services in pharmacy?
- Many challenges and barriers to uptake, implementation and sustainability
- Changing human behaviour:
> pharmacist habitually answering the phone
> some people are naturally late adopters
- Insufficient investment in staffing, equipment, space, training
- Insufficient staff engagement: need a change champion
- Maintaining fidelity and consistency
- Documentation requirements for research and reporting (need time and efficiencies)
- Lack of commitment by pateints
- Attitudes of some GPs
- Lack of formalised communication strategies
What are some strategies to address barriers presented in previous card?
- Understanding of the market being addressed –> diabetes patients
- Skills (training, education)
- Incentives
- Human resources processes (required for growth, particularly amongst independent pharmacies)
- Physical resources (infrastructure) e.g. rallocation of floor space for private and semi-private consultation areas
- Independent pharmacies –> networking to increase buying power and free up capital for investment in staffing
- documentation –> evidence for research and for payment
- technology for patient management and marketing
- established relationships with health professionals and community groups relating to the professional service –> dietitians for weight management service
- motivation factors –> first patients recruited, first interventions, positive feedback
- collaborative, supportive environment
- coordination between complementary services provided by the pharmacy –> blood pressure + blood glucose + weight management
How is priorities for research determined through
Consultation, literature, expressions of interest and working parties
What generates and evaluates new models of practice?
research
summary
