37 research outputs found
Qualitative study on the implementation of professional pharmacy services in Australian community pharmacies using framework analysis
Abbreviations: BCT, Behavioural change techniques taxonomy; BCW, Behavioural change wheel; CFIR, Consolidated
framework for implementation research; EPOC, Cochrane effective practice and organisation of care; FISpH, Framework
for the implementation of services in pharmacy; GIF, Generic implementation framework; KPI, Key performance
indicator; TDF, Theoretical domains frameworkBackground: Multiple studies have explored the implementation process and influences, however it appears there
is no study investigating these influences across the stages of implementation. Community pharmacy is attempting
to implement professional services (pharmaceutical care and other health services). The use of implementation
theory may assist the achievement of widespread provision, support and integration. The objective was to investigate
professional service implementation in community pharmacy to contextualise and advance the concepts of a generic
implementation framework previously published.
Methods: Purposeful sampling was used to investigate implementation across a range of levels of implementation in
community pharmacies in Australia. Twenty-five semi-structured interviews were conducted and analysed using a
framework methodology. Data was charted using implementation stages as overarching themes and each stage
was thematically analysed, to investigate the implementation process, the influences and their relationships. Secondary
analyses were performed of the factors (barriers and facilitators) using an adapted version of the Consolidated
Framework for Implementation Research (CFIR), and implementation strategies and interventions, using the
Expert Recommendations for Implementing Change (ERIC) discrete implementation strategy compilation.
Results: Six stages emerged, labelled as development or discovery, exploration, preparation, testing, operation
and sustainability. Within the stages, a range of implementation activities/steps and five overarching influences
(pharmacys' direction and impetus, internal communication, staffing, community fit and support) were identified.
The stages and activities were not applied strictly in a linear fashion. There was a trend towards the greater the
number of activities considered, the greater the apparent integration into the pharmacy organization. Implementation
factors varied over the implementation stages, and additional factors were added to the CFIR list and definitions
modified/contextualised for pharmacy. Implementation strategies employed by pharmacies varied widely.
Evaluations were lacking. Conclusions: The process of implementation and five overarching influences of professional services implementation
in community pharmacy have been outlined. Framework analysis revealed, outside of the five overarching influences,
factors influencing implementation varied across the implementation stages. It is proposed at each stage, for
each domain, the factors, strategies and evaluations should be considered. The Framework for the Implementation of
Services in Pharmacy incorporates the contextualisation of implementation science for pharmacy.The study was funded as part of a University of Technology Sydney (UTS)
Research Excellence Scholarship (RES), comprising of an Australian Postgraduate
Award (APA) Scholarship funded by the Australian Government, plus a Top-up
funded by the University of Technology Sydney, received from the primary
author (JCM)
Altered disc pressure profile after an osteoporotic vertebral fracture is a risk factor for adjacent vertebral body fracture
This study investigated the effect of endplate deformity after an osteoporotic vertebral fracture in increasing the risk for adjacent vertebral fractures. Eight human lower thoracic or thoracolumbar specimens, each consisting of five vertebrae were used. To selectively fracture one of the endplates of the middle VB of each specimen a void was created under the target endplate and the specimen was flexed and compressed until failure. The fractured vertebra was subjected to spinal extension under 150 N preload that restored the anterior wall height and vertebral kyphosis, while the fractured endplate remained significantly depressed. The VB was filled with cement to stabilize the fracture, after complete evacuation of its trabecular content to ensure similar cement distribution under both the endplates. Specimens were tested in flexion-extension under 400 N preload while pressure in the discs and strain at the anterior wall of the adjacent vertebrae were recorded. Disc pressure in the intact specimens increased during flexion by 26 ± 14%. After cementation, disc pressure increased during flexion by 15 ± 11% in the discs with un-fractured endplates, while decreased by 19 ± 26.7% in the discs with the fractured endplates. During flexion, the compressive strain at the anterior wall of the vertebra next to the fractured endplate increased by 94 ± 23% compared to intact status (p < 0.05), while it did not significantly change at the vertebra next to the un-fractured endplate (18.2 ± 7.1%, p > 0.05). Subsequent flexion with compression to failure resulted in adjacent fracture close to the fractured endplate in six specimens and in a non-adjacent fracture in one specimen, while one specimen had no adjacent fractures. Depression of the fractured endplate alters the pressure profile of the damaged disc resulting in increased compressive loading of the anterior wall of adjacent vertebra that predisposes it to wedge fracture. This data suggests that correction of endplate deformity may play a role in reducing the risk of adjacent fractures