engleski

Action research as a method for initial implementation of a new pharmacy-led care delivery model at the Health Centre Zagreb - Centre

Introduction New approaches are needed at an individual and population level to provide safe and effective pharmacotherapy to patients. Hence, a new pharmacist- led care delivery model was developed (1). The aim of this research was to describe the process of initial implementation of a practice management system of Comprehensive Medication Management (CMM) services at the Health Centre Zagreb – Centre. Methods This was a qualitative study that employed an action research methodology. The research was conducted by two pharmacists who were active in both, implementing and providing the service (acting as practitioners), and gathering and analysing data (acting as researchers). Piloting of the CMM services was located in an independent counselling unit, Pharmacotherapy counselling service, at the Health Centre Zagreb – Centre. Data were collected through semi-structured interviews with general practitioners (GPs) and other relevant stakeholders, group meetings (focus-groups), participant observation, and field journals with descriptions and reflections on the process of implementing and delivering CMM services, for a period of sixteen months. The patient care service employed in this study followed the philosophy and the standardized patient care process proposed by Cipolle et al (1). Results Initial implementation of CMM services occurred in two stages: pre- implementation and early implementation stage. During the pre-implementation stage, an implementation team was established, an interested health centre was reached, availability of the practice management infrastructure and education for the practitioners were assured, and a workflow diagram of CMM services was established. Once all the pre-requirements for CMM implementation were in place, the Pharmacotherapy counselling service initiated its work. During the early implementation stage the practice was set up, the patients’ recruitment initiated and various challenges identified. The recruitment of patients for the CMM services almost exclusively occurred through referral by GPs or self-referral. Multiple meetings with the GPs were held since the practice started, and only four of them have fully accepted the service, particularly those with less than 5 years of professional experience in primary health care. Discussions This is the first study providing an exhaustive research-based depiction of the process of the initial implementation of CMM services at a primary care practice site in Croatia and Europe. Conclusions (comprising key findings) The action research methodology enabled an effective approach to introducing a new pharmacist-led service in the Croatian primary health care. Lessons learned This study showed how challenging it is to introduce a new service into a rigid and already established health care system. Limitations Since the reimbursement for pharmacist-practitioners was not ensured, a full- service implementation was not possible at the time. Suggestions for future research A deeper qualitative study is needed to understand the underlying reasons for GPs’ lack of involvement. References 1. Cipolle RJ, Strand L, Morley PC. Pharmaceutical care practice: The patient-centered approach to medication management. 3rd ed. Newy Work: The McGraw-Hill Companies ; 2012.

action research ; health centre ; pharmacist ; delivery model

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