Linking Inner Context and Innovation Factors: Examining a pharmacy-based intervention through the eyes of pharmacy staff.

INTRODUCTION: Community pharmacies, as unique and accessible healthcare venues, are ideal locations to implement interventions aiming to improve patient care. However, these interventions may increase workload or disrupt workflow for community pharmacists, technicians, and other staff members, threatening long-term sustainment. There are growing calls from the field of implementation science to design for intervention sustainment and maintenance by maximizing innovation fit. Senior Safe™, an intervention to facilitate safer over-the-counter (OTC) product selection by older adults, serves as a case study to examine the congruence between Innovation Factors and community pharmacy Inner Context constructs and their implications for workload and sustainment. METHODS: Using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, this qualitative study identified factors surrounding Senior Safe implementation. Semi-structured interviews were conducted with staff from pharmacies where Senior Safe was implemented. Two coders independently analyzed interview transcripts using deductive analysis based on EPIS constructs. Thematic analysis was used to generate three themes that encapsulated innovation fit. RESULTS: Nineteen pharmacy staff members participated, with the majority reporting no significant change in their workload or workflow due to Senior Safe. Interview feedback supported a pre-existing culture of the healthcare system to engage patients, of leadership commitment to patient safety initiatives, and of an amplified role of pharmacy technicians. DISCUSSION AND CONCLUSION: Pharmacy staff interviews revealed congruence between Innovation Factors and Inner Context that likely yielded intervention workload neutrality. This study highlighted the importance for researchers to consider maintenance and sustainability when designing and implementing an intervention and the critical influence of culture and leadership support during this process.

Access to medications for opioid use disorder for formerly incarcerated individuals during community reentry: a mini narrative review.

Medications for opioid use disorder (MOUD) are especially important for formerly incarcerated individuals with opioid use disorder (OUD) and can reduce the risk of re-arrest and overdose during community reentry. Unfortunately, few formerly incarcerated individuals are able to access MOUD within the community, missing a critical tool for rehabilitation. A mini narrative review was conducted to highlight the published work that has been done to improve access to MOUD for formerly incarcerated individuals during reentry. The results yielded 15 records describing intervention evaluations, program descriptions, and research in progress. Most work is ongoing, showing promise that researchers have identified the importance of this problem. However additional research should be done to include other stakeholders and address the limitations of existing interventions and programs. Continued efforts can help ensure that formerly incarcerated individuals can safely and successfully reintegrate into society.

Adapting a community pharmacy intervention to improve medication safety.

BACKGROUND: Community pharmacies are an ideal location to address challenges of over-the-counter medication safety, yet many successful interventions are only tested in a few pharmacies without expansion, creating unrealized opportunities to improve patient care on a larger scale. Scaling up to numerous pharmacies can be challenging because each community pharmacy has unique needs and layouts and requires individualized adaptation. OBJECTIVES: This paper reports techniques for (a) adapting a community pharmacy intervention to fit the unique physical layout and patient needs of health system pharmacy sites without increasing staff workload, (b) identifying strategies to gather feedback on adaptations from stakeholders, and (c) developing materials to share with pharmacy champions for them to independently implement and sustain the intervention in their organization. PRACTICE DESCRIPTION: The study team collaborated with Aurora Pharmacy, Inc to develop an intervention designed to increase awareness of safe over-the-counter medication use for older adults. PRACTICE INNOVATION: Senior Safe, a community pharmacy-based intervention, was designed, implemented, and tested using the Exploration, Preparation, Implementation, and Sustainment implementation framework. EVALUATION METHODS: Senior Safe was adapted through pilot testing and a randomized control trial. Feedback was collected from key stakeholders, including pharmacy staff, older adults, and a research advisory group. RESULTS: A finalized version of Senior Safe, as well as an implementation package, was provided to Aurora Pharmacy to integrate into all 63 sites. CONCLUSION: This multiphase study illustrated that refining an intervention is possible and welcomed by pharmacy staff, but it requires time, resources, and funds to create an impactful, sustainable community pharmacy intervention.

Freelance information management agents: why information management is so hard on translational teams.

Introduction: To conduct high-quality, rigorous research, and advance scientific knowledge, Translational Teams (TTs) engage in information behaviors, including seeking, using, creating, sharing, storing, and retrieving information, in ways specific to the translational context. Currently, little is known about TTs' approach to information management. This qualitative pilot study explored how TTs at the University of Wisconsin-Madison interact with information, as well as the scientific and organizational impact of their interactions. Methods: We conducted interviews with ten members of UW TTs. Interviews were transcribed and thematic analysis was conducted. Results: Four themes emerged: (1) TT members did not recognize the centrality of information or information behaviors to their scientific work; (2) TT members engaged in similar information behaviors and used similar tools across disciplines and topics; (3) TT members did not receive support or guidance from their institution in managing information; and (4) Individualized choices of TT members conflicted at the team level, causing confusion and increasing the potential for data and information loss. Acting as freelance information management agents, TT members made individualized decisions about what tools to use and how to use them, often in a piecemeal manner and without communicating these decisions to other team members. Conclusion: Research institutions should both encourage teams to discuss their information management approaches at the beginning of a project and provide leaders with training on how to have these conversations and what topics should be included. Additionally, institutions can provide researchers with guidelines for using software platforms to help mitigate information management challenges.

Toward a translational team science hierarchy of needs: Exploring the information management challenges of team science.

Background: Clinical and Translational Research (CTR) requires a team-based approach, with successful teams engaging in skilled management and use of information. Yet we know little about the ways that Translational Teams (TTs) engage with information across the lifecycle of CTR projects. This qualitative study explored the challenges that information management imposes on the conduct of team-based CTR. Methods: We conducted interviews with ten members of TTs at University of Wisconsin. Interviews were transcribed and thematic analysis was conducted. Results: TTs' piecemeal and reactive approaches to information management created conflict within the team and slowed scientific progress. The lack of cohesive information management strategies made it more difficult for teams to develop strong team processes like communication, scientific coordination, and project management. While TTs' research was hindered by the institutional challenges of interdisciplinary team information sharing, TTs who had developed shared approaches to information management that foregrounded transparency, accountability, and trust, described substantial benefits to their teamwork. Conclusion: We propose a new model for the Science of Team Science field - a Translational Team Science Hierarchy of Needs - that suggests interventions should be targeted at the appropriate stage of team development in order to maximize a team's scientific potential.

Clinical decision support systems in community pharmacies: a scoping review.

OBJECTIVE: Clinical decision support systems (CDSS) were implemented in community pharmacies over 40 years ago. However, unlike CDSS studies in other health settings, few studies have been undertaken to evaluate and improve their use in community pharmacies, where billions of prescriptions are filled every year. The aim of this scoping review is to summarize what research has been done surrounding CDSS in community pharmacies and call for rigorous research in this area. MATERIALS AND METHODS: Six databases were searched using a combination of controlled vocabulary and keywords relating to community pharmacy and CDSS. After deduplicating the initial search results, 2 independent reviewers conducted title/abstract screening and full-text review. Then, the selected studies were synthesized in terms of investigational/clinical focuses. RESULTS: The selected 21 studies investigated the perception of and response to CDSS alerts (n = 7), the impact of CDSS alerts (n = 7), and drug-drug interaction (DDI) alerts (n = 8). Three causes of the failures to prevent DDIs of clinical importance have been noted: the perception of and response to a high volume of DDI alerts, a suboptimal performance of CDSS, and a dearth of sociotechnical considerations for managing workload and workflow. Additionally, 7 studies emphasized the importance of utilizing CDSS for a specific clinical focus, ie, antibiotics, diabetes, opioids, and vaccinations. CONCLUSION: Despite the range of topics dealt in the last 30 years, this scoping review confirms that research on CDSS in community pharmacies is limited and disjointed, lacking a comprehensive approach to highlight areas for improvement and ways to optimize CDSS utilization.