Application of behavioural theories, models, and frameworks in pharmacy practice research based on published evidence: a scoping review.

BACKGROUND: Pharmacy practice research often focuses on the design, implementation and evaluation of pharmacy services and interventions. The use of behavioural theory in intervention research allows understanding of interventions' mechanisms of action and are more likely to result in effective and sustained interventions. AIM: To collate, summarise and categorise the reported behavioural frameworks, models and theories used in pharmacy practice research. METHOD: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science and EBSCO (CINAHL PLUS, British Education index, ERIC) were systematically searched to capture all pharmacy practice articles that had reported the use of behavioural frameworks, theories, or models since inception of the database. Results were filtered to include articles published in English in pharmacy practice journals. Full-text screening and data extraction were independently performed by two reviewers. A narrative synthesis of the data was adopted. Studies were reviewed for alignment to the UK Medical Research Council (MRC) framework to identify in which phase(s) of the research that the theory/model/framework had been employed. RESULTS: Fifty articles met the inclusion criteria; a trend indicating an increasing frequency of behavioural theory/frameworks/models within pharmacy practice research was identified; the most frequently reported were Theory of Planned Behaviour and Theoretical Domains Framework. Few studies provided explicit and comprehensive justification for adopting a specific theory/model/framework and description of how it underpinned the research was lacking. The majority were investigations exploring determinants of behaviours, or facilitators and barriers to implementing or delivering a wide range of pharmacy services and initiatives within a variety of clinical settings (aligned to Phase 1 UK MRC framework). CONCLUSION: This review serves as a useful resource for future researchers to inform their investigations. Greater emphasis to adopt a systematic approach in the reporting of the use of behavioural theories/models/frameworks will benefit pharmacy practice research and will support researchers in utilizing behavioural theories/models/framework in aspects of pharmacy practice research beyond intervention development.

Scope, content and quality of clinical pharmacy practice guidelines: a systematic review.

BACKGROUND: Guidelines for pharmacy practitioners regarding various clinical pharmacy activities have been published in a number of countries. There is a need to review the guidelines and identify the scope of activities covered as a prelude to developing internationally acceptable common guidelines. AIM: To review the scope of clinical pharmacy guidelines and assess the extent to which these guidelines conform to quality standards as per the AGREE II instrument. METHOD: Medline, Embase, Guideline Central, International Pharmaceutical Abstracts, Google Scholar and Google (for grey literature) were searched for the period 2010 to January 2023. Guidelines which focused on any health care setting and any clinical pharmacy activity were included. Data were extracted and quality assessed independently by two reviewers using the English version of the AGREE II instrument. RESULTS: Thirty-eight guidelines were included, mostly originating from Australia (n = 10), Ireland (n = 8), UK (n = 7) and USA (n = 5). Areas covered included medication reconciliation, medicines optimisation, medication management and transition of care. As per the AGREE II assessment, the highest score was obtained for the scope and purpose domain and the lowest score for rigour of development, mainly due to non-consideration of literature/evidence to inform guideline development. CONCLUSION: Clinical pharmacy guidelines development processes need to focus on all quality domains and should take a systematic approach to guideline development. Guidelines need to further emphasise person-centred care and clinical communication. There is a scope to harmonise the guidelines internationally considering the diverse practices, standards and legislations across different geographies.

Correction: Using Assessment Design Decision Framework in understanding the impact of rapid transition to remote education on student assessment in health-related colleges: A qualitative study.

[This corrects the article DOI: 10.1371/journal.pone.0254444.].

Investigating physicians' views on non-formulary prescribing: a qualitative study using the theoretical domains framework.

BACKGROUND: Well-designed and well-maintained drug formularies serve as a reliable resource to guide prescribing decisions; they are associated with improved medicine safety and increased efficiency, while also serving as a cost-effective tool to help manage and predict medicine expenditure. Multiple studies have investigated the inappropriate prescribing of non-formulary drugs (NFDs) with statistics indicating that up to 70% of NFD usage being inappropriate or not following the ascribed NFD policies. AIM: To explore physicians' views and influences on their prescribing of non-formulary drugs. METHOD: Data collection and analysis were underpinned using the Theoretical Domains Framework (TDF). Thirteen semi-structured interviews were conducted within Hamad Medical Corporation, the main provider of secondary and tertiary healthcare in Qatar, with physicians who had submitted a NFD request in the preceding 12 months. RESULTS: Three overarching themes were identified: providing evidence-based care for individual patients; influences of others; and formulary management issues. Subthemes were mapped to specific TDF domains: environmental context and resources; social influences; professional role and identity; beliefs about consequences; goals; intentions. CONCLUSION: The behavioral influences identified in this study can be mapped to behavior change strategies facilitating the development of an intervention to promote appropriate prescribing of NFDs with implications for medicine safety and healthcare efficiency.

Factors that influence patient and public adverse drug reaction reporting: a systematic review using the theoretical domains framework.

BACKGROUND: Only 5-10% of all adverse drug reactions (ADRs) are reported. Mechanisms to support patient and public reporting offer numerous advantages to health care systems including increasing reporting rate. Theory-informed insights into the factors implicated in patient and public underreporting are likely to offer valuable opportunity for the development of effective reporting-interventions and optimization of existing systems. AIM: To collate, summarize and synthesize the reported behavioral determinants using the theoretical domains framework (TDF), that influence patient and public reporting of ADRs. METHOD: Cochrane, CINAHL, Web of science, EMBASE and PubMed were systematically searched on October 25th, 2021. Studies assessing the factors influencing public or patients reporting of ADRs were included. Full-text screening, data extraction and quality appraisal were performed independently by two authors. Extracted factors were mapped to TDF. RESULTS: 26 studies were included conducted in 14 countries across five continents. Knowledge, social/professional role and identity, beliefs about consequences, and environmental context and resources, appeared to be the most significant TDF domains that influenced patient and public behaviors regarding ADR reporting. CONCLUSION: Studies included in this review were deemed of low risk of bias and allowed for identification of key behavioural determinants, which may be mapped to evidence-based behavioral change strategies that facilitate intervention development to enhance rates of ADR reporting. Aligning strategies should focus on education, training and further involvement from regulatory bodies and government support to establish mechanisms, which facilitate feedback and follow-ups on submitted reports.

Attitudes and beliefs regarding the use of herbs and supplementary medications with COVID-19: A systematic review.

BACKGROUND AND AIM: There is growing interest in using herbs and supplementary medications to treat and/or prevent COVID-19, evidenced by multiple reports exploring their effectiveness and safety. From a health psychology perspective, the desire to use herbs and supplementary medications to prevent and/or treat COVID-19 is a health behavior which is attributed to attitudes and beliefs. This systematic review critically appraised and synthesized the data from studies investigating these attitudes and beliefs. METHODS: EMBASE, PubMed, ScienceDirect, Scopus, Cochrane (library), and WebOfScience were searched from inception to December 13, 2021 for studies investigating attitudes and beliefs on the use of herbs and supplementary medications to treat and/or prevent COVID-19. RESULTS: A total of 17 articles were identified for inclusion. All except one were of cross-sectional design. Participants across most studies had a positive attitude towards using herbs and supplementary medications. They believed that herbs and supplementary medications were effective and were confident in their value in preventing and/or treating COVID-19 symptoms. The majority of included studies had significant flaws in study design and reporting, including inconsistent definitions of herbs and supplementary medications, a lack of theoretical models and conceptual frameworks underpinning the study of beliefs and attitudes, in addition to methodological issues of robustness affecting the validity and reliability of data. CONCLUSION: The use of herbs and supplementary medicines to prevent and/or treat COVID-19 could well be driven by a positive attitude stemming from beliefs of effectiveness and safety. There is a need for well-designed studies on attitudes and beliefs that are driven by health behavior theories to permit generalizability of findings and establish more conclusive relationships between beliefs, attitudes and the decision to use herbs and supplementary medications to treat and/or prevent COVID-19.

A scoping review of theories used to investigate clinician adherence to clinical practice guidelines.

BACKGROUND: Routine utilization of evidence-based clinical practice guidelines (CPGs) is an effective strategy to optimize patient care and reduce practice variation. Healthcare professionals' failure to adhere to CPGs introduces risks to both patients and the sustainability of healthcare systems. The integration of theory to investigate adherence provides greater insight into the often complex reasons for suboptimal behaviors. AIM: To determine the coverage of literature surrounding the use of theory in studies of CPG adherence, report the key findings and identify the knowledge gaps. METHOD: In April 2021, three bibliographic databases were searched for studies published since January 2010, adopting theory to investigate health professionals' adherence to CPGs. Two reviewers independently screened the articles for eligibility and charted the data. A narrative approach to synthesis was employed. RESULTS: The review includes 12 articles. Studies were limited to primarily investigations of physicians, quantitative designs, single disease states and few countries. The use of behavioral theories facilitated pooling of data of barriers and facilitators of adherence. The domains and constructs of a number of the reported theories are captured within the Theoretical Domains Framework (TDF); the most common barriers aligned with the TDF domain of environmental context and resources, fewer studies reported facilitators. CONCLUSION: There is emerging use of behavioral theories investigating physicians' adherence to CPGs. Although limited in number, these studies present specific insight into common barriers and facilitators, thus providing valuable evidence for refining existing and future implementation strategies. Similar investigations of other health professionals are warranted.

Learning needs assessments in continuing professional development: A scoping review.

BACKGROUND: A rigorous learning needs assessment (LNA) is a crucial initial step in the Continuing Professional Development (CPD) process. This scoping review aimed to collate, summarize, and categorize the reported LNA approaches adopted to inform healthcare professional CPD and highlight the gaps for further research. METHOD: In August 2020, nine bibliographic databases were searched for studies conducted with any health professional grouping, reporting the utilized LNA to inform CPD activities. Two reviewers independently screened the articles for eligibility and charted the data. A descriptive analytical approach was employed to collate, summarize, and categorize the literature. RESULTS: 151 studies were included in the review; the majority adopted quantitative methods in the form of self-assessment surveys. Mixed-methods approaches were reported in only 35 studies. Descriptions of LNA development lacked detail of measures taken to enhance their rigor or robustness. DISCUSSION: These findings do not reflect recommendations offered by the CPD literature. Further investigations are required to evaluate more recently advocated LNA approaches and add to their limited evidence-base. Similarly, the existing support afforded to CPD developers warrants further study in order to identify the necessary resource, infrastructure and expertise essential to design and deliver effective CPD programs.

Patient activation and patient-reported outcomes of men from a community pharmacy lifestyle intervention after prostate cancer treatment.

PURPOSE: To report patient activation, which is the knowledge, skills, and confidence in self-managing health conditions, and patient-reported outcomes of men after prostate cancer treatment from a community pharmacy lifestyle intervention. METHODS: The 3-month lifestyle intervention was delivered to 116 men in nine community pharmacies in the UK. Patient Activation Measure (PAM) was assessed at baseline, 3 and 6 months. Prostate cancer-related function and quality of life were assessed using the European Prostate Cancer Index Composite (EPIC-26) and EuroQOL 5-dimension 5-level (EQ5D-5L) questionnaires at baseline and 6 months. Lifestyle assessments included Mediterranean Diet Adherence Screener (MEDAS) at baseline, 3 and 6 months and Godin Leisure Time Exercise Questionnaire (GLTEQ) at baseline and 3 months. RESULTS: PAM score increased from 62 [95% CI 59-65] at baseline to 66 [64-69] after the intervention (p = 0.001) and remained higher at 6 months (p = 0.008). Scores for all the EPIC-26 domains (urinary, bowel and hormonal) were high at both assessments, indicating good function (between 74 [70-78] and 89 [86-91]), except sexual domain, where scores were much lower (21 [17-25] at baseline, increasing to 24 [20-28] at 6 months (p = 0.012)). In EQ5D-5L, 3% of men [1-9] reported self-care problems, while 50% [41-60] reported pain and discomfort, and no significant changes over time. Men who received androgen deprivation therapy, compared with those who did not, reported higher (better) urinary incontinence scores (p < 0.001), but lower (worse) scores in the urinary irritative/obstructive (p = 0.003), bowel (p < 0.001) and hormonal (p < 0.001) domains. Poor sexual function was common across all age groups irrespective of prostate cancer treatment. CONCLUSIONS: The intervention led to significant improvements in patient activation, exercise and diet. Community pharmacy could deliver effective services to address sexual dysfunction, pain and discomfort which are common after prostate cancer.

A study to investigate the implementation process and fidelity of a hospital to community pharmacy transfer of care intervention.

BACKGROUND: Hospital to community pharmacy transfer of care medicines-related interventions for inpatients discharged home aim to improve continuity of care and patient outcomes. One such intervention has been provided for seven years within a region in England. This study reports upon the implementation process and fidelity of this intervention. METHODS: The process evaluation guidance issued by the Medical Research Council has informed this study. A logic model to describe the intervention and causal assumptions was developed from preliminary semi-structured interviews with project team members. Further semi-structured interviews were undertaken with intervention providers from hospital and community pharmacy, and with patient and public representatives. These aimed to investigate intervention implementation process and fidelity. The Consolidated Framework for Implementation Research and the Consolidated Framework for Intervention Fidelity informed interview topic guides and underpinned the thematic framework analysis using a combined inductive and deductive approach. RESULTS: Themes provided information about intervention fidelity and implementation that were mapped across the sub processes of implementation: planning, execution, reflection and evaluation, and engagement. Interviewees described factors such as lack of training, awareness, clarity on the service specification, governance and monitoring and information and feedback which caused significant issues with the process of intervention implementation and suboptimal intervention fidelity. CONCLUSIONS: This provides in-depth insight into the implementation process and fidelity of a ToC intervention, and the extant barriers and facilitators. The findings offer learning to inform the design and implementation of similar interventions, contribute to the evidence base about barriers and facilitators to such interventions and provides in-depth description of the implementation and mechanisms of impact which have the potential to influence clinical and economic outcome evaluation.

Using Assessment Design Decision Framework in understanding the impact of rapid transition to remote education on student assessment in health-related colleges: A qualitative study.

Maintaining integrity and validity with online assessment is a significant issue that is well documented. Overt policies encouraging educators to adopt e-Learning and implement digital services coupled with the dramatic change in the education system in response to the challenges posed by COVID-19, has furthered the demand for evidence-based approaches for the planning and delivery of assessments. This study employed the Assessment Design Decision Framework (ADDF), a theoretical model that considers key aspects of assessment design, to retrospectively investigate from a multi-stakeholder perspective the assessments implemented following the rapid transition to remote learning during the COVID-19 pandemic. One-to-one semi-structured interviews were conducted with faculty and students from the Colleges of Pharmacy, Medicine and Health Sciences. After inductive and deductive thematic analysis three major themes were identified. These reflected on the impact of sudden transition on assessment design and assessment plan; changing assessment environment; and faculty-student assessment related interactions which included feedback. The use of a comprehensive validated framework such as ADDF, to plan assessments can improve validity and credibility of assessments. The strengths of this study lie in the innovative adoption of the ADDF to evaluate assessment design decisions from both an educator and student perspective. Further, the data yielded from this study offers novel validation of the use of ADDF in circumstances necessitating rapid transition, and additionally identifies a need for greater emphasis to be attributed to the significance of timeliness of the various activities that are advocated within the framework.

A theoretically informed, mixed-methods study of pharmacists' aspirations and readiness to implement pharmacist prescribing.

Background Studies have highlighted advancing clinical pharmacy practice in Qatar. Objective To explore pharmacists' aspirations and readiness to implement pharmacist prescribing. Setting Hamad Medical Corporation (HMC), the main provider of secondary and tertiary care. Method A sequential explanatory mixed-methods design. Questionnaire items were derived from the Consolidated Framework of Implementation Research (CFIR), in domains of: awareness/support; readiness; implementation; and facilitators and barriers. Following piloting, all pharmacists (n = 554) were invited to participate. Questionnaire data were analysed using descriptive and inferential statistics with principal component analysis of attitudinal items. Focus groups were recorded, transcribed and analysed using the Framework Approach. Main outcome measure Aspirations and readiness to implement pharmacist prescribing. Results The response rate was 62.8% (n = 348), with respondents highly supportive of implementation in Qatar (median 4, scale 0-5, extremely supportive). The majority (64.9%, n = 226) considered themselves ready, particularly those more senior (p < 0.05) and classifying themselves innovative (p < 0.01). Outpatient (72.9%, n = 221 agreeing) and inpatient (71.1%, n = 218 agreeing) HMC settings were those perceived as being most ready. PCA identified 2 components, with 'personal attributes' being more positive than 'prescribing support'. Facilitators were access to records, organizational/management support and the practice environment, with physician resistance and scope of practice as barriers. Focus groups provided explanation, with themes in CFIR domains of innovation characteristics, characteristics of individuals and the inner setting. Conclusion HMC pharmacists largely aspire, and consider themselves ready, to be prescribers with inpatient and outpatient settings most ready. CFIR domains and constructs identified as facilitators and barriers should be focus for implementation.

A rapid review and narrative synthesis of hospital to community pharmacy transfer of care services in England.

OBJECTIVES: A new discharge medicines service in England has been proposed for rollout in July 2020. This study aims to appraise the evidence for hospital to community pharmacy referral services in England. A rapid review methodology was adopted, findings were synthesised and reported narratively. The PubMed search engine was used and specific pharmacy journals were searched in March 2020. Studies published since 2012, reporting on transfer of care (ToC) services provided from hospitals and community pharmacies in England were included. Study data analysed included clinical outcomes; findings relating to implementation, staff and patient perceptions and experiences. Studies were assessed for risk of bias using a critical appraisal checklist. KEY FINDINGS: Ten studies met the inclusion criteria. The ToC services varied in relation to patients targeted, mode of referral, and post-discharge service provided. There were some conservative observations that ToC services were associated with reduced hospital readmission rates, however other outcomes were less well substantiated. Pharmacy staff were generally supportive of these services for patient benefit, however, patient engagement and accessibility issues have been reported. SUMMARY: There is some emerging evidence that hospital to community pharmacy referral services are associated with reduced hospital readmission. Service delivery reported in these studies highlights barriers and facilitators to patient recruitment, engagement and follow-up and limitations on recording and measuring meaningful outcomes. Future work is recommended to take advantage of the implementation and delivery of the national service that includes the analysis of patient data at scale to substantiate evidence in this area.

Adopting a systems thinking approach to investigate the implementation and provision of a pharmacist-led post-discharge domiciliary medicines review service.

BACKGROUND: Intervention planners need to be sufficiently cognisant of the health system landscape to facilitate embedding, adoption and diffusion of new services. Pharmacist-led transfer of care initiatives from hospital to community have been developed to address a health system flaw: patient hospital readmissions. A hospital in England partnered with a chain of community pharmacies establishing a domiciliary pharmacist medicines use review service (DMRS) for discharged patients to reduce hospital readmissions. OBJECTIVES: We adopt a systems thinking approach to understand the adoption and diffusion of the service by investigating the perceptions of hospital and community pharmacy staff. The experience of a role swap between these settings is investigated to probe further system factors influencing service provision. METHODS: Semi-structured interviews informed by a conceptual model for the diffusion, dissemination and implementation of innovations, were conducted with hospital and community pharmacy staff between Oct-Dec 2016. Interviews were audio-recorded with consent, transcribed verbatim and a combination of inductive and deductive thematic analysis was used. RESULTS: Four each of hospital and community pharmacy staff were interviewed and four hospital staff were interviewed after the role swap. Staff indicated barriers and facilitators thematically related to organisational and individual-level components of a conceptual model about service diffusion and implementation. The role swap appeared to address the lack of a feedback loop, which was limiting engagement of hospital staff. The role swap led to improved trust and shared goals between the healthcare sectors and increased appreciation and self-efficacy of the hospital staff role. CONCLUSIONS: A systems thinking lens offered the opportunity to investigate the wider healthcare system within which the DMRS was being provided. The role swap aligned to the principles of participatory design of an intervention to facilitate successful adoption and diffusion and contribute to more insightful evaluation about the process and context of service implementation.

Maternal and perinatal outcomes and pharmacological management of Covid-19 infection in pregnancy: a systematic review protocol.

BACKGROUND: Over 4.2 million confirmed cases and more than 285,000 deaths, COVID-19 pandemic continues to harm significant number of people worldwide. Several studies have reported the impact of COVID-19 in general population; however, there is scarcity of information related to pharmacological management and maternal and perinatal outcomes during the pandemic. Altered physiological, anatomical, and immunological response during pregnancy makes it more susceptible to infections. Furthermore, during pregnancy, a woman undergoes multiple interactions with the health care system that increases her chance of getting infected; therefore, managing pregnant population presents a unique challenge. RESEARCH QUESTIONS: This systematic review seeks to answer the following questions in relation to COVID-19: What are the different clinical characteristics presented in maternal and perinatal population? What are the different maternal and perinatal outcome measures reported? What are the distinct therapeutic interventions reported to treat COVID-19? Is it safe to use "medications" used in the treatment of COVID-19 during antenatal, perinatal, postnatal, and breastfeeding? METHOD: The search will follow a comprehensive, sequential three step search strategy. Several databases relevant to COVID-19 and its impact on pregnancy including Medline, CINAHL, and LitCovid will be searched from the inception of the disease until the completion of data collection. The quality of this search strategy will be assessed using Peer Review of Electronic Search Strategies Evidence-Based Checklist (PRESS EBC). An eligibility form will be developed for a transparent screening and inclusion/exclusion of studies. All studies will be sent to RefWorks, and abstraction will be independently performed by two researchers. Risk of bias will be assessed using Cochrane Risk of Bias tool for randomized controlled trials, Newcastle-Ottawa Quality Assessment Scale for non-randomized studies, and for case reports, Murad et al. tool will be used. Decision to conduct meta-analysis will be based on several factors including homogeneity and outcome measures reported; otherwise, a narrative synthesis will be deemed appropriate. DISCUSSION: This systematic review will summarize the existing data on effect of COVID-19 on maternal and perinatal population. Furthermore, to the best of our knowledge, this is the first systematic review addressing therapeutic management and safety of medicines to treat COVID-19 during pregnancy and breastfeeding. SYSTEMATIC REVIEW REGISTRATION: This systematic review has been registered and published with Prospero ( CRD42020172773 ).

A service evaluation and stakeholder perspectives of an innovative digital minor illness referral service from NHS 111 to community pharmacy.

INTRODUCTION: The management of minor conditions represents a significant burden for urgent and emergency care services and reduces the capacity to provide specialist care for higher acuity healthcare need. A pilot Digital Minor Illness Service (DMIRS) was commenced in the North East of England in December 2017 to feasibility test the NHS 111 referral to community pharmacy for patients presenting with minor conditions. OBJECTIVES: A formative evaluation of the service activity data and qualitative investigation of stakeholders involved in the service design, management, delivery and use, aims to present and investigate the service outcomes. METHOD: Routine service activity data was evaluated during Jan-Dec 2018 to investigate the demographics of patients included in the service; the presenting conditions; and how those referrals were managed by community pharmacies. Semi-structured interviews with NHS 111 call handlers, project team members, community pharmacists and patients were undertaken to investigate the design, management, implementation and delivery of the service. RESULTS: 13,246 NHS 111 patient calls were referred to community pharmacy during the evaluative period. The most common presenting conditions were acute pain (n = 1144, 8.6%) and cough (n = 887, 6.7%). A large volume of complaints (47.1%, 6233) were resolved in community pharmacy. Stakeholders explained the structured approach to service design, organisation and implementation facilitated successful delivery and management. Patients reported positive experiences with accessing care via DMIRS. CONCLUSIONS: DMIRS demonstrated that patients could be referred to community pharmacy for the management of minor conditions, shifting a burden away from urgent and emergency care. The service data provides key information for further optimisation of service design, and stakeholder training and awareness. The service was acceptable and valued by patients. Evidence from the DMIRS pilot has been utilised to inform recent national healthcare policy and practice around the management of minor conditions within the urgent and emergency care setting.

Exploring the experiences and preparedness of humanitarian pharmacists in responding to an emergency-response situation.

BACKGROUND: Pharmacists are more frequently being deployed along with other members of the multi-disciplinary team in order to provide humanitarian aid. This team will need to work collaboratively to overcome challenges such as constraints in access to medication, medical supplies and medical records. Recent literature reports on the role of the pharmacist across all facets of care continuing to evolve into clinical areas to support patient care. To date there is a deficiency in description and understanding of the preparedness and contribution of pharmacists within a humanitarian capacity. OBJECTIVE: This study aims to investigate the preparedness of pharmacists working in the humanitarian field and to explore pharmacists' experiences including the challenges they face in an emergency response situation. METHODS: An interview topic guide was developed and informed by a review of the literature and one-to-one in-depth semi-structured telephonic interviews were conducted with pharmacists involved in the humanitarian field based in England. Interviews were audio recorded and were transcribed verbatim. A member of the research team conducted the data analysis (FS) consistent with the Braun and Clarke approach, the authors (ZN and HN) provided advice and input throughout the analysis process. RESULTS: Twelve pharmacists participated in this study, nine of whom had deployment experience; interviews took place between October 2017 and April 2018. Data analysis identified four descriptive themes (training and preparation; skills required; challenges/barriers; professional development) and numerous sub-themes. CONCLUSIONS: This study resonates with research investigating experiences of other healthcare professionals, which report the need for more tailored and appropriate training to improve preparedness for deployment. Pharmacists also suggest specific skills and knowledge facilitate adaptability and innovate working which areas of humanitarian need require. The pharmacists did not report any psychological burden or trauma from their experiences in emergency response, which requires further study to ensure this aspect of preparation, debriefing and support is not neglected.

Correction: A systematic review of the outcome data supporting the Healthy Living Pharmacy concept and lessons from its implementation.

[This corrects the article DOI: 10.1371/journal.pone.0213607.].

A systematic review of the outcome data supporting the Healthy Living Pharmacy concept and lessons from its implementation.

BACKGROUND: The Healthy Living Pharmacy (HLP) project, launched in England, UK in 2009 was a novel approach of introducing public health services within community pharmacy to tackle local health inequalities. A national roll-out followed a reported successful pilot; subsequent local evaluations ensued. OBJECTIVES: To summarise reported outcomes and investigate contextual factors that indicate the presence, absence and maturity of implementation determinants, thus offering useful lessons to stakeholders in implementing future initiatives to achieve successful outcomes. METHODS: A systematic review was conducted to identify all publications reporting on the HLP project. All HLP articles and conference abstracts were considered for inclusion and were assessed for methodological quality. The Consolidated Framework for Implementation Research (CFIR) was utilised to identify potential implementation determinants reported. Each article was then analysed to identify reported economic, humanistic or clinical outcomes. RESULTS: The review included six peer-reviewed journal articles and 12 conference abstracts. Joanna Briggs Institute Qualitative Assessment and Review Instrument indicated deficiencies in methodological quality. Through adoption of the CFIR framework, the implementation determinants relevant to the implementation of HLP into community pharmacy were identified. A resonating issue emerged in that the absence of adopting an evidence-based implementation process limited the ability to capture meaningful outcome data. This resulted in a lack of evidence to support sustainability and the failure to address many of the well cited barriers, e.g. lack of awareness amongst patients, public and other healthcare professionals, and weak support for future investment in resource for training and dissemination. CONCLUSIONS: Healthcare systems are increasingly called on to adopt evidence-based interventions that improve quality, control costs, and maximize value, thus offering opportunity to accelerate the implementation of clinical pharmacy services and programs aimed at improving patient care. Interventions, such as the HLP project require focused efforts on implementation and evaluation of those implementation efforts to produce effective and lasting changes in complex health care systems.

Community pharmacy minor ailment services: Pharmacy stakeholder perspectives on the factors affecting sustainability.

BACKGROUND: Self-care advice and management of minor ailments have long been provided in community pharmacies across England. However, formal pharmacy minor ailment service provision is geographically variable and has yet to gain recognition and political support as a valued sustainable service for nationwide adoption and commissioning. OBJECTIVE: To investigate the sustainability potential of pharmacy minor ailment services from the perspective of community pharmacy stakeholders within the North East of England. METHODS: A mixed methods approach was adopted to survey and interview stakeholders from the North East of England who commission; provide; and/or represent groups influencing the design, delivery and investment in community pharmacy clinical and public health services. The 40-item Programme Sustainability Assessment Tool, a validated instrument to assess a public health programme's capacity for sustainability across eight domains, was administered to fifty-three stakeholders, identified from a pharmacy minor ailments showcase event. The same stakeholders were invited for a semi-structured interview to explore issues further. Interviews were audio-recorded, transcribed verbatim, and underwent framework analysis. RESULTS: Forty-two (79.2% response rate) stakeholders representing commissioning, provider and influencing (e.g. Local Professional Network) organisations completed the assessment tool. Pharmacy minor ailment services were rated as unsustainable across the majority of the domains. Elements within the domain 'Partnerships' demonstrated potential for sustainability. Stakeholder interviews provided detailed explanation for the low scoring sustainability domains, highlighting the multifaceted challenges threatening these services. CONCLUSION: The Programme Sustainability Assessment Tool allowed stakeholders to evaluate the potential of pharmacy minor ailment services in England. Follow-up interviews highlighted that initial design and implementation of services was poorly conceived and lacked evidence, thereby impeding the services' sustainability. There are many challenges facing a widespread provision of pharmacy ailment services, but it is clear the profession needs to be clear on the service objectives to secure future interest and investment.