Assessing the comparative effectiveness of implementation strategies for professional services to community pharmacy: A systematic review

Abstract

Background: Despite the growth of research in how professional services are implemented in the community pharmacy setting, there is limited evidence for which implementation strategy is more effective.

Objective: The aim of this review was to assess the evidence for the comparative effectiveness of implementation strategies for pharmacist delivered professional services in the community pharmacy.

Methods: Studies comparing implementation strategies published in the last 13 years in English were extracted via four databases, combining the topics of 'pharmacy', 'pharmacy services' and 'implementation'. Experimental studies with quantitative evaluation of two or more implementation strategies were included. Selected studies were screened through three internationally recognised tools, two focusing on implementation: quality of evidence (Cochrane Qualitative & Implementation Methods Group), reporting standards (Standards for Reporting Implementation Studies - StaRI), and one assessing the risk of bias (The Risk of Bias in Non-randomised Studies of Interventions).

Results: Six studies were identified, assessing the implementation of services improving use of medicines (n = 2), primary care and public health services (n = 3), and one study evaluating the implementation of services in both categories. Some form of staff training was demonstrated to be more effective (n = 4). The risk of bias ranged from moderate to critical. With respect to reporting on StaRI tool items, the mention of these was, in the majority, indirect. Items such as harms and published protocols and economic evaluation were not reported in any of the studies included in the final review, highlighting opportunities for improvement.

Conclusions: Training may be superior for implementation of professional services to community pharmacies, although this finding is limited by a moderate to critical risk of bias. A recommendation to researchers is for the greater use of comparative implementation study designs that reflect recognised reporting, quality and validity tools.

Registration: None.

Keywords: Bias; Community pharmacy; Implementation strategy; Intervention; Professional services; Reporting.