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 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 (PCA) 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.

Randomized Trials of Retosiban Versus Placebo or Atosiban in Spontaneous Preterm Labor

Objective The aim of this study is to assess the efficacy and safety of retosiban in spontaneous preterm labor (sPTL). Study Design Two multicenter, randomized, and double-blind trials compared retosiban with placebo and retosiban with atosiban in women with a singleton pregnancy and intact membranes in sPTL at 24 to 336/7 weeks' gestation. Coprimary endpoints in the placebo-controlled trial were time to delivery (TTD) or treatment failure (whichever occurred first) and neonatal composite morbidity and mortality. The primary endpoint of the atosiban comparator trial was TTD. Results The trials were terminated early because of slow recruitment. The placebo-controlled trial enrolled 23 participants (February 2016–July 2017; 2.6% of target);the atosiban-comparator trial enrolled 97 (March 2015–August 2017; 29% of target). Baseline participant characteristics were similar between treatments. In the placebo-controlled trial, mean gestational ages at randomization were 30.8 (retosiban, n = 10) and 30.5 weeks (placebo, n = 13), and mean times to delivery/treatment failure were 18.9 days (retosiban) and 11.1 days (placebo). Two and four neonates in the retosiban and placebo groups, respectively, had ≥1 component of the neonatal composite endpoint. In the atosiban-comparator trial, mean gestational age at randomization was 31.5 weeks (for both retosiban, n = 47, and atosiban, n = 50), and adjusted mean TTDs were 32.51 days (retosiban) and 33.71 days (atosiban; p > 0.05). Adverse events were no more common with retosiban than placebo or atosiban. Conclusion Despite considerable efforts to conduct two adequate and well-controlled studies in patients with sPTL, both studies were unable to recruit effectively and consequently terminated prematurely. Key factors negatively affecting participation were patient and physician resistance to use of a placebo comparator, lack of investigator consensus on diagnostic criteria and acceptance of protocol procedures, and ethics committee decisions. Meaningful cooperation between pharmaceutical companies, regulatory authorities, and the obstetric community is essential for future development of drugs to treat sPTL.

P102: Perspectives surrounding paediatric procedural sedation using intranasal ketamine administration: a qualitative study of emergency nurses

Introduction: Intranasal ketamine (INK) has an emerging role for procedural sedation (PSA) in children in the emergency department (ED). While INK is less invasive and requires fewer personnel than IV ketamine, widespread adoption in the paediatric ED would require strong nursing acceptance. To inform INK implementation strategies, we explored nursing perspectives surrounding INK, including perceived barriers to its adoption. Methods: Nurses in the paediatric ED of London Health Sciences Centre, London, Ontario were recruited by email. Two, one-hour, in-person focus groups were conducted on January 26 and February 2, 2018 using a semi-structured interview format. Transcription was performed by a professional medical transcription service and analyzed using an inductive qualitative approach involving code words corresponding to recurring topics. Thematic analysis was used to group similar codes into themes. The analytic process was managed using the NVivo 11 software package. Results: Results: Eight nurses participated. All nurses were female and had a mean of 8.9 (range: 2.5 - 26) years of pediatric emergency nursing experience. Seven nurses had experience monitoring and administering INK to children for PSA. Five themes emerged: 1) attributes of INK, 2) INK effects on patients and families, 3) INK effects on health care providers, 4) INK effects on the ED environment, and 5) uncertainty regarding INK's effectiveness, predictability, and fit into institutional sedation protocols. Subthemes included 1) perceptions that INK produced a relatively shallower, slower-onset, and/or less titratable sedation, 2) the importance of patient cooperation (i.e. INK may be preferred by providers for older patients undergoing relatively painful or long procedures), 3) belief that INK was an effective anxiolytic and sedative with the potential to improve nursing resource utilization, and 4) belief that physician resistance to change and lack of personal familiarity were barriers to adoption. Conclusion: Conclusions: We identified clinical advantages to using INK in children, the importance of selecting appropriate patients, and barriers to widespread INK adoption. Importantly, our findings highlighted uncertainty about INK's effectiveness and incorporation into sedation protocols. Our findings will inform future knowledge translation strategies when implementing INK in the clinical setting.

Change management overlooked: physician perspectives on EHR implementation

PurposeThe purpose of this paper is to gain understanding into the human factors which might impede the change process. Change is inevitable in contemporary organizations and particularly within the healthcare field with respect to information technology (IT). Regardless of the amount of literature surrounding change management process organizational leaders will often ignore the human factors associated with the introduction of new IT.Design/methodology/approachThis study sought to examine physician resistance surrounding the Electronic health record (EHR) change process through the lens of each of these three aspects of the Bovey and Hede (2001a) model through semi-structured interviews with physicians. Semi-structured interviews were conducted with physicians from hospitals within the Midwest.FindingsThe findings suggest that physicians have been impacted by the EHR change management system within their hospitals. Though each of the participants experienced different issues; it was clear from the data the change to an EHR system was disruptive to their day-to-day routines and caused various challenges. EHR change management research demonstrates physicians are resisting the change despite recognizing its potential benefits.Originality/valueThis paper contributes to the change management literature by examining how physician resistance can have a negative impact on healthcare organizations during a precipitous technology change. The study also provides a unique understanding of how technology resistance can disrupt an organizational change process.

Electronic Health Record (EHR) Diffusion and an Examination of Physician Resistance

Since the enactment of the United States Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, there has been substantial progress in the diffusion of electronic health record (EHR) systems in medical clinics throughout the United States. Many physicians, however, continue to resist adopting EHR technology despite several accepted, long-term benefits and available government-sponsored financial incentives. The objective of this chapter is to provide insight into the question as to why physicians are resistant to adopting EHR technology. This chapter details several of the benefits of EHR systems and uses a systematic review of literature to critically analyze and detail the most common perceived physician barriers to the adoption of EHRs. With the awareness of the major physician barriers to the adoption of EHR technology, stakeholders and policymakers can address barriers and pursue actions to mitigate or reduce physician resistance to achieve nationwide diffusion targets and pursue initiatives to digitize all patient records.

Sociological Perspectives on Improving Medical Diagnosis Emphasizing CAD

Healthcare costs worldwide are increasing because of new medicines, new techniques, and more expensive and extensive research on diseases. It is essential that healthcare delivery systems be implemented that take advantage of these advances in a cost-effective economic manner. One critical aspect of the healthcare delivery system is the improvement in diagnosis of disease. This chapter emphasizes diagnosis and the need to collect key patient information (pivotal information) at the earliest possible point in the patient's disease process and put such pivotal information in physicians' hands. There is a potential for huge benefits in cost savings and greater effectiveness of treatment from these actions, but challenges must be overcome to realize their full benefits. The major problems include (1) market incentives in the current healthcare system, which fail to encourage collecting pivotal medical information as early as possible, (2) physician resistance to some of these ideas, and (3) technical and ethical problems that remain to be solved.