A randomized controlled study of practice facilitation to improve the provision of medication management services in Alberta community pharmacies

BackgroundThe provision of medication management (MM) services by community pharmacists has not been as widely implemented as expected. The Promoting Action on Research Implementation in Health Services framework proposes that in addition to evidence of benefit and a practice context conducive to change, health professionals benefit from facilitation to support their efforts. However, the impact of facilitation on patient care services in community pharmacy has not been studied.ObjectiveThe primary objective of this study was to explore the needs of community pharmacists in improving the provision of MM services to patients, and secondarily to use external facilitation to support pharmacies in increasing the number of MM services provided.MethodsTen community pharmacies in Alberta, Canada were randomized to external task-focused facilitation or usual practice. Facilitators interviewed staff of each intervention pharmacy to determine current workflow and barriers and facilitators to service provision, and collaborated to address these site-specific barriers over 6 months.ResultsBarriers identified by all intervention sites related to the impact of MM on dispensing, lengthy documentation, inefficient use of follow-up opportunities to address lower-priority concerns, and inconsistent patient identification. Strategies to address these barriers were generally well received by sites, which noted that facilitation improved staff communication and encouraged reflection on current practices; however, MM counts across both groups decreased over the intervention versus baseline. This decline was likely due to the unanticipated effect of the influenza vaccination season occurring concurrently with the intervention period.ConclusionsExternal facilitation appears to be a feasible and acceptable method to support community pharmacy provision of MM services. However, as the scope of pharmacists' practice increases, serious consideration of how, and when, these services can be consistently offered must be made. Relevant stakeholders should consider strategies to mitigate the barriers identified in this study when introducing new services or evaluating existing programs to ensure their uptake within existing workflow demands.Clinical trial registrationClinicaltrials.gov identifier NCT02191111.