The MEDMAN study : implementing change at the community pharmacy/general practice interface

Introduction Management of coronary heart disease (CHD), a major cause of mortality and morbidity in the UK, in primary care, remains sub-optimal. This work aimed to: evaluate impact of a community pharmacy-led intervention on appropriateness of treatment and quality of life of CHD patients; describe opinions and experiences of community pharmacists and GPs and use management of change literature as an explanatory framework for the findings. Methods The thesis comprises: two literature reviews (pharmacy-led interventions for CHD and NHS-based studies using change theories); an RCT evaluating the service; questionnaire surveys and qualitative interviews with community pharmacists and GPs, and comparison of a new model of change with two change theories. Results Review of pharmacy interventions revealed only small-scale studies demonstrating benefit for CHD patients. The change review revealed use of change management theories to implement change and as explanatory frameworks for change initiatives, in the NHS, but not in the pharmacy setting. The RCT recruited 1493 patients (980 intervention, 513 control), 70 pharmacies (102 pharmacists) and 48 practices (208 GPs). No significant differences were found in primary outcomes (appropriateness of treatment or quality of life). Questionnaires revealed positive attitudes to the service but need for pharmacist access to patient records and improved GP/community pharmacist relationships. Qualitative interviews indicated more divergent views. Attitudes were influenced by understanding and previous experience of medicines management, change drivers and implementation processes. Themes conceptualised into a ‘change readiness’ model, had similarities with Lewin’s planned change approach and Pettigrew’s receptivity model. All three models identified areas of sub-optimal intervention implementation and delivery. The new service did not improve appropriateness of treatment or quality of life because it was implemented and delivered sub-optimally. There is a need for greater use of an evidence based systematic approach to introduce new services, but research is required to confirm this approach would confer the hypothesised benefits.EThOS - Electronic Theses Online ServiceGBUnited Kingdo