Towards equity: a qualitative exploration of the implementation and impact of a digital educational intervention for pharmacy professionals in England

Latif, Asam; Waring, Justin; Pollock, Kristian; Solomon, Josie; Gulzar, Nargis; Choudhary, Shahida; Anderson, Claire

Abstract

Background
Patients belonging to marginalised (medically under-served) groups experience problems with medicines (i.e. non-adherence, side effects) and poorer health outcomes largely due to inequitable access to healthcare (arising from poor governance, cultural exclusion etc.). In order to promote service equity and outcomes for patients, the focus of this paper is to explore the implementation and impact of a new co-produced digital educational intervention on one National Health Service (NHS) funded community pharmacy medicines management service.

Methods
Semi-structured interviews with a total of 32 participants. This included a purposive sample of 22 community pharmacy professionals, (16 pharmacists and 6 pharmacy support staff) all who offered the medicine management service. In order to obtain a fuller picture of the barriers to learning, five professionals who were unable to complete the learning were also included. Ten patients (from a marginalised group) who had received the service (as a result of the digital educational intervention) were also interviewed. Drawing on an interpretative analysis, Normalisation Process Theory (NPT) was used as a theoretical framework.

Results
Three themes are explored. The first is how the digital learning intervention was implemented and applied. Despite being well received, pharmacists found it challenging completing and cascading the learning due to organisational constraints (e.g. lack of time, workload). Using the four NPT constructs (coherence, cognitive participation, collective action and reflexive monitoring) the second theme exposes the impact of the learning and the organisational process of ‘normalisation’. Professional reflective accounts revealed instances where inequitable access to health services were evident. Those completing the intervention felt more aware, capable and better equipped to engage with the needs of patients who were from a marginalised group. Operationally there was minimal structural change in service delivery constraining translation of learning to practice. The impact on patients, explored in our final theme, revealed that they experience significant disadvantage and problems with their medicines. The medication review was welcomed and the discussion with the pharmacist was helpful in addressing their medicine-related concerns.

Conclusions
The co-produced digital educational intervention increases pharmacy professionals’ awareness and motivation to engage with marginalised groups. However structural barriers often hindered translation into practice. Patients reported significant health and medicine challenges that were going unnoticed. They welcomed the additional support the medication review offered. Policy makers and employers should better enable and facilitate ways for pharmacy professionals to better engage with marginalised groups. The impact of the educational intervention on patients’ health and medicines management could be substantial if supported and promoted effectively.

Citation

Latif, A., Waring, J., Pollock, K., Solomon, J., Gulzar, N., Choudhary, S., & Anderson, C. (2019). Towards equity: a qualitative exploration of the implementation and impact of a digital educational intervention for pharmacy professionals in England. International Journal for Equity in Health, 18, Article 151. https://doi.org/10.1186/s12939-019-1069-0

• Journal Article Type: Article
• Acceptance Date: Sep 30, 2019
• Online Publication Date: Oct 12, 2019
• Publication Date: 2019-12
• Deposit Date: Nov 11, 2019
• Publicly Available Date: Nov 12, 2019
• Journal: International Journal for Equity in Health
• Electronic ISSN: 1475-9276
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 18
• Article Number: 151
• DOI: https://doi.org/10.1186/s12939-019-1069-0
• Keywords: Community pharmacy, Co-production, Digital learning, Medically under-served groups, Medicines use reviews (MURs), Normalisation process theory (NPT)
• Public URL: https://nottingham-repository.worktribe.com/output/3031378
• Publisher URL: https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-019-1069-0
• Additional Information: Received: 9 August 2019; Accepted: 30 September 2019; First Online: 12 October 2019; : Ethical approval was received from East Midlands Research Ethics Committee (REC reference: Derby 16/EM/0237) on 15th July 2015, along with governance clearance through the NHS Health Research Authority (HRA) (Nottingham, UK).; : Written Informed consent was obtained from all individual participants included in the study.; : The authors declare that they have no competing interests The funding sponsors had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results.
• Contract Date: Nov 12, 2019