Evaluate the effects of the implementation of clinical guidelines on community pharmacy practice. Describe and assess the effectiveness of the types of implementation strategies used.
Electronic databases Medline, EMBASE, CINAHL Plus, Web of Science, Informit and the Cochrane Library will be searched. The search strategy for Medline is available in the published protocol. The search terms will be adapted for use with other bibliographic databases.
No restrictions on language or publication period will be used during database search, although only articles printed in English will be included in the final selection. Reference lists of final articles selected will also be screened.
Pharmacy practice research is relatively new and the methodologies in this field are still being refined. In many instances it is not feasible to conduct randomized controlled trials (RCTs). This review will therefore include all original research involving an intervention (the implementation of clinical guidelines to pharmacists) and subsequent assessment. This may encompass experimental, quasi-experimental, intervention and observational study design. Clinical guidelines for the purposes of this review are defined as:
“Systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances”
Condition or domain being studied
Clinical guidelines aim to improve patient health care by shifting the practice of health professionals towards evidence-based medicine. Much effort in recent years has been put into the development of clinical guidelines, however this does not necessarily translate to practitioner uptake and adherence. Recent research in Australia indicates that patients receive appropriate, evidence based care, on average, only 57% of the time.
Worldwide, community pharmacy practice is gradually evolving to incorporate health service delivery and a greater focus on patient care. Legislative changes to medicine scheduling and remuneration models in Australia have contributed to the shift in practice. In response to these practice changes there has been an increase in development of clinical guidelines for use in community pharmacy.
However, little is known about the implementation of clinical guidelines in community pharmacy and their impact on the practice of pharmacists and the patients they treat.
Pharmacists operating in community pharmacies
Interventions involving the implementation of clinical guidelines to pharmacists that:
• Report implementation and dissemination strategies
• Aim to influence “practice behaviour” of pharmacists towards guideline adherence
“Patient programmes” where the intervention was directed to patients and not community pharmacists
Outcome measures of interest in guideline implementation will include, but will not be restricted to the following:
• Practice assessments in pharmacists e.g. adherence to guidelines; appropriate patient referral; appropriate product supply (as per guidelines)
• Patient health measures (including clinical measures and self-reported humanistic measures e.g. quality of life)
• Economic evaluations
Qualitative measures e.g. practitioner attitudes towards guideline adherence, patient satisfaction
Data extraction, (selection and coding)
Two authors will independently screen the articles retrieved from the databases, using the outlined search strategy. They will compare their final list of studies for inclusion in the review and any discrepancies will be resolved by consensus and mediation by a third author if required.
A modified version of a NICE evidence table will be used to tabulate extracted data. Two authors will independently complete the table and a final version will be achieved by consensus.
Risk of bias (quality) assessment
It is anticipated most of the studies will be quasi-experimental controlled before and after trials. Therefore the criteria to assess bias will be based on that suggested by the Cochrane Effective Practice and Organisation of Care (EPOC) group. Nine standard criteria are suggested:
• Was the allocation sequence adequately generated?
• Was the allocation adequately concealed?
• Were the baseline outcome measurements similar?
• Were baseline characteristics similar?
• Were incomplete data adequately addressed?
• Was knowledge of the allocated interventions adequately prevented during the study?
• Was the study adequately protected against contamination?
• Was the study free from selective outcome reporting?
• Was the study free from other risks of bias?
This assessment provides for studies to be judged under each criteria and overall as “low risk”, “high risk” or “unclear risk”
Strategy for data synthesis
A narrative synthesis of studies is anticipated to include findings such as; the type of intervention, details of the intervention and outcomes measured. Intervention effects for each study will be measured using risk ratios (for dichotomous outcomes) or standardized mean differences (for continuous outcomes). Meta-analysis will be considered if articles are deemed homogeneous. Heterogeneity of these articles will be evaluated using the I2 statistic. Meta-analysis will not be performed if a value of greater than 0.5 is obtained.
Analysis of subgroups or subsets
We intend to publish the results of this review in a peer-reviewed journal
Contact details for further information
The University of Western Australia,
The School of Medicine and Pharmacology
35 Stirling Highway
Organisational affiliation of the review
The University of Western Australia (UWA); Aston University, Birmingham United Kingdom
Ms Kim Watkins, The University of Western Australia Mr Ajay Karia, The University of Western Australia Dr Carl Schneider, Aston University, Birmingham Professor Peter Kendall, Fremantle Hospital, Western Australia Dr Rhonda Clifford, The University of Western Australia
Anticipated or actual start date
15 August 2012
Anticipated completion date
31 December 2012
The University of Western Australia
Conflicts of interest
Subject index terms status
Subject indexing assigned by CRD
Subject index terms
Community Pharmacy Services; Humans; Practice Guidelines as Topic
Date of registration in PROSPERO
27 September 2012
Date of publication of this revision
27 September 2012
Stage of review at time of this submission
Piloting of the study selection process
Formal screening of search results against eligibility criteria
Risk of bias (quality) assessment
PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites.