Implementing cognitive services in community pharmacy: a review of models and frameworks for change

Abstract

Objective: To investigate models and frameworks for the implementation of cognitive pharmaceutical services (CPS) in community pharmacy. Method: Relevant literature published in English was identified through searches of online data-bases (no date limits), texts, conference proceedings, and bibliographies of identified literature. Literature that involved a discussion of models or frameworks for community pharmacy practice change in relation to the implementation of CPS was selected for review. Many of the identified studies were conceptual in nature, and although they were selected in the same way as the empirical research papers, were not able to be critically reviewed in an equivalent manner. A narrative, rather than systematic review, was considered more appropriate. Key findings: Many of the identified models focused on specific services, seeming to overlook the complexity of the implementation process. Many relied on behavioural theories, with an assumption that changing pharmacists' knowledge, skills or attitude will automatically result in successful change, often ignoring organisational aspects of change. Models that included business aspects remain largely untested, and where testing occurred sample sizes were generally small and populations conveniently or purpo sively sampled, limiting the generalisability of the findings. Conclusion: The factors affecting change are more than just those confined to the individual pharmacist who is providing a service, and the implementation process is more complex, involving a range of organisational factors. Research is needed to identify the key elements of a framework for how new CPS should be implemented and delivered. © 2006 The Authors.