Expected and experienced barriers for the implementation of sick day guidance in community pharmacies

Abstract

Background Patients with impaired renal function are at increased risk for acute kidney injury (AKI) during dehydration. Dehydration can occur during so called ‘sick days’ and or due to high environmental temperatures. In these situations certain medications should be adjusted as the risk for AKI is increased. Implementation of sick day guidance in primary care remains difficult.

Aim This study aimed to identify the expected and experienced barriers for the implementation of sick day guidance in Dutch community pharmacies.

Method Semi-structured interviews with community pharmacists were performed to identify expected barriers. The interviews were based on The Consolidated Framework for Implementation Research (CFIR), and were conducted by three researchers, mostly in duos. Interviews were recorded and transcribed verbatim using Amberscript. The coding was done in NVivo version 14. Experienced barriers were evaluated through monthly progress evaluations, which were performed by telephone.

Results A total of 24 pharmacies participated. Pharmacists mostly mentioned barriers associated with highworkload, staff shortages and recognition of sick days by pharmacy technicians. Additionally, the challenging communication with home care organisations, the limited trust of general practitioners and patients in the pharmacists and the cognitive limitations of the patients were also noted.

Conclusion This study identified multiple barriers that impede the implementation of sick day guidance in community pharmacies. These findings highlight the need for tailored implementation strategies focused on integration into existing work processes and involvement of pharmacist technicians and home care