الخلاصة

Abstract Introduction Improvement in patient safety is one of the most important considerations in modern healthcare systems. The improvement of warfarin outpatient therapy has attracted considerable attention. Evaluation studies of community pharmacy (CP) warfarin-based interventions have concluded that such interventions provide a more cost effective care approach with an opportunity to establish better relationships with patients and to improve patient knowledge. However, it has also been underlined that involving larger-scale intervention studies are essential to generalise the beneficial outcomes. This study examines the evaluation of a warfarin care bundle intervention (warfarin CBI) implemented by community pharmacies (CPs) in NHS Grampian and NHS Fife health boards. Aim To identify the drivers of success and challenges encountered by the CP teams involved in the Scottish Patient Safety Programme-Pharmacy in Primary Care (SPSP-PPC) collaborative during implementation of the warfarin CBI to inform future policy. Methods A mixed methods approach was used: all 12 CPs (five CPs from NHS Grampian and seven CPs from NHS Fife) deploying the intervention completed a High Risk Medicine (HRM) questionnaire (n= 21); one CP from each health board was identified to conduct an observational site visit and interview staff (n= 9). Results The case studies’ (CSs) findings were consistent with the results of HRM questionnaire in terms of developing the working skills and knowledge of pharmacy staff about warfarin therapy. Strengthening staff teamwork was also highlighted in the CSs although results of teamwork descriptive from HRM questionnaire showed that there was variation across the pharmacies in regard to strengthening teamwork. Staff in both case studies reported a perceived improvement in patient’s knowledge and relationship with the CP. The main challenges encountered during the implementation of the service included: the need to prepare locally tailored operating procedures; workload and time constrains. Moreover, issues with access to patients and patients’ yellow books and alert cards were flagged in NHS Grampian site whereas insufficient financial support was emphasised by one of NHS Fife site interviewees. Conclusion This work identified factors including working skills development and improvement of staff knowledge about warfarin along with positive patient response (in terms of therapy knowledge and relationships with the healthcare providers) as successful outcomes of the warfarin CBI. However, challenges included the need to set up additional pharmacy procedures and time constrains. It will be important to recognise and address these barriers in the design of any national rollout program and potential translation internationally of the warfarin CBI.