What works for whom in pharmacist-led smoking cessation support: realist review

BMC Medicine

Research Article

Fraser Macfarlane¹  Liz Steed¹  Robert Walton¹  Trisha Greenhalgh² 

[1] Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and The LondonSchool of Medicine and Dentistry, Queen Mary University of London, London, UK;Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK;

关键词: Smoking Cessation;    Community Pharmacy;    Community Pharmacist;    Smoking Cessation Intervention;    Pharmacy Practice;   

DOI  :  10.1186/s12916-016-0749-5

 received in 2016-10-07, accepted in 2016-11-14,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundNew models of primary care are needed to address funding and staffing pressures. We addressed the research question “what works for whom in what circumstances in relation to the role of community pharmacies in providing lifestyle interventions to support smoking cessation?”MethodsThis is a realist review conducted according to RAMESES standards. We began with a sample of 103 papers included in a quantitative review of community pharmacy intervention trials identified through systematic searching of seven databases. We supplemented this with additional papers: studies that had been excluded from the quantitative review but which provided rigorous and relevant additional data for realist theorising; citation chaining (pursuing reference lists and Google Scholar forward tracking of key papers); the ‘search similar citations’ function on PubMed. After mapping what research questions had been addressed by these studies and how, we undertook a realist analysis to identify and refine candidate theories about context-mechanism-outcome configurations.ResultsOur final sample consisted of 66 papers describing 74 studies (12 systematic reviews, 6 narrative reviews, 18 RCTs, 1 process detail of a RCT, 1 cost-effectiveness study, 12 evaluations of training, 10 surveys, 8 qualitative studies, 2 case studies, 2 business models, 1 development of complex intervention). Most studies had been undertaken in the field of pharmacy practice (pharmacists studying what pharmacists do) and demonstrated the success of pharmacist training in improving confidence, knowledge and (in many but not all studies) patient outcomes. Whilst a few empirical studies had applied psychological theories to account for behaviour change in pharmacists or people attempting to quit, we found no studies that had either developed or tested specific theoretical models to explore how pharmacists’ behaviour may be affected by organisational context. Because of the nature of the empirical data, only a provisional realist analysis was possible, consisting of five mechanisms (pharmacist identity, pharmacist capability, pharmacist motivation and clinician confidence and public trust). We offer hypotheses about how these mechanisms might play out differently in different contexts to account for the success, failure or partial success of pharmacy-based smoking cessation efforts.ConclusionSmoking cessation support from community pharmacists and their staff has been extensively studied, but few policy-relevant conclusions are possible. We recommend that further research should avoid duplicating existing literature on individual behaviour change; seek to study the organisational and system context and how this may shape, enable and constrain pharmacists’ extended role; and develop and test theory.

【 授权许可】

CC BY   
© The Author(s). 2016