Investigación participativa para el desarrollo de servicios farmacéuticos en farmacia comunitaria / participatory research for the development of community pharmacy services
- Autores: Lucía Franco Trigo
- Directores de la Tesis: Daniel Sabater Hernández (dir. tes.), Fernando Martínez Martínez (codir. tes.)
- Lectura: En la Universidad de Granada ( España ) en 2019
- Idioma: español
- Tribunal Calificador de la Tesis: María José Faus Dáder (presid.), María del Carmen Ramírez Tortosa (secret.), Marcel L. Bouvy (voc.), Mercedes Fernández Arévalo (voc.), Miguel Ángel Gastelurrutia Garralda (voc.)
- Programa de doctorado: Programa de Doctorado en Medicina Clínica y Salud Pública por la Universidad de Granada
- Materias:
- Texto completo no disponible (Saber más ...)
- Resumen
Joint doctoral degree: University of Technology Sydney (Australia) & University of Granada (Spain) Doctorado conjunto entre la University of Technology Sydney (Australia) y la Universidad de Granada (España).
Teseo summary (English) When developing, implementing and evaluating a community pharmacy service (CPS), it is critical to involve and engage the individuals, groups and/or organisations that may be affected by, have an influence on, or have an interest in, the health issues or needs addressed by such a service (i.e., stakeholders). Selecting key stakeholders with varied roles and perspectives and bringing them together from the initial steps of the planning process, increases the potential of a service to respond to real needs, to be accepted and, ultimately, to become integrated into practice. Therefore, understanding how to perform the initial steps of a collaborative planning process for a CPS could be considered of paramount importance to its success.
The general objective of this thesis was to generate knowledge on collaboratively planning of CPSs and to put into practice the initial steps of the development of a CPS aimed at preventing cardiovascular disease. These initial steps were explored through the use of stakeholder analysis, which assisted in identifying and analysing the stakeholders involved, and through the development of a stakeholder-shared vision, which assisted in establishing a common ground and focusing planning efforts. The thesis is composed of four research studies presented as chapters with the following specific objectives, methods and results.
First, Stakeholder Analysis in Health Innovation Planning Processes: A Systematic Scoping Review gathered existing evidence on the use of stakeholder analysis over the planning process of health innovations. The findings showed that stakeholder analyses are conducted worldwide, are used in all types of health innovations including health services and are applied in all phases of planning processes. Heterogeneity characterised stakeholder analysis in terms of the steps of the analysis, the methods used, stakeholder attributes and the reporting of analyses. The RISA tool was proposed as a guideline to foster the systematic reporting of stakeholder analyses.
Second, Stakeholder Analysis for the Development of a Community Pharmacy Service Aimed at Preventing Cardiovascular Disease reported on a stakeholder analysis performed in New South Wales, Australia. Potential stakeholders for a planning group aiming to develop a cardiovascular disease-prevention CPS were identified and differentiated during a workshop. Out of the 46 stakeholders identified, 12 were considered key stakeholders because of their potential to drive or hinder the development of the service. Secondary results of this study included the identification of current needs and gaps in cardiovascular care (n=6), roles for community pharmacists in cardiovascular prevention (n=12) and potential factors that can hinder the integration of CPS into practice (n=7).
Third, Collaborative Health Service Planning: A Stakeholder Analysis with Social Network Analysis to Develop a Community Pharmacy Service reported on a stakeholder analysis carried out in Andalucía, Spain, for the development of a cardiovascular disease-prevention CPS. On this occasion, key informant interviews, the snowballing technique and an online web-based questionnaire were used to identify stakeholders, differentiate them and analyse their relationships. As a result, 217 stakeholders were identified, of which 57 were considered critical after analysis. An existing collaboration network between stakeholders was revealed. The results provided an understanding of which stakeholders were relevant to the different phases of the planning process and how their capacities and willingness to contribute pointed to the feasibility of the collaborative development of the service.
Fourth, A Stakeholder Visioning Exercise to Enhance Chronic Care and the Integration of Community Pharmacy Services presented the next step in the planning process: the development of a stakeholder-shared vision. Thirteen stakeholders participated in a workshop to develop a vision of a cardiovascular care model that integrated community pharmacists. They also identified the initiatives they considered necessary to achieve this vision. Stakeholders reframed the objective of the study to develop a vision focused on chronic disease rather than just cardiovascular disease. Seven general principles of care and six environmental factors that can influence the implementation of these principles were identified by the stakeholders and combined to produce a preliminary model of chronic care (the New South Wales model for chronic care). Twenty-four specific initiatives to achieve this vision were identified, of which enhancing teamwork and conducting needs assessments were considered by stakeholders to be the main priority.
In conclusion, this thesis contributed to the knowledge of CPS planning processes by demonstrating the usefulness of stakeholder analyses and shared visions in initiating such processes. Likewise, it proved that stakeholder analyses are valuable in the other phases of the planning process. The research highlighted the number and variety of stakeholders that should be taken into account and the importance of stakeholder participation since the early phases of the process. As a product of this thesis, detailed reports were produced on the first two steps of the CPS collaborative planning process and two tools were generated that other researchers and planners can use in their work. One of them is the RISA tool, which is a guideline for systematising reports on stakeholder analyses, and the other is the New South Wales Model for Chronic Care, whose structure may facilitate the context analysis in future planning processes. This research explained the utility and part of the complexity that involves the participation of actors in the collaborative planning of CPS. Future research could increase knowledge in this area by exploring stakeholder engagement throughout the remaining phases of the planning process. Of particular interest are ways of dealing with power relationships and conflict among stakeholders to ensure that collaborations are successful.
Resumen Teseo (Español) A la hora de desarrollar, implantar y evaluar un servicio profesional farmacéutico asistencial (SPFA), es crítico involucrar a los individuos, grupos y/u organizaciones que podrían verse afectados, tener influencia o interés sobre los problemas o necesidades de salud abordados por dicho servicio (en adelante denominados actores como equivalente al término stakeholders utilizado en inglés). Seleccionar actores clave con funciones y perspectivas variadas, y reunirlos desde los pasos iniciales del proceso de planificación, aumenta el potencial del servicio para responder a necesidades reales, para ser aceptado y, en última instancia, para que sea integrado en la práctica. Por tanto, entender cómo llevar a cabo los pasos iniciales de un proceso de planificación participativo para un SPFA es de suma importancia para su éxito.
El objetivo general de esta tesis fue generar conocimiento en la planificación colaborativa de los SPFA y poner en práctica los pasos iniciales del desarrollo de un SPFA orientado a la prevención de la enfermedad cardiovascular. Estos pasos iniciales se exploraron a través del uso de análisis de actores, que ayudó a identificar y analizar a los actores involucrados, y a través del desarrollo de una visión conjunta entre los actores, que ayudó a establecer una base común y centrar los esfuerzos de planificación. Para ello, se llevaron a cabo cuatro estudios de investigación que se presentan como capítulos con los objetivos, métodos y resultados descritos a continuación: En el primero, Stakeholder Analysis in Health Innovation Planning Processes: A Systematic Scoping Review, se reunieron las pruebas existentes sobre el uso del análisis de actores a lo largo del proceso de planificación de innovaciones en salud. Los resultados mostraron que los análisis de actores se llevan a cabo en todo el mundo, se utilizan para todos los tipos de innovaciones en salud, incluidos los servicios sanitarios, y se aplican en todas las fases del proceso de planificación. La heterogeneidad caracterizó a los análisis de actores en cuanto a los pasos utilizados para realizar dicho análisis, los métodos utilizados, los atributos de los actores que se analizaron y la forma de reportar los análisis. Se propuso la guía RISA para potenciar la descripción sistemática de los análisis de actores.
En el segundo, Stakeholder Analysis for the Development of a Community Pharmacy Service Aimed at Preventing Cardiovascular Disease, se realizó un análisis de actores en New South Wales, Australia. En un taller se identificaron y diferenciaron actores que podrían formar parte de un grupo de planificación para desarrollar un SPFA orientado a la prevención cardiovascular. De los 46 actores identificados, 12 fueron considerados actores clave debido a su potencial para impulsar u obstaculizar el desarrollo del servicio. Los resultados secundarios de este estudio incluyeron la identificación de seis carencias y necesidades actuales en el cuidado cardiovascular, 12 papeles que los farmacéuticos comunitarios podrían jugar en prevención cardiovascular y siete factores que podrían obstaculizar la integración de los SPFA en la práctica.
En el tercero, Collaborative Health Service Planning: A Stakeholder Analysis with Social Network Analysis to Develop a Community Pharmacy Service, se realizó un análisis de actores en Andalucía, España, para el desarrollo de un SPFA orientado a la prevención cardiovascular. En esta ocasión se utilizaron entrevistas a actores clave, la técnica de la bola de nieve y un cuestionario en línea para identificar actores, diferenciarlos y analizar las relaciones entre ellos. Como resultado, se identificaron 217 actores, de los que 57 se consideraron críticos tras el análisis. Se puso de manifiesto la existencia de una red de colaboración entre los actores. Los resultados permiten entender qué actores son relevantes para el proceso de planificación y como sus habilidades y voluntad para contribuir apuntan hacia la factibilidad del desarrollo participativo del servicio.
En el cuarto, A Stakeholder Visioning Exercise to Enhance Chronic Care and the Integration of Community Pharmacy Services, se presentó el siguiente paso en el proceso de planificación: el desarrollo de una visión conjunta entre los actores. Trece actores participaron en un taller para desarrollar una visión de un modelo de cuidado cardiovascular integrando a los farmacéuticos comunitarios. Asimismo, identificaron las iniciativas que consideraron necesarias para alcanzar dicha visión. En primer lugar, los actores ampliaron el alcance de la visión para centrarse finalmente en enfermedades crónicas en general. Se identificaron siete principios de cuidado y seis factores ambientales que pueden influir en la implantación de estos principios que se combinaron para producir un modelo preliminar de cuidado crónico (el modelo New South Wales de cuidado crónico). Se identificaron 24 iniciativas para alcanzar esta visión, de las que los actores consideraron prioritarias mejorar el trabajo en equipo y realizar un análisis de necesidades.
En conclusión, esta tesis ha contribuido a generar conocimiento sobre los procesos de planificación colaborativos de SPFA, demostrando la utilidad de los análisis de actores y del desarrollo de una visión conjunta como modo de poner en marcha tales procesos. Además, ha probado que los análisis de actores también son de utilidad en las otras fases del proceso de planificación. La investigación ha mostrado la cantidad y variedad de actores que se deben tener en cuenta y la importancia de su participación desde las etapas iniciales del proceso. Como producto de esta tesis, se generaron informes detallados de los dos primeros pasos del proceso de planificación colaborativa de SPFA y dos herramientas que pueden utilizar otros investigadores y planificadores en su trabajo. Una de estas herramientas es la guía RISA para sistematizar las descripciones de análisis de actores y la otra el modelo New South Wales de cuidado crónico, cuya estructura puede facilitar el análisis del contexto en futuros procesos de planificación. Con este trabajo, se ha explicado la utilidad y parte de la complejidad que conlleva la participación de actores en la planificación colaborativa de SPFA. Sería beneficioso que en un futuro se aumentase el conocimiento en este área explorando la involucración de actores a lo largo de las demás fases del proceso de planificación. Tendría especial interés investigar los métodos para lidiar con las relaciones de poder y los conflictos entre actores para asegurar el éxito de las colaboraciones.
Main bibliography / Principal bibliografía 1. Ackermann F, Eden C. Strategic management of stakeholders: Theory and practice. Long Range Plan. 2011;44:179-196.
2. Arksey H, O'Malley L. Scoping studies: Towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19-32.
3. Bartholomew LK, Parcel GS, Kok G, Gottlieb NH, Fernández ME. Planning Health Promotion Programs: An Intervention Mapping Approach. 3rd ed. San Francisco, CA: Jossey-Bass; 2011.
4. Bengtsson M. How to plan and perform a qualitative study using content analysis. NursPlus Open. 2016;2:8-14.
5. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. Jama. 2002;288:1775-1779.
6. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness: the chronic care model, Part 2. Jama. 2002;288(15):1909-1914.
7. Boomer C, Collin I, McCormack B. ‘I have a dream’: A process for visioning in practice development. Pract Dev Health Care. 2008;7:70-78.
8. Borgatti SP, Everett MG, Johnson JC. Analyzing Social Networks. London, Thousand Oaks, New Delhi, Singapore: Sage; 2013.
9. Brugha R, Varvasovszky Z. Stakeholder analysis: a review. Health Policy Plan. 2000;15:239-246.
10. Bryman A. Social Research Methods. 4th ed. New York: Oxford university press Inc; 2012.
11. Bryson JM, Patton MQ, Bowman RA. Working with evaluation stakeholders: A rationale, step-wise approach and toolkit. Eval Program Plan. 2011;34:1-12.
12. Bryson JM, Quick KS, Slotterback CS, Crosby BC. Designing public participation processes. Public Adm Rev. 2013;73:23-34.
13. Bryson JM. What to do when stakeholders matter: Stakeholder identification and analysis techniques. Public Manag Rev. 2004;6:21-53.
14. Caniato M, Vaccari M, Visvanathan C, Zurbrugg C. Using social network and stakeholder analysis to help evaluate infectious waste management: A step towards a holistic assessment. Waste Manag. 2014;34:938-951.
15. Cargo M, Mercer SL. The value and challenges of participatory research: Strengthening its practice. Annu Rev Public Health. 2008;29:325-350.
16. Cho JY, Lee E-H. Reducing confusion about grounded theory and qualitative content analysis: Similarities and differences. Qual Rep. 2014;19:1.
17. Colquhoun HL, Levac D, O'Brien KK, Straus S, Tricco AC, Perrier L, et al. Scoping reviews: Time for clarity in definition, methods, and reporting. J Clin Epidemiol. 2014;67(12):1291-4.
18. Costenbader E, Valente TW. The stability of centrality measures when networks are sampled. Soc Netw. 2003;25:283-307.
19. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: The new Medical Research Council guidance. Bmj. 2008;337:a1655.
20. Freeman LC. Centrality in social networks conceptual clarification. Soc Netw. 1978;1:215-239.
21. Freeman RE. Strategic Management: a Stakeholder Approach. Boston, Massachusetts: Pitman; 1984.
22. Gilmour J, Beilin R. Stakeholder mapping for effective risk communication: Australian Centre for Excellence in Risk Analysis; 2007 [Available from: https://cebra.unimelb.edu.au/__data/assets/pdf_file/0006/2220990/gilmour0609.pdf] [Accessed 2018, June 27].
23. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurs Educ Today. 2004;24:105-112.
24. Green L, Kreuter M. Health Program Planning: An Educational and Ecological Approach. 4th ed. Boston: McGraw-Hill; 2005.
25. Hinchcliff R, Greenfield D, Braithwaite J. Is it worth engaging in multi-stakeholder health services research collaborations? Reflections on key benefits, challenges and enabling mechanisms. Int J Qual Health Care. 2014;26:124-128.
26. Levac D, Colquhoun H, O'Brien KK. Scoping studies: Advancing the methodology. Implement Sci. 2010;5:69.
27. Lienert J, Schnetzer F, Ingold K. Stakeholder analysis combined with social network analysis provides fine-grained insights into water infrastructure planning processes. J Environ Manag. 2013;125:134-148.
28. Luyet V, Schlaepfer R, Parlange MB, Buttler A. A framework to implement stakeholder participation in environmental projects. J Environ Manag. 2012;111:213-219.
29. McKenzie JF, Neiger BL, Thackeray R. Planning, Implementing & Evaluating Health Promotion Programs, A Primer: 7th ed. United States, WA: Pearson; 2016.
30. Meadows M, O’Brien F. Under pressure: Visioning in a regulated environment. Systemic Practice and Action Research. 2006;19(6):537-551 31. Mendis S, Puska P, Norrving B. Global atlas on cardiovascular disease prevention and control: World Health Organization; Geneva 2011.
32. Nanus B. Leading the vision team. The Futurist. 1996;30(3):20.
33. National Association of County & City Health Officials. Visioning. Mobilizing for Action through Planning and Partnerships (MAPP). http://archived.naccho.org/topics/infrastructure/mapp/upload/visioning_full.pdf; 2016 Accessed September 05, 2016.
34. O'Brien F, Meadows M. Corporate visioning: A survey of UK practice. J Operational Research Society. 2000;51:36-44.
35. Peters MD, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews. International journal of evidence-based healthcare. 2015;13(3):141-6.
36. Preskill H, Jones N. A Practical Guide for Engaging Stakeholders in Developing Evaluation Questions. Robert Wood Johnson Foundation Evaluation Series: Robert Wood Johnson Foundation; 2009. http://www.pointk.org/resources/files/rwj.stakeholders.final.1.pdf Accessed March 25, 2019.
37. Reed M, Curzon R. Stakeholder mapping for the governance of biosecurity: a literature review. J Integr Environ Sci. 2015;12:15-38.
38. Reed M, Graves A, Dandy N, et al. Who’s in and why? A typology of stakeholder analysis methods for natural resource management. J Environ Manag. 2009;90:1933-1949.
39. Sabater-Hernández D, Moullin J, Hossain L, et al. Intervention mapping for developing pharmacy-based services and health programs: A theoretical approach. Am J Health-Syst Pharm. 2016;73:156-164.
40. Sabater-Hernández D, Sabater Galindo M, Fernandez-Llimos F, et al. A systematic review of evidence-based community pharmacy services aimed at the prevention of cardiovascular diseases. J Manag Care Spec Pharm 2016;22(6):699-713.
41. Schoen MW, Moreland-Russell S, Prewitt K, Carothers BJ. Social network analysis of public health programs to measure partnership. Soc Sci Med. 2014;123:90-95.
42. Scott J. Social Network Analysis. 4th, ed. London, Thousand Oaks, New Delhi, Singapore: Sage; 2017.
43. Stewart JM. Future state visioning—A powerful leadership process. Long range planning. 1993;26(6):89-98.
44. Varvasovszky Z, Brugha R. A stakeholder analysis. Health Policy Plan. 2000;15:338-345.
45. Ziegler W. Envisioning the future. Futures. 1991;23:516-527.
