Investigación participativa para el desarrollo de servicios farmacéuticos en farmacia comunitaria / participatory research for the development of community pharmacy services
- Franco Trigo, Lucía
- Daniel Sabater Hernández Director
- Fernando Martínez Martínez Co-director
Defence university: Universidad de Granada
Fecha de defensa: 19 September 2019
- María José Faus Dáder Chair
- María del Carmen Ramírez Tortosa Secretary
- Miguel Ángel Gastelurrutia Garralda Committee member
- Marcel L. Bouvy Committee member
- Mercedes Fernández Arévalo Committee member
Type: Thesis
Abstract
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. 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