An Investigation into the Factors that Influence the Implementation of Clinical Pharmacy Services in Hospital Paediatric Care in Hong Kong

Abstract

The role of paediatric clinical pharmacists in secondary care has a positive influence on patient care through their contributions and interventions. However, the contextual variation in healthcare settings has affected the uptake and sustainability of clinical pharmacy services, thereby causing them to be inconsistently implemented. In Hong Kong, although paediatric clinical pharmacy service has been delivered for almost a decade in the public sector, little is known about how it has been implemented, and the factors that influenced the implementation of the service. A systematic review was undertaken to identify factors that influence the implementation of paediatric clinical pharmacy service from service users’ perspectives in hospital settings across the literature. The findings of the systematic review helped to deliver a meticulous summary of evidence available in the literature and facilitated the design of interview guides for the qualitative studies. Three qualitative studies were conducted to identify factors that influenced the implementation of paediatric clinical pharmacy service in Hong Kong with three subgroups using semi-structured interviews. These groups were clinical pharmacists, physicians and nurses, and parents, caregivers, and former patients. The data were then synthesised and analysed using a framework approach. The main facilitators that enabled paediatric clinical pharmacy service implementation in Hong Kong include the support from physicians, nurses, and parents, direct and coherent communication between healthcare professionals, and clinical pharmacists filling the clinical gap as medicine information providers. Barriers that were identified that hindered service implementation include a lack of a patient-focused approach, limited availability of clinical pharmacists, a culture of medical dominance, and the need for a better understanding of the role of clinical pharmacists. Improving implementation of paediatric clinical pharmacy service in Hong Kong appeared to be a crucial issue for policy and practice, and the strategies developed through these factors should be evaluated in future studies to assess the uptake and sustainability of the implemented services.