The application of implementation science to the design, test and scale up of high risk medicine care bundles

Student thesis: Doctoral Thesis


Warfarin and non-steroidal anti-inflammatory drugs (NSAIDs) result in preventable adverse effects and hospital admissions. Internationally, the community pharmacy setting is evolving to offer more patient-facing services. Therefore, the aim of this thesis was to design warfarin and NSAIDs interventions - termed 'care bundles' - and to test their implementation within the Scottish community pharmacy setting. To design the care bundles (Stage 1), consensus methods were applied.;A six-item warfarin care bundle and a six-item NSAIDs care bundle were developed, with the NSAIDs care bundle stratified into two parts: a Communication Care Bundle and a Safer Care Bundle. The second stage of this thesis evaluated their pilot implementation within 24 community pharmacies. This involved a postal questionnaire; task-analysis techniques conducted during on-site visits; and telephone interviews with patients. Stage 2 identified that the determinants of implementation success differed between the care bundles.;On-site visits to pharmacies evidenced that both care bundles penetrated well within community pharmacy practice and integrated within the dispensing process. However, the care bundles were not always delivered as intended in practice. When patients were interviewed about the warfarin care bundle, none of the warfarin patients recalled receiving a care bundle and its necessity was queried. Conversely, the NSAID participants were satisfied with their experience of the NSAIDs care bundle and it mostly had a positive impact.;Overall, these findings indicated that scale up efforts should centre on the NSAIDs care bundle. Stage 3 of this thesis informed this through active dissemination of the results to key stakeholders, which shaped the national implementation strategy for the NSAIDs Communication Care Bundle in 2018. To achieve maximal improvements in the safer use of NSAIDs, national implementation of the NSAIDs Safer Care Bundle should also be realised. Future research should explore the attainment of intended outcomes of the NSAIDs care bundles.
Date of Award17 May 2019
Original languageEnglish
Awarding Institution
  • University Of Strathclyde
SupervisorMarion Bennie (Supervisor) & Rosemary Newham (Supervisor)

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