title: Exploring long term implementation of cognitive services in community pharmacies - a qualitative study.
abstract: Implementing cognitive services in community pharmacies faces certain obstacles. One approach aimed at improving long-term implementation is to consider the implementation process as consisting of different stages, all of which require tailored initiatives. Taking this approach into account, there is a marked need for increased knowledge regarding the initiatives necessary to support especially the later phases of the implementation process.
  
  
  OBJECTIVE
  The aim of this project was to develop insight into factors pertaining to the later phases of implementing cognitive services in community pharmacies.
  
  
  METHODS
  A qualitative study was conducted, consisting of semi-structured interviews with 12 Danish pharmacy staff members, who were all in charge of improving the implementation of the Inhaler Technique Assessment Service (ITAS) in the 5 years following its introduction. The interviews were used to explore which implementation barriers had been identified by the staff and how they had sought to overcome them. The interviews were analyzed by combining content and critical common sense analysis with theoretical interpretations based on Rogers "Diffusion of innovation" theory.
  
  
  RESULTS
  The most predominant long-term barrier was the staff members' adoption of the ITAS at very different rates. The problem of laggards was not lack of competencies, but a lack of self-efficacy in believing that their actual competencies were sufficient to provide the service. Lack of time and attention to the service and obtaining support from the more senior members of the pharmacy were also problematic. Both individual and group activities were launched to overcome the identified challenges belonging to different phases of the implementation process.
  
  
  CONCLUSIONS
  Those in charge of ensuring long term implementation of cognitive services in community pharmacies should consider the necessity to handle several simultaneous actions of both an individual and collective kind at the same time. Hence, the implementation process should be perceived as a series of interrelated stages rather than a linear process where one stage succeeds the other.
authors.affiliation: Department of Pharmacology and Pharmacotherapy, The Faculty of Health and Medical Sciences, University of Copenhagen . Copenhagen ( Denmark ).
authors.forename: Susanne
authors.initials: S
authors.lastname: Kaae
authors.forename: Søren Troels
authors.initials: ST
authors.lastname: Christensen
keywords: Community Pharmacy Services; Denmark; Pharmacists; Professional Practice; Qualitative Research