A consolidated framework for implementation research (CFIR) guided exploration of key informant perspectives on establishing a pharmacist-led anticoagulation service in primary care: a qualitative study

Abstract

Background: Globally, pharmacist-led anticoagulation services have improved patient outcomes in secondary and tertiary care settings. However, there is a paucity of literature about establishing such services within primary care settings. Aim: This study explored key informants' perceptions regarding the systemic and procedural factors influencing development and implementation of a pharmacist-led anticoagulation service in a primary care setting. Method: A descriptive qualitative study was conducted at Qatar's largest primary healthcare institution, the Primary Health Care Corporation (PHCC). Selected key informants, including healthcare center managers, pharmacy leads, physician leads and primary care physicians with cardiology privileges, were purposively recruited. Semi-structured interviews were guided by the Consolidated Framework for Implementation Research (CFIR) and analyzed using framework analysis. Results: Elven key informants were interviewed. The participants expressed confidence in the feasibility and effectiveness of implementing anticoagulation service in primary care to address patients' needs. Key factors (mapped to CFIR domains) included ensuring pharmacist competency (Characteristics of Individuals), establishing effective internal and external communication (Inner and Outer Setting), and addressing staffing shortages (Inner Setting). Participants also emphasized on developing standardized operational protocols and training programs (Process), as well as integrating services with secondary care (Outer Setting). Despite challenges such as staffing, participants believed the service would effectively address patient needs if adequately supported. Conclusion: The implementation of pharmacist-led anticoagulation services in primary care settings was identified as both feasible and essential for improving patient outcomes. The insights from this study can inform future initiatives aimed at enhancing anticoagulation management in primary care settings.