General practitioners’ views of pharmacist services in general practice: a qualitative evidence synthesis

Abstract Background Pharmacist services in general practice are expanding worldwide, with evidence to show pharmacists’ presence in general practice has financial, workload, and clinical benefits. Yet, little is known globally about general practitioners’ (GPs’) views on their presence in general practice. Objective To synthesize the qualitative research evidence on GPs’ views of pharmacist services in general practice. Methods Qualitative evidence synthesis; 8 electronic databases were searched from inception to April 2021 for qualitative studies that reported the views of GPs regarding pharmacist services in general practice. Data from included studies were analyzed using thematic synthesis. The Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach was used to assess the confidence in individual review findings. Results Nineteen studies were included, which captured the views of 159 GPs from 8 different countries. Four analytical themes describing the factors that should be considered in the development or optimization of pharmacist services in general practice, based on the views of GPs, were developed from the coded data and descriptive themes: (i) optimal environment for a pharmacist, (ii) the ideal pharmacist characteristics, (iii) complex stakeholder relationships, and (iv) benefits of an effective pharmacist. Conclusion Based on the synthesis of GPs’ views, we have created a conceptual model of factors that should be considered by policymakers, GPs, pharmacists, and other relevant stakeholders when developing or optimizing pharmacist services in general practice going forward.

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Qualitative Evidence Synthesis: Where Are We at?

International Journal of Qualitative Methods ◽

10.1177/1609406921993276 ◽

2021 ◽

Vol 20 ◽

pp. 160940692199327

Author(s):

Kate Flemming ◽

Jane Noyes

Keyword(s):

Qualitative Research ◽

Systematic Reviews ◽

Evidence Synthesis ◽

Synthesis Methods ◽

Qualitative Evidence Synthesis ◽

Policy Makers ◽

Qualitative Evidence ◽

Health And Social Care ◽

Method Paper ◽

Increasing Demand

Qualitative evidence syntheses (QES) have increased in prominence and profile over the last decade as a discrete set of methodologies to undertake systematic reviews of primary qualitative research in health and social care and in education. The findings from a qualitative evidence synthesis can enable a richer interpretation of a particular phenomenon, set of circumstances, or experiences than single primary qualitative research studies can achieve. Qualitative evidence synthesis methods were developed in response to an increasing demand from health and social professionals, policy makers, guideline developers and educationalists for review evidence that goes beyond “what works” afforded by systematic reviews of effectiveness. The increasing interest in the synthesis of qualitative research has led to methodological developments documented across a plethora of texts and journal articles. This “State of the Method” paper aims to bring together these methodological developments in one place, contextualizing advances in methods with exemplars to support readers in making choices in approach to a synthesis and aid understanding. The paper clarifies what a “qualitative evidence synthesis” is and explores its role, purpose and development. It details the kind of questions a QES can explore, the processes associated with a QES, including the methods for synthesis. The rational and methods for integrating a QES with systematic reviews of effectiveness are also detailed. Finally approaches reporting and recognition of what a “good” or rigorous QES look like are provided.

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Barriers and enablers to monitoring and deprescribing opioid analgesics for chronic non-cancer pain: protocol for a qualitative evidence synthesis using the Theoretical Domains Framework

BMJ Open ◽

10.1136/bmjopen-2019-034039 ◽

2019 ◽

Vol 9 (11) ◽

pp. e034039

Author(s):

Amanda J Cross ◽

Rachelle Buchbinder ◽

Allison Bourne ◽

Christopher Maher ◽

Stephanie Mathieson ◽

...

Keyword(s):

Qualitative Research ◽

Cancer Pain ◽

Assessment Tool ◽

Data Extraction ◽

Evidence Synthesis ◽

Theoretical Domains Framework ◽

Opioid Analgesics ◽

Qualitative Evidence Synthesis ◽

Barriers And Enablers ◽

Qualitative Evidence

IntroductionThe over-prescription and overuse of opioid analgesics for chronic non-cancer pain (CNCP) is a growing issue. Synthesis of evidence about the barriers and enablers to reducing long-term opioid prescribing and use will enable the development of tailored interventions to address both problems.ObjectiveTo synthesise the barriers and enablers to monitoring the ongoing appropriateness of opioid treatment and deprescribing opioids for CNCP from the clinician, patient and general public point of view, and to map the findings to the Theoretical Domains Framework (TDF).Methods and analysisWe will perform a qualitative evidence synthesis using the TDF. We will include qualitative research that has explored clinician, patient and the general public’s perceptions regarding barriers and enablers to monitoring and deprescribing opioids for CNCP. Studies will be identified via searches in MEDLINE, EMBASE, CINAHL, AMED and PsycINFO. Databases will be searched from inception to July 2019, and the studies must be published in English. Article selection and data extraction will be completed independently by two review authors. Methodological quality of included studies will be independently assessed by two review authors using the Critical Appraisal Skills Programme quality assessment tool. We will conduct thematic synthesis and then map identified themes and sub-themes to TDF domains. Confidence in synthesis findings will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation Confidence in the Evidence from Reviews of Qualitative Research tool.Ethics and disseminationEthical approval is not required to conduct this review. We will publish the results in a peer-reviewed journal.PROSPERO registration numberCRD42019140784

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A qualitative evidence synthesis using meta-ethnography to understand the experience of living with pelvic organ prolapse

International Urogynecology Journal ◽

10.1007/s00192-020-04494-z ◽

2020 ◽

Vol 31 (12) ◽

pp. 2631-2644

Author(s):

Francine Toye ◽

Jeannine Pearl ◽

Katy Vincent ◽

Karen Barker

Keyword(s):

Decision Making ◽

Qualitative Research ◽

Pelvic Organ Prolapse ◽

Evidence Synthesis ◽

Pelvic Organ ◽

Qualitative Evidence Synthesis ◽

Conceptual Approach ◽

Qualitative Evidence ◽

Healthcare Improvement ◽

Healthcare Decision Making

Abstract Introduction and hypothesis Pelvic organ prolapse (POP) affects the lives of many people. We aimed to systematically search for, identify and synthesize qualitative research that explores what it is like to live with POP and make this knowledge available for healthcare improvement. Methods We systematically searched Medline, PsychInfo, Embase and CINAHL, from inception to March 2020, for qualitative research exploring the experience of living with POP. We used meta-ethnography to synthesize findings. This is a conceptual approach to qualitative evidence synthesis. We used the recent guidelines for reporting meta-ethnography. Results We screened 3103 titles and 255 abstracts and included 37 primary studies. These incorporated the experience of 777 women, (aged 18 to 95 years) from a range of countries. We organized 162 ideas into 27 conceptual categories and 10 themes. We developed a conceptual model that helps us to understand the experience of pelvic organ prolapse. This model indicates that (1) the physical losses of POP are intricately linked to loss of identity; (2) women conceptualized POP as part of womanhood, yet also its thief; (3) there is a vicious cycle of taboo, silence and misunderstanding about POP and its treatment; (4) this silence is exacerbated by a feeling that POP is not taken seriously in healthcare. Conclusions This meta-ethnography helps us to understand the experience of living with a POP. Our model illustrates the complex process of healthcare decision making. Further studies to explore the complexity of decision making from the perspective of patient and health professional are timely.

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Qualitative evidence synthesis for complex interventions and guideline development: clarification of the purpose, designs and relevant methods

BMJ Global Health ◽

10.1136/bmjgh-2018-000882 ◽

2019 ◽

Vol 4 (Suppl 1) ◽

pp. e000882 ◽

Cited By ~ 51

Author(s):

Kate Flemming ◽

Andrew Booth ◽

Ruth Garside ◽

Özge Tunçalp ◽

Jane Noyes

Keyword(s):

Qualitative Research ◽

Systematic Reviews ◽

Guideline Development ◽

Evidence Synthesis ◽

Complex Interventions ◽

Real Life ◽

Synthesis Methods ◽

Qualitative Evidence Synthesis ◽

Qualitative Evidence ◽

Broad Term

This paper is one of a series exploring the implications of complexity for systematic reviews and guideline development, commissioned by the WHO. The paper specifically explores the role of qualitative evidence synthesis. Qualitative evidence synthesis is the broad term for the group of methods used to undertake systematic reviews of qualitative research evidence. As an approach, qualitative evidence synthesis is increasingly recognised as having a key role to play in addressing questions relating to intervention or system complexity, and guideline development processes. This is due to the unique role qualitative research can play in establishing the relative importance of outcomes, the acceptability, fidelity and reach of interventions, their feasibility in different settings and potential consequences on equity across populations. This paper outlines the purpose of qualitative evidence synthesis, provides detail of how qualitative evidence syntheses can help establish understanding and explanation of the complexity that can occur in relation to both interventions and systems, and how qualitative evidence syntheses can contribute to evidence to decision frameworks. It provides guidance for the choice of qualitative evidence synthesis methods in the context of guideline development for complex interventions, giving ‘real life’ examples of where this has occurred. Information to support decision-making around choice qualitative evidence synthesis methods in the context of guideline development is provided. Approaches for reporting qualitative evidence syntheses are discussed alongside mechanisms for assessing confidence in the findings of a review.

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Understanding Shoulder Pain: A Qualitative Evidence Synthesis Exploring the Patient Experience

Physical Therapy ◽

10.1093/ptj/pzaa229 ◽

2020 ◽

Author(s):

Christina Maxwell ◽

Katie Robinson ◽

Karen McCreesh

Keyword(s):

Qualitative Research ◽

Shoulder Pain ◽

Methodological Quality ◽

Evidence Synthesis ◽

Treatment Options ◽

Included Study ◽

Qualitative Evidence Synthesis ◽

Qualitative Evidence ◽

The Impact ◽

Research Studies

Abstract Objective The objective of this study was to review and synthesize qualitative research studies exploring the experiences of individuals living with shoulder pain to enhance understanding of the experiences of these individuals as well as facilitate health care developments. Methods A meta-ethnographic approach was adopted to review and synthesize eligible published qualitative research studies. The findings from each included study were translated into one another using the Noblit and Hares 7-stage process. A systematic search of 11 electronic databases was conducted in March 2020. Methodological quality was assessed using the Critical Appraisal Skills Programme (CASP) appraisal tool. Results Nineteen studies were included in the meta-synthesis. Included articles explored the lived experiences as well as treatment-related experiences of participants. All of the included articles were deemed to be of high methodological quality. Three themes were identified: (1) negative emotional, social, and activity impact (“It has been a big upheaval”), (2) developing an understanding (“Why is it hurting so much?”), and (3) exercise (“Am I going to go through a lot of pain in moving it…?”). Across the included studies, the severe emotional and physical impact of shoulder pain was a core finding. Many people sought a “permanent” solution involving surgery. Openness to other treatment options was influenced by factors including understanding of pain, prior experiences, and treatment expectations. Conclusion These findings deepen understanding of the impact of shoulder pain on peoples’ lives and provide novel insight into the experience of treatment. Enhanced awareness of people’s experiences of shoulder pain and treatment is crucial for clinicians when planning and implementing evidence-based recommendation. Impact To the knowledge of the authors, this is the first qualitative evidence synthesis to explore the treatment-related experiences of individuals with shoulder pain. Shoulder surgery was considered by many as the only means to achieve a more permeant resolution of symptoms. Lay Summary Shoulder pain causes emotional and physical turmoil that can permeate every facet of life. People’s understanding of their shoulder pain appears to be deeply rooted in a biomechanical view of pain, which influences their expectations relating to diagnosis and treatment.

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Rapid qualitative evidence syntheses (rQES) in health technology assessment: experiences, challenges, and lessons

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462320000720 ◽

2020 ◽

pp. 1-9

Author(s):

Umair Majid ◽

Laura Weeks

Keyword(s):

Qualitative Research ◽

Health Technology Assessment ◽

Technology Assessment ◽

Evidence Synthesis ◽

Health Technology ◽

Lessons Learned ◽

Qualitative Evidence Synthesis ◽

Health Technologies ◽

Related Data ◽

Qualitative Evidence

Abstract Healthcare decision makers are increasingly demanding that health technology assessment (HTA) is patient focused, and considers data about patients' perspectives on and experiences with health technologies in their everyday lives. Related data are typically generated through qualitative research, and in HTA the typical approach is to synthesize primary qualitative research through the conduct of qualitative evidence synthesis (QES). Abbreviated HTA timelines often do not allow for the full 6–12 months it may take to complete a QES, which has prompted the Canadian Agency for Drugs and Technologies in Health (CADTH) to explore the concept of “rapid qualitative evidence synthesis” (rQES). In this paper, we describe our experiences conducting three rQES at CADTH, and reflect on challenges faced, successes, and lessons learned. Given limited methodological guidance to guide this work, our aim is to provide insight for researchers who may contemplate rQES. We suggest several lessons, including strategies to iteratively develop research questions and search for eligible studies, use search of filters and limits, and use of a single reviewer experienced in qualitative research throughout the review process. We acknowledge that there is room for debate, though believe rQES is a laudable goal and that it is possible to produce a quality, relevant, and useful product, even under restricted timelines. That said, it is vital to recognize what is lost in the name of rapidity. We intend our paper to advance the necessary debate about when rQES may be appropriate, and not, and enable productive discussions around methodological development.

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A Qualitative Evidence Synthesis Review of Longitudinal Qualitative Research in Gerontology

The Gerontologist ◽

10.1093/geront/gny134 ◽

2018 ◽

Vol 59 (6) ◽

pp. e791-e801 ◽

Cited By ~ 3

Author(s):

Andrea L Nevedal ◽

Liat Ayalon ◽

Sherylyn H Briller

Keyword(s):

Qualitative Research ◽

Best Practices ◽

Evidence Synthesis ◽

Qualitative Evidence Synthesis ◽

Group Level ◽

Exclusion Criteria ◽

Qualitative Evidence ◽

Design And Methods ◽

Longitudinal Qualitative Research ◽

Level Analysis

Abstract Background and Objectives Gerontologists have long been interested in longitudinal qualitative research (LQR), yet ambiguity remains about best practices. The purpose of this review was to conduct a qualitative evidence synthesis to identify strengths and limitations in existing gerontological LQR. Research Design and Methods We searched for studies published in English before September 2017, using longitudinal qualitative methods and focusing on gerontology. We searched the following databases: PubMed and ProQuest. This was followed up by a snowball search to identify additional LQR articles that were not gerontologically focused but provided conceptual or methodological information to enhance gerontological LQR. Article titles and abstracts were reviewed, and selected articles were independently evaluated by all authors and summarized in a descriptive matrix based on design, analysis, and strengths and limitations. Results Our literature search resulted in 225 articles, which was then narrowed to 71 articles from 47 different journals based on our inclusion/exclusion criteria. LQR in gerontology varies considerably by study design and analysis approach. LQR design considerations involve number of time points and duration; rapport and retention; and consistent or different sampling, data collection, and measures. LQR analysis considerations involve synchronic and diachronic approaches, consistent or evolving coding, and individual- or group-level analysis. Gerontological LQR articles vary in the extent to which they address special aging considerations. Discussion and Implications This review indicates that there are areas where gerontological LQR can be strengthened going forward. We provide researchers with strategies to improve LQR rigor in our field and beyond.

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Clinician, patient and general public beliefs about diagnostic imaging for low back pain: protocol for a qualitative evidence synthesis

BMJ Open ◽

10.1136/bmjopen-2017-019470 ◽

2018 ◽

Vol 8 (2) ◽

pp. e019470 ◽

Cited By ~ 2

Author(s):

Adrian C Traeger ◽

Benjamin J Reed ◽

Denise A O’Connor ◽

Tammy C Hoffmann ◽

Gustavo C Machado ◽

...

Keyword(s):

Qualitative Research ◽

Low Back Pain ◽

Back Pain ◽

Diagnostic Imaging ◽

General Public ◽

Evidence Synthesis ◽

Qualitative Evidence Synthesis ◽

Low Back ◽

Public Beliefs ◽

Qualitative Evidence

IntroductionLittle is known about how to reduce unnecessary imaging for low back pain. Understanding clinician, patient and general public beliefs about imaging is critical to developing strategies to reduce overuse.ObjectiveTo synthesise qualitative research that has explored clinician, patient or general public beliefs about diagnostic imaging for low back pain.Methods and analysisWe will perform a qualitative evidence synthesis of relevant qualitative research exploring clinician, patient and general public beliefs about diagnostic imaging for low back pain. Exclusions will be studies not using qualitative methods and studies not published in English. Studies will be identified using sensitive search strategies in MEDLINE, EMBASE, CINAHL, AMED and PsycINFO. Two reviewers will independently apply inclusion and exclusion criteria, extract data, and use the Critical Appraisal Skills Programme quality assessment tool to assess the quality of included studies. To synthesise the data we will use a narrative synthesis approach that involves developing a theoretical model, conducting a preliminary synthesis, exploring relations in the data, and providing a structured summary. We will code the data using NVivo. At least two reviewers will independently apply the thematic framework to extracted data. Confidence in synthesis findings will be evaluated using the GRADE Confidence in the Evidence from Reviews of Qualitative Research tool.Ethics and disseminationEthical approval is not required to conduct this review. We will publish the results in a peer-reviewed journal.PROSPERO registration numberCRD42017076047.

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Clinician and patient beliefs about diagnostic imaging for low back pain: a systematic qualitative evidence synthesis

BMJ Open ◽

10.1136/bmjopen-2020-037820 ◽

2020 ◽

Vol 10 (8) ◽

pp. e037820 ◽

Cited By ~ 1

Author(s):

Sweekriti Sharma ◽

Adrian C Traeger ◽

Ben Reed ◽

Melanie Hamilton ◽

Denise A O’Connor ◽

...

Keyword(s):

Qualitative Research ◽

Low Back Pain ◽

Back Pain ◽

Diagnostic Imaging ◽

General Public ◽

Evidence Synthesis ◽

Qualitative Studies ◽

Qualitative Evidence Synthesis ◽

Low Back ◽

Qualitative Evidence

ObjectiveOveruse of diagnostic imaging for patients with low back pain remains common. The underlying beliefs about diagnostic imaging that could drive overuse remain unclear. We synthesised qualitative research that has explored clinician, patient or general public beliefs about diagnostic imaging for low back pain.DesignA qualitative evidence synthesis using a thematic analysis.MethodsWe searched MEDLINE, EMBASE, CINAHL, AMED and PsycINFO from inception to 17 June 2019. Qualitative studies that interviewed clinicians, patients and/or general public exploring beliefs about diagnostic imaging for low back pain were included. Four review authors independently extracted data and organised these according to themes and subthemes. We used the Critical Appraisal Skills Programme tool to critically appraise included studies. To assess confidence in review findings, we used the GRADE-Confidence in the Evidence from Reviews of Qualitative Research method.ResultsWe included 69 qualitative studies with 1747 participants. Key findings included: Patients and clinicians believe diagnostic imaging is an important test to locate the source of low back pain (33 studies, high confidence); patients with chronic low back pain believe pathological findings on diagnostic imaging provide evidence that pain is real (12 studies, moderate confidence); and clinicians ordered diagnostic imaging to reduce the risk of a missed diagnosis that could lead to litigation, and to manage patients’ expectations (12 studies, moderate confidence).ConclusionClinicians and patients can believe that diagnostic imaging is an important tool for locating the source of non-specific low back pain. Patients may underestimate the harms of unnecessary imaging tests. These beliefs could be important targets for intervention.PROSPERO registration numberCRD42017076047.

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Socioeconomic factors affecting access to preferred place of death: A qualitative evidence synthesis

Palliative Medicine ◽

10.1177/0269216319835146 ◽

2019 ◽

Vol 33 (6) ◽

pp. 607-617 ◽

Cited By ~ 7

Author(s):

Victoria Turner ◽

Kate Flemming

Keyword(s):

Qualitative Research ◽

Socioeconomic Factors ◽

Evidence Synthesis ◽

Population Level ◽

Place Of Death ◽

Cochrane Library ◽

Qualitative Evidence Synthesis ◽

Factors Affecting ◽

Quantitative Evidence ◽

Qualitative Evidence

Background: Existing quantitative evidence suggests that at a population level, socioeconomic factors affect access to preferred place of death. However, the influence of individual and contextual socioeconomic factors on preferred place of death are less well understood. Aim: To systematically synthesise the existing qualitative evidence for socioeconomic factors affecting access to preferred place of death in the United Kingdom. Design: A thematic synthesis of qualitative research. Data sources: Cochrane Library, MEDLINE, Embase, CINAHL, ASSIA, Scopus and PsycINFO databases were searched from inception to May 2018. Results: A total of 13 articles, reporting on 12 studies, were included in the synthesis. Two overarching themes were identified: ‘Human factors’ representing support networks, interactions between people and decision-making and ‘Environmental factors’, which included issues around locations and resources. Few studies directly referenced socioeconomic deprivation. The main factor affecting access to preferred place of death was social support; people with fewer informal carers were less likely to die in their preferred location. Other key findings included fluidity around the concept of home and variability in preferred place of death itself, particularly in response to crises. Conclusion: There is limited UK-based qualitative research on socioeconomic factors affecting preferred place of death. Further qualitative research is needed to explore the barriers and facilitators of access to preferred place of death in socioeconomically deprived UK communities. In practice, there needs to be more widespread discussion and documentation of preferred place of death while also recognising these preferences may change as death nears or in times of crisis.

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