From blueprint to practice: Implementation strategies for behavioral health programs in community pharmacy

Despite the need for practical implementation systems, few studies have focused on operationalizing and exploring use of clearly articulated implementation strategies to support uptake of patient care interventions in community pharmacies. This project involved implementation of a behavioral health (BH) intervention for depression and anxiety at 7 pharmacy sites over a 6-11 month period.

This study describes the comprehensive, multifaceted blueprint that guided pharmacies through the implementation process, and summarizes the lessons learned related to use of its implementation strategies.

The implementation blueprint involved operationalization of 8 strategy clusters adapted from Waltz and colleagues' Expert Recommendations for Implementing Change taxonomy. Lessons learned were generated through 30-45 minutes interviews with 7 pharmacists leading the implementation. These interviews focused on successes, barriers, and key insights related to implementation. The transcripts were analyzed using directive content analysis involving an a-priori coding structure.

Five lessons learned emerged: (1) offering the BH intervention as an add-on to already existing patient care services facilitates integration; (2) patient engagement strategies hinge on clarifying the role the pharmacist can play in behavioral health care; (3) level of connectivity between the pharmacist and the local BH community influence follow-on care; (4) convenience of patient care workflows and availability of implementation supports are critical implementation strategies; and (5) intent to continue offering the BH services is dependent on perceived value for both patients and pharmacists.

Beyond the immediate improvements that can be made to the original blueprint, results highlight 3 key findings with implications for advancing community pharmacy practice through implementation science: the importance of customizing implementation strategies for community pharmacy; the need to further emphasize and integrate relational strategies into implementation blueprints and frameworks; and the value of leveraging the interdependencies among implementation strategies to improve effective implementation.