A socio-technical analysis of the Patient Medication Record (PMR) system in English Community Pharmacy
The English National Health Service (NHS) has expressed the desire for safe and effective healthcare through pharmacy professional role extension. The ambition is to engage the transformative power of digital technology to deliver clinical services from community pharmacy through their integration into mainstream national healthcare pathways. This PhD thesis explores the role of the computerised Patient Medication Record (PMR) system in supporting the transformation of current community pharmacy practice. Drawing on socio-technical theoretical principles, the study takes an ethnographic approach to investigate the drivers that impact how the PMR system is procured and utilised within community pharmacy organisations. It further examines how these factors impact the quality outcomes of healthcare delivery. Data was collected from four purposefully selected English community pharmacy sites using field observations inclusive of Think Aloud studies and document analysis. This was followed by semi-structured interviews of eighteen key informants consisting of pharmacists, dispensers, PMR system managers, and representatives of system suppliers or vendors. A conceptual framework based on socio-technical theoretical principles was used to identify factors that influenced how PMR systems were developed, implemented, and used within community pharmacy, and the related impact on clinical services that are delivered to patients. The study found that the PMR system played an integral (and even critical) role in clinical work processes, while at the same time facilitating and constraining utilisation by pharmacy staff in their efforts to meet their professional obligations. The appropriateness of PMR system functionalities and configurations, including organisational drivers, conditions its use in ways that have profound effect on patient and pharmacy staff experiences of care. This includes the proliferation of multiple record systems and adoption of workarounds in order to meet documentation needs when providing patient care. Consequently, there is an increased potential for unintended consequences which leads to greater risk of safety issues and restricted ability to share patient health information across different settings. Despite the disadvantages, the PMR system offers possibilities for supporting the broadening of future community pharmacy clinical services through enhanced risk management and collaborative practice. This can be achieved by increasing the knowledgebase around the PMR system through additional research, by accelerating clinical system development through adoption of sophisticated and innovative technologies, by promoting greater digital literacy among pharmacy staff, and by recognising the wellbeing impact of the PMR system on its users. It is suggested that a concerted effort by pharmacy professionals and their employing organisations, system suppliers, pharmacy professional bodies, and regulatory institutions is required to ensure that future PMR systems possess the necessary features and can be used appropriately. This way, there is better chance of the government realising its objective of delivering more clinical services from community pharmacy premises.
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