Facilitators and Barriers of Implementation of Clinical Pharmacy Services in County Hospitals Based on CFIR: A Qualitative Study

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INTRODUCTION: Clinical pharmacy services comprise a range of patient-centered, systematic care activities delivered by pharmacists, aiming to optimize medication use and improve patient outcomes. Despite growing recognition of the role of clinical pharmacy in medication safety, there is limited comprehensive analysis of barriers or actionable strategies, especially in under-resourced areas. This study aims to explore the state of implementation of clinical pharmacy practice, to elucidate the influencing factors and associated strategies. METHODS: Data were collected through quantitative surveys, participant observation, and semi-structured interviews. Data collection and analysis were guided by the Consolidated Framework for Implementation Research (CFIR). Directed content analysis was used to code the data and identify factors influencing clinical pharmacy services. Implementation strategies were developed using the CFIR-ERIC matching tool. RESULTS: Case studies were conducted in six county hospitals, with a total of 64 interviewees. We identified 25 facilitators and 21 barriers across five CFIR domains, with 15 distinguishing constructs between well and poorly performing centers. Our findings highlighted the critical role of local condition, policies and laws, external support, standardized appraisal systems, leadership, available resources, staffing and performance-linked incentives in sustaining service quality. Our analysis also proposed 8 tailored strategies to support sustainable implementation. The main distinguishing constructs between well and poorly performing implementation centers included outer setting, inner setting, individuals and implementation process. CONCLUSIONS: The implementation and sustainability of clinical pharmacy services are still limited by factors such as inadequate resources, inappropriate regulatory frameworks, lack of leadership, and insufficient competency of pharmacists. Corresponding implementation strategies should be adopted to promote the development of clinical pharmacy services, and the professional development of clinical pharmacists, especially in under-resourced areas. CLINICAL TRIAL REGISTRATION: N/A.

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