Narrative Reports to Monitor and Evaluate the Integration of Pharmacists Into Family Practice Settings

Dear Editor,

I have read the paper from Dr. Pottie et al with enthusiasm and I applaud their efforts that help take innovations in practice-based research to the next level. I found the idea of integrating nondispensing pharmacists into family practice settings very interesting and promising. Using narrative reports to evaluate implementations in practice-based research is also an intriguing concept.

This approach seems to be quite similar to practice facilitation, a method our Practice-Based Research Network (OKPRN) introduced in the United States in 2000. Our Practice Facilitators (PF) also used narrative- like structured "field notes" extensively to describe the process of implementations, but also strategies that emerged from implementations and drove change and innovation in practices.

Some advantages of systematic practice facilitation that could contribute to the described model are listed below:

1) Experience shows that at least initial practice change can be facilitated by an "insider-outsider" person more effectively than by those who are already part or slowly become part of the care delivery process and thus they are forced to give up their outsider viewpoint under the pressure of their new roles and responsibilities (e.g. completing reports becomes a significant burden). 2) A PF can work at several practice sites within a network and bring in a wealth of information and experience on best practices from other sites or even networks that significantly broaden the "learning community" over the boundaries of individual practices. 3) As change agents, PFs are specifically trained, so that via "diaries" or "field notes" they not just identify problems, but also have the capacity to immediately address them (short feedback loop). 4) It is the integral part of the PFs' work to look at practices as complex adaptive systems from a number of different angles (e.g. in this example not just from the pharmacist's point of view, but also that of the clinicians and staff) and consider feedback from all participants in and beyond the organization when looking for solutions.

I am anxious to see the next paper about this project that will perhaps include the outcomes of the qualitative analysis through the iterative grounded theory approach. I will also enjoy learning about feedback from clinicians and staff, perhaps in the form of clinician or staff narratives on the same implementation process.

Zsolt Nagykaldi, PhD Assistant Professor of Research University of Oklahoma Health Sciences Center Department of Family & Preventive Medicine

Competing interests:   None declared