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Narrative medicine is a humanities-based discipline that posits that attention to the patient narrative and the collaborative formation of a narrative between the patient and provider is essential for the provision of health care. In this Special Article, we review the basic theoretical constructs of the narrative medicine discipline and apply them to the perioperative setting. We frame our discussion around the 4 primary goals of the current iteration of the perioperative surgical home: enhancing patient-centered care, embracing shared decision making, optimizing health literacy, and avoiding futile surgery. We then examine the importance of incorporating narrative medicine into medical education and residency training and evaluate the literature on such narrative medicine didactics. Finally, we discuss applying health services research, specifically qualitative and mixed methods, in the rigorous evaluation of the efficacy and impact of narrative medicine clinical programs and medical education curricula.

Numerous studies have been undertaken to evaluate pharmaceutical services. These include both the evaluation of existing practice and assessments of innovative services in both hospital and community settings. Evaluation requires employment of methods and measures to ensure that relevant data on the effects of a programme are obtained. To evaluate a service from different perspectives (eg, acceptability to health professionals or patients, uptake, clinical outcomes or resource implications), a number of methods may be required. The outcomes may also be wide-ranging. Measures must be selected which provide a true reflection of the extent to which these outcomes are, or are not, achieved. Designs and frameworks used in the evaluation of pharmacy services have been discussed previously,1 this paper reviews the methods and measures that have been employed.

The aim of this paper is to review the methodologies employed by health service and pharmacy practice researchers in the evaluation of pharmacy services. The review is in two parts. Part 1 discusses the application of different study designs and frameworks in the evaluation of existing and innovative services and interventions; part 2, to be published in a later issue, will address the methods and measures employed in the evaluation process. The studies included in this review were selected to give examples of different study objectives, designs and frameworks and their application in pharmacy settings. Although many of the issues regarding study design and evaluation frameworks may be relevant to clinical trials comparing the efficacy of alternative drug therapies, the focus of this paper is on pharmacy services.

This paper reviews research undertaken in pharmacy practice and related settings employing focus groups and observation methods. The aim of the review is to identify the main methodological considerations of these approaches to enable pharmacy practice researchers to benefit from the experiences of their colleagues when conducting their own research. The paper is in two parts. Focus groups have become increasingly prominent in pharmacy practice and health services research. They are an attractive and effective alternative to individual qualitative interviews for particular problems in pharmacy research. In this paper, the use of focus groups by researchers in pharmacy practice and related settings is reviewed. Observation studies have been applied widely to address many research questions. They are a valuable method of obtaining data, documenting actual events and activities rather than relying on self-reports of behaviours and events. Observation methods have been used both as a sole method for a research study and in combination with other methods. In the pharmacy practice literature there are examples of participant and non-participant observation studies and both quantitative and qualitative approaches. Through the experiences of pharmacy practice researchers, the methodological and ethical issues that these studies present are identified and ways in which they have been addressed are explored.

Qualitative approaches have gained an increased prominence in health services and pharmacy practice research in recent years. Although the numbers of qualitative studies are small compared with those using survey methodology, a substantial body of work has been undertaken in pharmacy practice and related settings. The aim of this paper is to review research employing qualitative interviews in terms of the methodological issues and problems that this approach presents and to explore how these have been addressed. Study objectives, sampling procedures, data collection, processing and analysis and issues of validity, reliability and generalisability will be discussed.

Social surveys are an important tool in health services research. They have been used in a high proportion of pharmacy practice research studies and in a wide range of settings. Extensive hand searches of published studies has enabled a review of the issues and problems that survey methods present when applied in pharmacy practice and an exploration of how they have been addressed by researchers. It is hoped that the review will enable pharmacy practice researchers to benefit from the experience of their colleagues when conducting their own research. This is the second part of a two-part review of surveys in pharmacy practice research. The first part (IJPP, 1997;5:152) focused on research questions, study design, sampling frames and procedures, response and non-response. This second part discusses the development of survey instruments and the issues of validity, reliability and generalisability.

Social survey methodology is the most widely used approach by pharmacy practice researchers, accounting for a higher proportion of published papers than any other. Survey techniques have been used to address a range of research objectives in a variety of populations and settings. Extensive hand searches of published survey research have enabled a review of the issues and problems that social survey research presents when applied in pharmacy settings, and an exploration of how they have been addressed. This review is in two parts. This first part focuses on the research questions that have been addressed by survey methods, design of the studies, sampling frames and procedures, response rates and management of non-response. A second paper will discuss the development of survey instruments, and the issues of validity, reliability and generalisability.

A political competency for leaders is to effectively articulate the evidence behind management best practices. Evidence-based practice requires special skills from the nurse leader, many of which are found in health services research (HSR) methods. This review presents approaches associated with HSR, which can be used by nurse managers for the benefit of their units. HSR methods reviewed are cost analyses, small area analysis, geographic information systems, use of existing databases, quality of care measures, and risk adjustment. This review examines the kind of evidence various HSR methods provide, as well as examples of their use and resources needed to apply them.

Many complementary and alternative medicine (CAM) researchers believe that a new set of research methods is needed to study CAM. Health services research (HSR) is listed as a new research goal in the National Center for Complementary and Alternative Medicine 2005-2009 strategic plan. Does HSR offer solutions to the research needs of CAM? This article presents an overview of HSR, a summary of the HSR studies that have been published in CAM, and discussions of what HSR might offer CAM and what studies of CAM might offer conventional HSR.Our literature search, which was performed at the University of Arizona, found 84 published CAM HSR studies. A comparison of the search results-mostly surveys of CAM users or providers and economic outcome studies-with the breadth of topics that may be studied using HSR, showed that research in this field has not reached its potential. More work, including studies of interactions between patient, provider, and the system as well as patient-centered outcomes studies, is needed. Several areas in which CAM could benefit from HSR were identified and discussed. These included studies supporting the integration of CAM and conventional medicine, insurance coverage for CAM therapies, the development practice guidelines, and studies of the effectiveness and cost-effectiveness of CAM therapies and whole medical systems. The study of CAM, especially studies focusing on patients' attraction to CAM, may also help expand the topics and methods of conventional HSR.HSR methods may address many of CAM's methodological challenges and improve clinical, patient-centered, and economic outcomes across all systems of care-both conventional and CAM.

This article forms the introduction to a series of review articles designed to guide readers on the selection and application of different health service research methodologies in pharmacy practice research. The reviews will discuss different methods that have been used in pharmacy practice settings, their advantages and disadvantages, problems that have arisen and how these have been addressed. The first article, on survey research, follows on p152. Future articles, which will include discussion of semi-structured and qualitative interviews, observation studies, and research into service evaluation, are planned for later issues

The difficulty in applying research methods to the operational environment is not unique to health services administration. Roper et al. observed that many physicians lack the skills to interpret and critically evaluate medical literature and have difficulty incorporating information about probabilities of disease and outcomes of care into the decisions they make. The science of health care evaluation is still in its formative stages. Methods of gathering and analyzing data on health outcomes and effectiveness are limited. The same may also be true of applying research methods to the management process within our institutions. While it is clear that research methods can contribute to the management process, much work is still needed within our institutions to provide an organizational environment conducive to its effective application. The lack of successful implementation of these methods does not result from intrinsic deficiencies in the health administration curriculum, but rather reflects the ongoing complexity of the operational world. Training in research methods must be viewed as a long-term investment by senior managers. Specific initiatives must be taken by senior management to establish the organizational climate that will foster the application of research methods to the management process. The academic community should also recognize the need to provide ongoing learning opportunities for the senior management levels of our organizations. Exposure to new and innovative research methods must be viewed as a continuing process. Efforts must be increased to close the gap between those who teach research methods and those who are attempting to apply them. Continuing education efforts, curriculum refinements, and innovative linkages between the practitioner and the health services educator will be essential.

Health services research methods , N Black, J Brazier, F Fitzpatrick, B Reeves, eds, pp xii + 268. BMJ Books, London, 1998. £30 (£28 to BMA members), paperback. ISBN 1 85996 271 8. ★★★★ This book provides a detailed description and assessment of all aspects of health services research. The first two sections describe how health and disease can be measured and the types of study designs available to test new interventions and technologies. Examples of topics included …

Background Antimicrobial stewardship aims to optimise antibiotic use and minimise selection of antimicrobial resistance. The methodological quality of published studies in this field is unknown. Objectives Our objective was to perform a comprehensive systematic review of antimicrobial stewardship research design and identify features which limit validity and translation of research findings into clinical practice. Data sources The following online database was searched: PubMed. Study eligibility criteria:Studies published between January 1950 and January 2017, evaluating any antimicrobial stewardship intervention in the community or hospital setting, without restriction on study design or outcome. Methods We extracted data on pre-specified design quality features and factors that may influence design choices including: (1) clinical setting, (2) age group studied, (3) when the study was conducted, (4) geographical region and (5) financial support received. Results The initial search yielded 17,382 articles; 1,008 were selected for full-text screening, of which 825 were included. Most studies (675/825, 82%) were non-experimental and 104 (15%) used interrupted time series analysis, 41 (6%) used external controls and 19 (3%) used both. Studies in the community setting fulfilled a median of 5/10 quality features (IQR 3-7) and 3 (IQR 2-4) in the hospital setting. Community setting studies (25%, 205/825) were significantly more likely to use randomisation (OR 5.9 (95%CI 3.8-9.2)), external controls (OR 5.6 (95%CI 3.6-8.5)) and multiple centres (OR 10.5 (95%CI 7.1-15.7)). From all studies, only 48% (398/825) reported clinical and 23% (190/825) reported microbiological outcomes. Quality did not improve over time. Conclusions Overall quality of antimicrobial stewardship studies is low and has not improved over time. Most studies do not report clinical and microbiological outcome data. Studies conducted in the community setting were associated with better quality. These limitations should inform the design of future stewardship evaluations so that a robust evidence base can be built to guide clinical practice.