Sustainability of innovations in healthcare: A systematic review and conceptual framework for professional pharmacy services

Background: Implementation science emerged to address the challenges associated with the incorporation of evidence-based innovations into practice. Once the challenge is overcome, the ultimate goal is to achieve the sustainability of innovations to promote their continuity and long-term integration. Conceptual approaches and assessment tools have been designed to assess the sustainability of innovations in research and practice environments. However, the variability of approaches and tools available becomes a challenge for policymakers, researchers and practitioners, particularly when deciding how to evaluate the sustainability of innovations. Objectives: To identify conceptual approaches and assessment tools for the sustainability of healthcare innovations and to develop a specific discipline-based framework for the sustainability of professional pharmacy services. Methods: A systematic literature review was conducted in January of 2019 using PubMed, Scopus, and Web of Science. General information regarding the conceptual approaches (based on Nilsen's classification), assessment tools and the factors affecting the sustainability of the healthcare innovations was retrieved. Results: From 3123 articles screened, 132 articles were selected from which 106 conceptual approaches and 26 assessment tools were identified. Several key factors moderating the sustainability of the innovations in healthcare were identified (e.g. funding, adaptation). A framework for the sustainability of professional pharmacy services is proposed based on these factors. It presents three performance domains influencing the service sustainability (i.e. environment, social and economic). Conclusions: The identified approaches in different healthcare settings have allowed the adaptation and design of a specific framework for pharmacy. The core factors included in the proposed framework are moderators of the sustainability process and should be considered in sustainability studies and evaluations. This framework will guide pharmacy practice researchers and practitioners to measure and achieve the sustainability of professional pharmacy services. Furthermore, the adaptation of this framework will allow its application to other healthcare settings.