Table 4 Themes and representative quotes

  Opportunity to problem-solve with other clinicians

I really find the work groups, very invaluable to talk with other sites that are implementing to share ideas, there’s been a handful of folks from my implementation group that I actually had…one on one meetings with either because they had challenges or I had challenges.…So, I really feel like the networking and kind of the using those other person resources, has been one of the most helpful aspects of it [Academy]. (CL10)

  Clinical-training support

But I did think, …it was really helpful to have the clinical layout for how to teach it [COPD CARE Clinician training]. Because sometimes it’s hard to lay that out linearly from my own head. So,…I thought it was really helpful to have, like, the nursing training handbook and the pharmacist training handbook and have those things set out for you so that you can use it as a jump off point to teach. (CL18)

  Clinician training increased comfort in treating COPD

I feel like for us the actual training modules for…the pharmacist…was the most helpful because…COPD isn’t something that we’ve done with Med management ourselves at all. So it’s not something we had a lot of comfort with to begin with, so I think getting a lot of that background information was really good for us because I mean, we’re used to like doing the hypertension and the diabetes and things, and that’s kind of our comfort zone, so getting more information to go past that I think was the most helpful. (IL13)

  Academy lacked sufficient clinical content

[…] I think it would have been helpful to have like an subject matter expert…like a pulmonologist, kind of walk us through…the PFTs [pulmonary function tests] like I still find it challenging to read some of the PFTs you know as a pharmacist, you know I know about the drugs, but reading the PFTs may be challenging…So, that…would be… great if we had, you know, a session. (CL1)

  Academy lacked sufficient guidance and resources for referral process

I know for us like one of our hiccups…is the Cadillac versus the Ford Model [COPD CARE referral model], and I felt like…I didn’t maybe have the best resources in doing it [setting up the referral model] ...That was maybe like a gap. So I don’t know if that…was lacking a little in that session or if there could have been more, maybe expanded on it or if we could have had a different session and invited the people that may be doing that [using the COPD CARE Referral tool]. But I just think…there could be room for improvement in those resources. (IL14)

  Step-by-step approach was appropriate

There was a lot of infrastructure built into the [Academy] workbook, in a stepwise fashion. The steps are well thought out and made sense you know getting leadership support, making sure that we had the supplies on hand…I am an experienced supervisor, I’ve built a bunch of clinics before so the documentation [Academy workbook] of how to…build the clinics…was spot on….Especially if I was a new supervisor or…a frontline staff pharmacist, I would have a good idea of how to communicate that build. (IL3)

  Facilitated accountability

[…] the accountability of having…the weekly [Academy] sessions. …that accountability of hey, we should be moving along with this, it’s easy whenever you are just given a workbook and said, okay implement this to just be like, oh, I’ll do it later, but when you have to check in each week and, say what your progress, is it puts a little bit more pressure to get it done right. (IL7)

  External implementation approach was motivating

[…] [National COPD CARE facilitator] has been really…supportive and encouraging…he [National COPD CARE facilitator] said…it doesn’t have to be perfect. Starting off, as long as you…do something and start something, and then grow it as you’re able to, I think that was very encouraging and I think it motivated me … to just…start something within our health system, even though it may not be as robust or as… interdisciplinary as other sites. (IL2)

  Academy topics not aligned with VAMC implementation phase

[…] the COPD CARE Academy was very prescriptive…week one to week six. Well, I may still have been working on tasks from week 2. But, you know, sometimes getting the right engagement and service involvement from these other folks, took several weeks to do…So…as we got to the later weeks of COPD CARE [Academy] where other sites were implementing kind of adjacent to the timing of the weekly schedule, our timeline was very, very different and so I think…it [Academy] became less and less applicable because it was on like Step six, and I’m still trying to get step two moving. (IL10)

  Academy content and informatics tools are pharmacist centric

I think a lot of the focus [of COPD CARE Academy] as far as like the education goes was very pharmacist-centric…There wasn’t so much about how the nurse is actually involved in the process and what they’re doing for follow-up…and the pharmacist note template, it has a lot of detail in it …but the nursing template seemed a little bit sparse…I don’t think they [Nurses] had as much feel for what they should be doing as part of the process as well. (IL13)

 Continued COPD team communication after Academy completion

I attended…the COPD or the gold conference. I did the virtual, so they have lots of good presentations and so each week since we started the COPD CARE launch in January, I’ve been sending weekly emails [to clinicians implementing COPD CARE at site] and just asking for questions and then trying to follow up with questions and things that we’re noticing. (IL7)

 Integration of Academy training into existing meetings

[…] we have a twice a year, education day and so our fall one was…I think it was half the day that was dedicated to COPD CARE so we all sat through the modules to get there and watch things together... (IL13)

 Long-term use of Academy resources

[…] I think that the handout provided and all the videos were really well done. I think most of us here we’re kind of unfamiliar with COPD. And then, and then after going through it, again, I think the training was just was really good and the handouts, we still use we reference now has been a couple of months… (CL14)

 Benefit of monthly post-Academy meetings

I mean some of the information that’s been ongoing discussion in the community working group has been more helpful, because a lot of the questions my clinical pharmacists have were just like those higher level nuanced you know specific case questions like, some of the things we’ve been talking about as far as like steroids deprescribing or concomitant asthma diagnosis. (IL9)