Evaluating an implementation programme for medication review with follow-up in community pharmacy using a hybrid effectiveness study design: translating evidence into practice

Abstract

ObjectivesTo evaluate an implementation programme of a community pharmacy medication review with follow-up (MRF) service using a hybrid effectiveness-implementation study design, and to compare the clinical and humanistic outcomes with those in a previously conducted cluster randomised controlled trial (cRCT).SettingCommunity pharmacies in Spain.Participants135 community pharmacies and 222 pharmacists providing MRF to polymedicated patients aged 65 or over.InterventionThe intervention was an implementation programme for the MRF service. A national level group was established, mirrored with a provincial level group. A series of interventions were defined (1) to engage pharmacy owners with the implementation model and (2) to provide training to pharmacists consisting of clinical case studies, process of MRF, communication skills and data collection methods and (3) practice change facilitators.Primary and secondary outcome measuresThe primary outcomes for the implementation programme were progress, reach, fidelity and integration. The secondary outcomes were number of medications, non-controlled health problems, emergency visits, hospitalisations and health-related quality of life, which were compared with a previous 6-month cluster RCT.Results55% of pharmacies reached the implementation phase and 35.6% remained in the testing phase at 12 months. A reach of 89.3% (n=844) was achieved. Fidelity average score was 8.45 (min: 6.2, max: 9.3) out of 10. The integration mean score was 3.39 (SD: 0.72) out of 5. MRF service outcomes were similar to the cluster RCT study; however, the magnitude of the outcomes was delayed.ConclusionsThe implementation of pharmacy services is a complex multifactorial process, conditioned by numerous implementation factors. In the absence of remuneration, the implementation of the MRF service is a slow process, taking at least 12 months to complete.Trial registration numberCGFTRA-2017-01.

Integrating design thinking and implementation science principles in delivering a medication review service in the community pharmacy setting—An implementation testing study

“…The implementation reach was based on two key factors: firstly, the count of pharmacies that embarked on the process of recruiting and actively implementing the service (n = 11); and secondly, the established threshold of minimum patients derived from the insightful study conducted by Varas-Doval, which stands at seven patients per pharmacy for a non-remunerated service. [ 38 ] Guided by these considerations, the targeted number of patients to be enrolled in the study was set at 77 (7 patients per pharmacy × 11 participating pharmacies). Applying this calculated benchmark, the implementation reach emerged as 70.12%.…”

“…The evaluation of the implementation outcomes encompassed a comprehensive four-phase framework: exploration, preparation, testing, and operation (implementation). These phases were guided by definitions and patient progression criteria established by Varas-Doval et al for a non-remunerated service, as detailed in Table 1 [ 38 ]. In addition to scrutinizing the implementation phases, the study delved into measuring key process outcomes, specifically focusing on dimensions such as reach, acceptability, and fidelity.…”

Evaluation of an enhanced service for medication review with follow up in Swiss community pharmacies: Pre-post study protocol

“…A sub analysis for elderly people is proposed due to the increase in life expectancy resulting in a greatest prevalence for using a high number of medicaments for elderly people [ 18 , 38 ]. For the evaluation of the present study, a pre-test/post-test design is used, considering CPs as cluster of the study to decrease the potential for contamination.…”

“…Medication review with follow up reduces patients' problems related with the use of medicines [18]. Although it will not be included in the study, MRF has also suggested other positive impacts in test labs such as glycosylated hemoglobin, blood pressure or cholesterol [36], avoidance of medication-related hospitalizations [37,38] and it has positive effects across clinical, economic, and humanistic outcomes [22]. A sub analysis for elderly people is proposed due to the increase in life expectancy resulting in a greatest prevalence for using a high number of medicaments for elderly people [18,38].…”

“…Although it will not be included in the study, MRF has also suggested other positive impacts in test labs such as glycosylated hemoglobin, blood pressure or cholesterol [36], avoidance of medication-related hospitalizations [37,38] and it has positive effects across clinical, economic, and humanistic outcomes [22]. A sub analysis for elderly people is proposed due to the increase in life expectancy resulting in a greatest prevalence for using a high number of medicaments for elderly people [18,38]. For the evaluation of the present study, a pre-test/post-test design is used, considering CPs as cluster of the study to decrease the potential for contamination.…”