German healthcare professionals’ perspective on implementing recommendations about polypharmacy in general practice: a qualitative study

Straßner, Cornelia; Steinhäuser, Jost; Freund, Tobias; Szécsényi, Joachim; Wensing, Michel

doi:10.1093/fampra/cmx127

Cited by 16 publications

(38 citation statements)

References 28 publications

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“…In contrast to Straßner et al [ 31 ], we found that on the individual level, physicians consider pharmacological information an essential dimension in the prescribing process in polypharmacy. They expect the digital availability of pharmacological knowledge to simplify decision-making.…”

Section: Discussioncontrasting

confidence: 99%

From sensitization to adoption? A qualitative study of the implementation of a digitally supported intervention for clinical decision making in polypharmacy

et al. 2020

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Objective Formative evaluation of the implementation process for a digitally supported intervention in polypharmacy in Germany. Qualitative research was conducted within a cluster randomized controlled trial (C-RCT). It focused on understanding how the intervention influences behavior-related outcomes in the prescription and medication review process. Methods/setting Twenty-seven general practitioners (GPs) were included in the study in the two groups of the C-RCT, the intervention, and the wait list control group. Behavior-related outcomes were investigated using three-step data analysis (content analytic approach, documentary method, and design of a model of implementation pathways). Results Content analysis showed that physicians were more intensely aware of polypharmacy-related risks, described positive learning effects of the digital technology on their prescribing behavior, and perceived a change in communication with patients and pharmacists. Conversely, they felt uncertain about their own responsibility when prescribing. Three main dimensions were discovered which influenced adoption behavior: (1) the physicians’ interpretation of the relevance of pharmaceutical knowledge provided by the intervention in changing decision-making situations in polypharmacy; (2) their medical code of ethics for clinical decision making in the context of progressing digitalization; and (3) their concepts of evidence-based medicine on the basis of professional experiences with polypharmacy in primary care settings. In our sample, both simple and complex pathways from sensitization to adoption were observed. The resulting model on adoption behavior includes a paradigmatic description of different pathways and a visualization of different observed levels and applied methodological approaches. We assumed that the GP habitus can weaken or strengthen interventional effects towards intervention uptake. This formative evaluation strategy is beneficial for the identification of behavior-related implementation barriers and facilitators. Conclusion Our analyses of the adoption behavior of a digitally supported intervention in polypharmacy revealed both simple and complex pathways from awareness to adoption, which may impact the implementation of the intervention and therefore, its effectiveness. Future consideration of adoption behavior in the planning and evaluation of digitally supported interventions may enhance uptake and support the interpretation of effects. Trial registration NCT03430336, 12 February 2018.

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Section: Discussioncontrasting

confidence: 99%

From sensitization to adoption? A qualitative study of the implementation of a digitally supported intervention for clinical decision making in polypharmacy

et al. 2020

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“…This is consistent with prior studies that show that factors such as cohesion, trust and support predict organizational readiness for change and implementation success . INSN providers also share a desire for ongoing interdisciplinary communication related to NHF, a desire reported in a variety of settings throughout the world . Our study emphasises that collaboration is a key element prior to implementation and essential for change in an organization.…”

Section: Discussionsupporting

confidence: 89%

Key considerations prior to nasal high flow deployment in a Peruvian PICU from providers’ perspectives

Ellington

Jacob‐Files²,

Becerra

et al. 2018

Acta Paediatrica

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Aim: Implementation of healthcare interventions in resource-limited settings remains challenging. This exploratory qualitative study describes social and institutional factors to consider prior to nasal high flow deployment in a middle-income country.Methods: Researchers conducted eight nursing focus groups and four semi-structured physician interviews at Instituto Nacional de Salud del Niño in Lima, Peru. Participants were identified via purposive sampling. Data were transcribed, translated and coded using a rigorous and iterative process. Pertinent themes were identified using thematic analysis with Dedoose software.Results: Thirty-nine nurses and four physicians participated in focus groups and interviews, respectively. Participants identified five major factors: (i) Adequate training, (ii) Clinician buy-in, (iii) Resource-limited setting, (iv) Local social context and (v) Organizational change management. To create buy-in, physicians and nurses emphasised the need to recognise benefit of the intervention and agree with clinical practice standardization. Physicians and nurses described barriers specific to resource-limited settings, including unreliable supply chain, whereas nurses shared concerns about increasing workload and physician-nurse social hierarchy. Participants recognised the importance of team commitment and ongoing interdisciplinary communication for sustainability.Conclusion: While some factors to consider prior to deployment of healthcare technology are universal, resource-limited settings have unique implementation barriers.

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“…Determinant frameworks, specifically, are used to identify barriers and enablers of implementation [40]. To date, a number of empirical studies used the TICD and other theoretical frameworks to explore implementation issues across therapeutic areas, including lower back pain [41,42], hand hygiene [43], blood transfusion [44], medication prescribing [45], laboratory testing [46], polypharmacy [47], evidence-based recommendations for chronic conditions [48] and primary care [49], schizophrenia [50] and dementia [51]. In general, uncertainty about how to choose interventions that best match implementation determinants in a given context have been reported [52].…”

Section: Discussionmentioning

confidence: 99%

Assessing the Implementation of Pharmacogenomic Panel-Testing in Primary Care in the Netherlands Utilizing a Theoretical Framework

Wouden

Paasman

Teichert

et al. 2020

JCM

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Despite overcoming many implementation barriers, pharmacogenomic (PGx) panel-testing is not routine practice in the Netherlands. Therefore, we aim to study pharmacists' perceived enablers and barriers for PGx panel-testing among pharmacists participating in a PGx implementation study. Here, pharmacists identify primary care patients, initiating one of 39 drugs with a Dutch Pharmacogenetic Working Group (DPWG) recommendation and subsequently utilizing the results of a 12 gene PGx panel test to guide dose and drug selection. Pharmacists were invited for a general survey and a semi-structured interview based on the Tailored Implementation for Chronic Diseases (TICD) framework, aiming to identify implementation enablers and barriers, if they had managed at least two patients with actionable PGx results. In total, 15 semi-structured interviews were performed before saturation point was reached. Of these, five barrier themes emerged: (1) unclear procedures, (2) undetermined reimbursement for PGx test and consult, (3) insufficient evidence of clinical utility for PGx panel-testing, (4) infrastructure inefficiencies, and (5) HCP PGx knowledge and awareness; and two enabler themes: (1) pharmacist perceived role in delivering PGx, and (2) believed clinical utility of PGx. Despite a strong belief in the beneficial effects of PGx, pharmacists' barriers remain, an these hinder implementation in primary care.

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German healthcare professionals’ perspective on implementing recommendations about polypharmacy in general practice: a qualitative study

Abstract: While many interventions to improve polypharmacy focus on the provision of pharmacological knowledge, a much wider range of domains need to be addressed, such as communication skills, patient involvement and practice organization.

Cited by 16 publications

References 28 publications

From sensitization to adoption? A qualitative study of the implementation of a digitally supported intervention for clinical decision making in polypharmacy

From sensitization to adoption? A qualitative study of the implementation of a digitally supported intervention for clinical decision making in polypharmacy

Key considerations prior to nasal high flow deployment in a Peruvian PICU from providers’ perspectives

Assessing the Implementation of Pharmacogenomic Panel-Testing in Primary Care in the Netherlands Utilizing a Theoretical Framework

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