A case study of the implementation and sustainability of medication reviews in older patients by clinical pharmacists

Kempen, Thomas; Gillespie, Ulrika; Färdborg, Maria; McIntosh, Jennifer; Mair, Alpana; Stewart, Derek

doi:10.1016/j.sapharm.2018.12.006

Cited by 6 publications

(11 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These findings will support the interpretation of the MedBridge trial's results, which are expected in 2020. successfully performed in practice. 27 Throughout this process, any potential control group will subsequently be contaminated. 28…”

Section: Implications For Research and Practicementioning

confidence: 99%

Intervention fidelity and process outcomes of medication reviews including post‐discharge follow‐up in older hospitalized patients: Process evaluation of the MedBridge trial

et al. 2020

Self Cite

View full text Add to dashboard Cite

What is known and objective Drug‐related problems (DRPs) are a growing healthcare burden worldwide. In an ongoing cluster‐randomized controlled trial in Sweden (MedBridge), comprehensive medication reviews (CMRs) including post‐discharge follow‐up have been conducted in older hospitalized patients to prevent and solve DRPs. As part of a process evaluation of the MedBridge trial, this study aimed to assess the intervention fidelity and process outcomes of the trial's interventions. Methods For intervention delivery, the percentage of patients that received intervention components was calculated per study group. Process outcomes, measured in about one‐third of all intervention patients, included the following: the number of identified medication discrepancies, DRPs and recommendations to solve DRPs, correction rate of discrepancies, and implementation rate of recommendations. Results and discussion The MedBridge trial included 2637 patients (mean age: 81 years). The percentage of intervention patients (n = 1745) that received the intended intervention components was 94%‐98% during admission, and 40%‐81% upon and after discharge. The percentage of control patients (n = 892) that received at least one unintended intervention component was 15%. On average, 1.1 discrepancies and 2.0 DRPs were identified in 652 intervention patients. The correction and implementation rates were 79% and 73%, respectively. Stop medication was the most frequently implemented recommendation (n = 293) and 77% of the patients had at least one corrected discrepancy or implemented recommendation. What is new and conclusion The intervention fidelity within the MedBridge trial was high for CMRs during hospital stay and lower for intervention components upon and after discharge. The high prevalence of corrected discrepancies and implemented recommendations may explain potential effects of CMRs in the MedBridge trial.

show abstract

Section: Implications For Research and Practicementioning

confidence: 99%

Intervention fidelity and process outcomes of medication reviews including post‐discharge follow‐up in older hospitalized patients: Process evaluation of the MedBridge trial

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…Only 12% ( n = 8) of the included studies used a quantitative research design [ 75 – 82 ]. Of the 31 qualitative studies, 94% ( n = 29) used interviews to collect evaluation data [ 19 – 22 , 24 – 40 , 42 – 49 ]; however, only 59% ( n = 17) of those reported interviews as the sole data collection method [ 20 , 21 , 24 – 27 , 29 , 30 , 32 , 33 , 37 , 38 , 40 , 43 , 45 , 47 , 48 ]. The remaining 3 qualitative studies used an onsite inspection and assessment tool [ 41 ], steering-committee meeting minutes [ 23 ], and a combination of workshop sessions and field notes [ 49 ].…”

Section: Resultsmentioning

confidence: 99%

“…Of the 64 included evaluation studies, 61% ( n = 39) provided a clear definition for sustainability [ 19 – 21 , 27 – 36 , 39 , 42 – 50 , 53 , 54 , 56 , 58 , 60 – 62 , 64 , 65 , 67 , 71 , 73 , 74 , 76 , 77 , 80 , 81 ] and 39% ( n = 25) did not explicitly define sustainability [ 22 – 26 , 30 , 37 , 38 , 40 , 41 , 51 , 52 , 55 , 57 , 59 , 63 , 66 , 68 – 70 , 72 , 75 , 78 , 79 , 82 ]. Of the 39 studies with a clear definition, 66% ( n = 26) drew upon one empirical source to define sustainability [ 20 , 28 , 29 , 31 – 36 , 39 , 42 – 44 , 46 , 47 , 50 , 53 , 54 , 56 , 60 , 64 , 65 , 73 , 74 , 77 , 80 ], 26% ( n = 10) drew upon multiple sources [ <...…”

Section: Resultsmentioning

confidence: 99%

“…Of the 64 studies, 44% ( n = 28) reported that they used a framework as their primary theoretical approach to evaluate sustainability [ 19 – 21 , 26 , 29 – 31 , 34 – 36 , 39 , 43 – 52 , 55 , 57 , 59 , 61 , 63 , 75 , 82 ]. The next most common theoretical approach was a model, used in 26% ( n = 17) of included studies [ 22 – 24 , 27 , 32 , 33 , 37 , 38 , 54 , 56 , 58 , 64 , 66 , 72 , 74 , 76 , 78 ]. A tool was the primary theoretical approach in 11% (7/64) of the included studies [ 60 , 62 , 68 , 69 , 71 , 80 , 81 ].…”

Section: Resultsmentioning

confidence: 99%

“…A wide range of frameworks were used to evaluate sustainability; the Consolidated Framework for Implementation Research (CFIR [ 83 ]) was used most frequently ( n = 5) [ 20 , 30 , 36 , 61 , 82 ], followed by the Promoting Action on Research Implementation in Health Services (PARiHS) Framework ( n = 3) [ 26 , 46 , 63 ]. A total of 17% ( n = 11) studies used a combination of theoretical approaches, as opposed to a single theoretical approach [ 38 , 45 , 51 , 52 , 54 – 56 , 58 , 66 , 74 , 78 ].…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Identifying existing approaches used to evaluate the sustainability of evidence-based interventions in healthcare: an integrative review

et al. 2022

View full text Add to dashboard Cite

Background There is limited evidence to evaluate the sustainability of evidence-based interventions (EBIs) for healthcare improvement. Through an integrative review, we aimed to identify approaches to evaluate the sustainability of evidence-based interventions (EBIs) and sustainability outcomes. Methods Following Whittemore and Knafl’s methodological process: (1) problem identification; (2) literature search; (3) data evaluation; (4) data analysis; and (5) presentation, a comprehensive search strategy was applied across five databases. Included studies were not restricted by research design; and had to evaluate the sustainability of an EBI in a healthcare context. We assessed the methodological quality of studies using the Mixed Methods Appraisal Tool. Results Of 18,783 articles retrieved, 64 fit the inclusion criteria. Qualitative designs were most commonly used for evaluation (48%), with individual interviews as the predominant data collection method. Timing of data collection varied widely with post-intervention data collection most frequent (89%). Of the 64 studies, 44% used a framework, 26% used a model, 11% used a tool, 5% used an instrument, and 14% used theory as their primary approach to evaluate sustainability. Most studies (77%) did not measure sustainability outcomes, rather these studies focused on sustainability determinants. Discussion It is unclear which approach/approaches are most effective for evaluating sustainability and what measures and outcomes are most commonly used. There is a disconnect between evaluating the factors that may shape sustainability and the outcomes approaches employed to measure sustainability. Our review offers methodological recommendations for sustainability evaluation research and highlights the importance in understanding mechanisms of sustainability to advance the field.

show abstract

Implementation frameworks for polypharmacy management within healthcare organisations: a scoping review

et al. 2023

View full text Add to dashboard Cite

Background Several guidelines support polypharmacy management in individual patients. More organisational-level focus is needed on the use of implementation frameworks. Aim To characterise the peer reviewed literature on implementation frameworks, focussing on barriers and facilitators to implementation at organisational level in the context of polypharmacy management. Method A scoping review protocol was devised, supporting retrieval of studies published in English, reporting from any sector of practice. Medline, International Pharmaceutical Abstracts, Cumulative Index of Nursing and Allied Health Literature and Business Source Complete were searched to January 2022 using Medical Subject Headings including: ‘polypharmacy’, ‘deprescriptions’, ‘strategic planning’ and ‘organizational innovation’. A narrative approach to data synthesis was applied. Searching, data extraction and synthesis were undertaken independently by two reviewers. Results After screening 797 records eight papers remained. Two were descriptive outlining details of specific initiatives, six used qualitative methods to explore determinants for implementation including barriers and enablers. Organisation level barriers included: poor organisational culture with a lack of sense of urgency and national plans, resource availability and communication issues including patient information and at transitions of care. Organisational facilitators included availability of government funding and regulatory environment promoting patient safety, a national emphasis on quality of care for older adults, co-ordinated national efforts and local evidence. Conclusion Limited literature focusses on the use of implementation frameworks at organisational levels. This review highlights the need for further work on implementation frameworks in this context to help achieve effective organisational change.

show abstract

A case study of the implementation and sustainability of medication reviews in older patients by clinical pharmacists

Abstract: A case study of the implementation and sustainability of medication reviews in older patients by clinical pharmacists. Research in social and administrative pharmacy [online], In Press.

Cited by 6 publications

References 37 publications

Intervention fidelity and process outcomes of medication reviews including post‐discharge follow‐up in older hospitalized patients: Process evaluation of the MedBridge trial

Intervention fidelity and process outcomes of medication reviews including post‐discharge follow‐up in older hospitalized patients: Process evaluation of the MedBridge trial

Identifying existing approaches used to evaluate the sustainability of evidence-based interventions in healthcare: an integrative review

Implementation frameworks for polypharmacy management within healthcare organisations: a scoping review

Contact Info

Product

Resources

About